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What is cancer

What is cancer?

What is cancer? Our bodies are made up of trillions of cells. Usually, every cell has a certain function in the body. Cancer is caused by cells that no longer work properly. Uncontrolled cell growth can crowd out other cells and become a tumour (Fig. 1). Fig. 1: Cancer cells crowding out healthy cells. Types of

FAQs on COVID-19 and Kidney Cancer

On this page you will find FAQs about COVID-19 and Kidney Cancer. If you have any additional questions, please submit these on our page FAQs about COVID-19. 1 Q: What are some of the renal complications that might arise as a result of COVID-19 infection? A: In most patients COVID-19 infection is minor, but in

FAQs on COVID-19 and Prostate Cancer

On this page you will find FAQs about COVID-19 and Prostate Cancer. If you have any additional questions, please submit these on our page FAQs about COVID-19. 1 Q: I am participating in a clinical trial for prostate cancer, what should I know? A: A good place to start is visiting your cancer centre or

FAQs on COVID-19 and Bladder Cancer

On this page you will find FAQs about COVID-19 and Bladder Cancer. If you have any additional questions, please submit these on our page FAQs about COVID-19. 1 Q: What can I do, as a caregiver, to help my loved one who has bladder cancer? A: Here are some active ways to help your loved

Immunotherapy in Kidney Cancer

Cancers

Urologic cancers are a collection of diseases related to the genitourinary system of both men and women. These diseases are caused by cells that no longer work properly. These abnormal cells grow uncontrolled in the body. Read more about what cancer is on the page 'What is cancer?'. On this website you will find reliable

Penis cancer

What is penis cancer? Cancer is abnormal cell growth in the skin or organ tissue. When this cell growth starts in the penis, it is called penis cancer or penile cancer. Penis cancer is rare and affects less than 1% of men in Europe. It is more common in men older than age 40, but

Urachal cancer

What is the urachus? The urachus is a tube-like structure that forms in a developing embryo. It connects the umbilical cord to the urinary bladder before birth. After birth, the urachus usually shrinks into a small ligament. However, traces of the urachus (called urachal residues) can be detected in up to one-third of adults. Urachal

Testicular cancer

What is testicular cancer? The testicles (also called the “testes”) are part of the male reproductive system (Fig. 1). They are found in the scrotum—the pouch of skin that hangs below the penis. The testicles make testosterone and sperm. Testicular cancer is a growth called a tumour that starts in the testicle (Fig. 2) and

Prostate cancer

What is prostate cancer? Prostate cancer is a malignant tumour in the prostate. Your treatment and experience will depend on a variety of factors including the specific characteristics of the tumour, your general health, your personal preferences and the advice of your medical team. The sections in this series provide general information about prostate cancer, diagnosis,

Primary urethral cancer

What is primary urethral cancer? You have been diagnosed with primary urethral cancer. This means you have a cancerous growth (malignant tumour) in your urethra. The urethra carries urine out of the body from the bladder, also known as urinary bladder. In men, the urethra runs through the prostate and the penis (Fig. 1). In women,

Kidney cancer

What is kidney cancer? Kidney cancer is a malignant cell growth (a tumour) in the kidneys. Its medical name is renal cell carcinoma. A tumour in the kidney can also be benign (non-cancerous). Kidney cancer is a general term. There are many variations of tumours in the kidney and stages of the disease. Your treatment and

Bladder cancer

What is bladder cancer? Bladder cancer is the growth of abnormal tissue (tumour) in the bladder. There are several stages of bladder cancer. Your treatment and experience will depend on the specific characteristics of the tumour (referred to as “staging” the tumour) and the expertise of your medical team. This section provides general information about

Surgery for urachal cancer

Tumour removal Surgery is recommended to remove a urachal cancer tumour that has not spread to other tissues or organs. The tumour will be removed along with surrounding tissue in the abdomen, the navel, and the top of the bladder to make sure no cancer cells remain. In rare cases, some or all of the

European Code Against Cancer

12 ways to reduce your cancer risk The European Code Against Cancer (ECAC) is an initiative of the European Commission, developed by the World Health Organization’s International Agency for Research on Cancer (IARC). The ECAC aims to inform people about actions they can take for themselves or their families to reduce their risk of cancer.

