Kidney Tumors. Kidney cancer accounts for approximately 3% of all cancers, with a higher incidence in industrialised countries. There are different types, each with specific histopathological and genetic characteristics. The most commonly encountered is the clear cell variant. The causes of kidney cancer are unknown, but some potential risk factors that can promote its onset can be identified:

• Cigarette smoking. The number of cigarettes smoked per day and the number of years of exposure are directly proportional to the increase in the risk of this disease.
• Chronic exposure to certain metals and particular substances. Asbestos and cadmium, phenacetin and thorotrast are all suspected of possessing carcinogenic action.
• Family History
• Obesity
• Hypertension

Bladder Tumors. Bladder cancer is the fourth most common cancer in men and the second most frequent cancer affecting the urinary tract. At the time of diagnosis, 70% of patients are experiencing non-muscle-invasive disease. The causes of bladder cancer are unknown, but some potential risk factors that can promote its onset can be identified:

• Smoking is the most important risk factor. The incidence of bladder cancer is directly related to the years of exposure, the number of cigarettes smoked and early age of starting smoking.
• Chronic exposure to certain substances, particularly benzene derivatives and aromatic amines.
• Urinary schistosomiasis, a parasitic infection endemic in Africa, Asia, South America, associated with the development of squamous cell type bladder cancer.

 Prostate cancer is one of the most frequent diseases in males, representing about 15% of all cancers diagnosed in men. It rarely occurs under the age of 45.

Testicular Tumors.Germ cell tumours account for approximately 1% of all cancers and about 6% of all cancer related to the male genitourinary system, and it is a rare disease. Tumours are more frequent in the age range between 20 and 35. In 95% of cases, they occur from the testicular cells or germ cells and in 95% of cases they occur in the testes, but may also occur in unusual locations such as the chest, abdomen or other areas. The main recognised risk factors are:

• cryptorchidism (testes failed to descend into the scrotum)
• Klinefelter syndrome (presence of one extra X chromosome in men)
• personal or family history of testicular cancer and abnormal testicular development (gonadal dysgenesis).

Cancers of the testes are divided into germinal (seminomas and non-seminomas (embryonal, choriocarcinoma, teratoma, yolk sac tumours) and stromal cancers.

Adrenal cancers. Adrenal cancer is very rare and affects 1-2 people in one million, according to data from the Cancer Registry, with higher incidence in the adult population. It is estimated that in Italy 3-5% of individuals have a mass in the adrenal gland but only 10% of these masses are malignant. Only 30% of cases are diagnosed at an early stage. The risk factors are not known. No relationship has been documented with either smoking or family history. However, an association has been found with some genetic mutations and some syndromes, such as Cushing's disease. 

Kidney cancers. Kidney cancers do not often cause early symptoms and the majority of renal neoplasms have an accidental finding during radiological investigations. 

The appearance of blood in the urine not associated with the presence of urinary infection or recurrent urinary infection should lead to investigations such as abdominal ultrasound. Excessive fatigue, unjustified weight loss, low-grade night fever with no other viable reason, palpable masses in the abdomen and persistent soreness on the side of the body are delayed symptoms.

An ultrasound can identify the renal tumour while computed tomography (CT) in addition to distinguishing the nature of the mass provides more information on the extension of the disease. Other diagnostic tests are magnetic resonance and urography, which evaluates the urinary tract and the smooth passage of urine. This test is the most relevant in case of blood in the urine and it is mainly used to assess the presence of cancer in the urinary tract, urethra, bladder, ureters, and renal pelvis.

Bladder Tumours. The cardinal symptom for the diagnosis of this cancer is macro-haematuria (blood in urine), although the disease can be completely asymptomatic at onset. In cases of suspected bladder cancer, diagnostic procedures are based on ultrasound, radiology (urography and CAT), magnetic resonance and endoscopic methods, such as cystoscopy. The latter is the introduction of a fibre optic instrument into the bladder through the urinary tract and allows evaluation of the inside of the bladder and potentially taking samples of suspicious tissue for analys. A further diagnostic aid is provided by searching for cancer cells in the urine sample via urinary cytology. CAT, PET and bone scintigraphy are also useful for evaluating whether the cancer has spread beyond the bladder, involving other organs. 

Testicular cancers. The main symptoms are the presence of an often painless nodule, an increase in testicular volume, swelling, a change in the testicular consistency, a feeling of heaviness in the testicle, a sharp pain in the abdomen or groin, or lastly, fluid in the scrotum. 

If a malignant cancer in the testes is suspected, the indications are for urological objective examination, blood tests that include beta HCG, LDH markers and alpha-fetoprotein markers, as well as testicular ultrasound. CT scan of the chest, abdomen, and pelvis is used for staging and for visits following up therapy.

Adrenal cancers. The majority of adrenal cancers are often found accidentally during radiological investigations. 

Kidney cancers. Surgery is the gold standard of treatment for renal cancer. Once, radical nephrectomy, which is the complete removal of the diseased kidney, was the more widespread intervention. At present, however, when tumour size permits, conservative surgery that removes only the tumour mass and preserves healthy tissue is the treatment of choice. In recent years, robotic surgery has started to gradually replace traditional open surgery because of increasing development in minimally-invasive procedures. For patients eligible for robotic treatment, our Division offers robotic surgery that achieves great results with cancer, reduced intra- and perioperative morbidity with little impact on quality of life and faster recovery time. Advanced kidney cancer forms are eligible for systemic treatment with "target" drugs instead of chemotherapy, which hit specific targets responsible for the control of cell proliferation and programmed death of the tumour. 

Bladder cancers. Available surgical treatments of bladder cancer include transurethral resection (TURV), an often decisive treatment for small non-infiltrating tumours and cystectomy (removal of the organ). The therapeutic approach also includes the possibility of combined interventions employing chemotherapy and radiotherapy before, after or as an alternative to surgery with the intent of preserving the bladder in selected cases. 

Intravesical treatment with Bacillus Calmette-Guerin (BCG) or other chemotherapeutic agents have high efficacy in metastatic non-infiltrating carcinoma. In advanced stage bladder cancer, the therapeutic approach is polychemotherapy with the aid of several drugs such as cisplatin, gemcitabine, vinflunine, anthracyclines and taxanes.

Testicular cancers. The initial stages are cured with testis surgery alone. Medical treatment is represented by chemotherapy containing cisplatin (PEB), which is proposed after the surgery for a number of cycles varying according to the stage of the disease and the purpose of the treatment. Systemic chemotherapy is also proposed in the event of disease relapse or incomplete healing after initial chemotherapy. Given the young age of these patients, increased attention to problems related to fertility is important.

Adrenal cancers. Surgical removal of the entire gland is the treatment of choice in cases of localised disease, with good results in terms of disease-free survival. In cases where there is no indication for surgical intervention, the use of anti-hormonal drugs, chemotherapy and radiation therapy can be considered (if the lesion is confined). The arrival of minimally-invasive adrenalectomy has been a turning point in the surgical removal of adrenal tumours, previously burdened with a higher rate of complications. The use of robots is characterised by the well-known advantages, such as less blood loss, less post-operative pain, better cosmetic result, and shorter hospital stay. 

At the European Institute of Oncology, a specialised team operates in the diagnosis and treatment of urological cancers that guarantee 360° patient management by integrating medical and nursing competencies and placing the patient at the centre of the therapeutic process with an active role at each step.

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