Challenges in the treatment of upper urinary tract tumours

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Published: 8 May 2019
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Prof Amr Emara - Basingstoke and North Hampshire Hospital, Basingstoke, UK

Prof Amr Emara speaks to ecancer at the 2019 International Gastrointestinal, Liver and Uro-Oncology Conference (IGILUC) in Cairo about the difficulties urologists and uro-oncologists are faced with when treating upper urinary tract tumours.

Prof Emara explains the challenges associated with transitional cell carcinomas due to their rarity; which makes it increasingly difficult for oncologists to treat.

To address these challenges, Prof Emara believes an exchange of knowledge must occur between oncologists to ensure maximum patient benefit.

Prof Emara also describes current studies that use laparoscopic and robotic clause techniques in the surgical treatment of these cancers. These studies have achieved decreased recurrence rates of tumour progression in the bladder. He also discusses the addition of chemotherapeutic agents and the value they provide in the bladder.

For the future, Prof Emara believes improvements in the early diagnosis of these cancers, together with the use of minimally invasive techniques; while increasing patient awareness will help develop this area further.

 

There is kidney cancer and there are urothelial cancers and the kidney cancer actually the more common part is the kidney parenchyma cancer. However, there is renal pelvis and urothelial cancer which is another group of cancers that we call transitional cell carcinomas. These cancers are less common ones and the challenge is that when you have a common disease you know more about it. When you have a less common disease your experience is less and here come the challenges. For urologists and uro-oncologists and medical oncologists it’s always nice to have this kind of knowledge to exchange experience between different colleagues and to understand more about the disease. Every team should have this kind of exchange of knowledge which at the end enhances the medical field in general.

Can you give an overview of your talk?

I’m talking today about what we call upper tract urinary cancers and these are one of the maybe less common cancers in the kidneys and the ureter. We today are planning to discuss some of these scenarios that a urologist and medical oncologist and uro-oncologist can face. I’m going to highlight how to deal with these challenges, different techniques, new technologies, using the endoscopic approaches, using the percutaneous approaches and even using robotic as well. We are hoping at the end that we’ll have an exchange of knowledge between myself and the colleagues in the same field.

How can these challenges be addressed?

Understanding what we’re dealing with and the problem with less common disease is that the more common you have the more knowledge you have; the less common the disease is the less experience you have. But getting experience from yourself and other people and putting all these experiences together always ends up in more benefit on the patient’s side. So you get more benefit on the patient’s side.

Are there any important updates from data in this area?

There are always updates, there are always trials going on. I’m going to address, actually, some of our current data especially using the laparoscopic approach. I’m also talking about the robotic claws technique which is used by my colleague who does robotic surgery and talking about the early results which have proven efficacy in minimising the recurrence rate of this tumour into the bladder. Also we’ll talk about the value of adding an installation of chemotherapeutic agents in the bladder and the timing of adding these chemotherapeutic agents. All this will be discussed today in my presentation.

How will this area develop over the next few years?

We are always heading to the direction of how to early diagnose this cancer, how to use minimally invasive techniques. Early diagnosis is by raising the patient’s awareness, getting the media, people like yourself, to address all this to the patient, explain how they can diagnose this cancer earlier. The earlier the cancer diagnosis the much easier for us to deal with it. And also using the new technologies, using the laparoscopy more with all this involvement in the endoscopic field, the vision is better, the diagnosis is better, all these new technologies and the CT, the MRI, all the scans have been very helpful. So we can include this always to the benefit of the patient and at the same time we are in the era of robotics and we have always to look at the site, how to make the patient’s life easier, the hospital stay less, getting the patient back home and to function quicker. All of this is very important.