Pelvic Cancer
Pelvic cancer is a broad term used to describe cancers that develop within the organs and structures of the pelvis. In urological practice, this most commonly includes cancers of the bladder, prostate, kidneys, ureters, urethra, and nearby lymph nodes. Early diagnosis is essential, as many pelvic cancers can be treated successfully when detected before they spread. Modern treatment options, including minimally invasive and robotic-assisted surgery, have significantly improved outcomes for many patients.
What is Pelvic Cancer?
Pelvic cancer refers to malignant tumours that arise within the pelvic cavity. Depending on the organ affected, these cancers behave differently and require individualised treatment.
Common urological pelvic cancers include:
- Prostate cancer
- Bladder cancer
- Upper urinary tract urothelial cancer
- Urethral cancer
- Kidney cancer extending into the pelvis
- Secondary (metastatic) cancers involving pelvic lymph nodes or surrounding tissues
Because several organs are located close together within the pelvis, symptoms can sometimes overlap, making prompt specialist assessment important.
What are the Symptoms of Pelvic Cancer?
Symptoms vary depending on the type and stage of the cancer. Some patients experience no symptoms during the early stages, while others develop noticeable urinary or pelvic complaints.
Common symptoms include:
- Blood in the urine (haematuria)
- Difficulty passing urine
- Frequent urination
- Urgency to urinate
- Pain or burning during urination
- Pelvic pain or pressure
- Lower back or flank pain
- Blood in the semen
- Erectile dysfunction in some men
- Unexplained weight loss
- Fatigue
- Swollen legs if lymphatic drainage is affected
- Bone pain in advanced disease
Persistent urinary symptoms or visible blood in the urine should always be investigated promptly.
What Causes Pelvic Cancer?
The exact cause of pelvic cancers is often unknown, but several factors increase the risk of developing these conditions.
Common risk factors include:
- Increasing age
- Smoking
- Family history of urological cancers
- Certain inherited genetic syndromes
- Long-term exposure to industrial chemicals
- Chronic bladder inflammation
- Previous pelvic radiation therapy
- Obesity
- High blood pressure
- Certain chronic urinary tract infections
- Exposure to arsenic or other environmental toxins
- Advancing age in men, particularly for prostate cancer
Many patients develop pelvic cancer despite having no obvious risk factors.
How is Pelvic Cancer Diagnosed?
Diagnosis involves a combination of clinical assessment, laboratory testing, imaging, and tissue sampling.
Investigations may include:
- Medical history and physical examination
- Digital rectal examination (DRE) for prostate assessment
- Urine analysis and urine cytology
- Blood tests, including prostate-specific antigen (PSA) where appropriate
- Ultrasound examination
- CT scan
- MRI scan
- PET scan in selected patients
- Flexible cystoscopy to examine the bladder and urethra
- Prostate biopsy, including MRI fusion biopsy when indicated
- Tissue biopsy of suspicious masses
- Bone scan for advanced prostate cancer
- Staging investigations to determine whether the cancer has spread
Accurate staging helps guide treatment planning and predict outcomes.
What are the Treatment Options for Pelvic Cancer?
Treatment depends on the type of cancer, its stage, overall health, and the patient's treatment goals. Care is often provided by a multidisciplinary team.
Treatment options may include:
- Active surveillance for selected low-risk cancers
- Robotic-assisted surgery
- Open surgery where appropriate
- Radical prostatectomy
- Radical cystectomy
- Partial or radical nephrectomy
- Transurethral resection of bladder tumours (TURBT)
- Chemotherapy
- Immunotherapy
- Hormone therapy for prostate cancer
- Targeted therapy
- Radiotherapy
- Clinical trials where appropriate
- Palliative treatments to relieve symptoms in advanced disease
Following treatment, regular follow-up is essential to monitor recovery, detect recurrence, and manage any long-term effects of treatment. Surveillance may include blood tests such as PSA, imaging studies, cystoscopy, and routine clinical examinations. Advances in robotic surgery, systemic therapies, and personalised cancer care continue to improve survival rates and quality of life for patients diagnosed with pelvic cancers, allowing many individuals to return to their normal daily activities after treatment.