Treatment of penis cancer

This section offers general information. Your specific treatment will be recommended by your doctor based on your individual needs. Individual recommendations may depend on your country and health care system. The treatment you have will depend on: what you prefer what your doctor thinks is best for your type of cancer which treatments are available

Bladder cancer

An improved approach to prostate cancer

Europa Uomo chairman André Deschamps sets out the need for an improved approach to prostate cancer diagnosis and treatment. 30 million men in Europe are confronted with a diagnosis of prostate cancer in their lifetime. Each year 75,000 men die from prostate cancer. A questionnaire amongst our members in 24 European states showed that: Less

Cancer survivorship

Cancer survivorship has traditionally received little prioritisation and attention. For a long time, the treatment of cancer has been the main focus of healthcare providers’ efforts. It is time to increase the amount of attention given to patients’ long-term well-being and their ability to return to a productive and good life. This article describes the

Treatment of locally advanced primary urethral cancer

Preoperative chemotherapy Different types of urethral cancer are treated differently. Some urethral cancer, called urothelial carcinoma, specifically affects urothelial cells. Chemotherapy followed by surgery is critical to remove urothelial carcinoma. Chemotherapy that contains platinum (eg, cisplatin, carboplatin) is most effective against urethral cancer. Chemotherapy combinations like MVAC (which uses the drugs methotrexate, vinblastine, Adriamycin [doxorubicin],

Treatment for women with localised urethral cancer

Primary radical urethrectomy Your doctor will recommend complete removal of the urethra (urethrectomy), including part of the bladder and the surrounding tissue to ensure the highest chance of cure. Usually, the bladder neck is closed during the procedure, and a new way to store and regulate the flow of urine is created (urinary diversion). Urethra-sparing

Treatment of primary urethral cancer

Localised urethral cancer Localised primary urethral cancer is confined to the urethra. Treatment for men and women differs. Your doctor will recommend a treatment that aims to remove all cancer and preserve your quality of life. To do this, the location of the tumour is important. Treatment for men localised urethral cancer Treatment for women

Treatment for men with localised urethral cancer

Partial urethrectomy Partial urethrectomy: If your cancer is limited to the part of the urethra nearest the opening, but still close to the tip, partial removal of the urethra (urethrectomy) with penile preservation may be the best option. Your doctor might also recommend removal of enlarged lymph nodes to rule out metastasis. The main goal

Urachal cancer

Testicular cancer

Radiation therapy castration-resistant prostate cancer

Castration-resistant prostate cancer can be managed with radiation therapy. The radiation damages and kills cancer cells. The treatment will help to relieve pain and may allow you to live longer. Common side effects are a burning sensation when you urinate, urinary frequency, and anal irritation.

Chemotherapy castration-resistant prostate cancer

Chemotherapy with docetaxel Chemotherapy is a type of cancer treatment that uses chemicals to destroy cancer cells. Chemotherapy drugs can be injected into the bloodstream to attack cells throughout the body. They can also be applied directly to the tumour. Your doctor may recommend the chemotherapy docetaxel to manage castration-resistant prostate cancer. The drug relieves

Immunotherapy castration-resistant prostate cancer

Immunotherapy is a type of treatment that uses your own immune system to fight the tumour cells. In prostate cancer the drug Sipuleucel-T is used as immunotherapy. Because your own blood is used to prepare the drug, you need to get blood drawn before the procedure. Immunotherapy is administered through an IV, in an outpatient

Treatment of urachal cancer

Urachal cancer is often diagnosed at later stages. Based on your disease stage and predicted outcomes, recommended treatment may include: Surgery Chemotherapy Palliative care Recommended treatment and predicted outcomes will be based on your cancer stage. The planned treatment approach should be discussed by a multidisciplinary tumour board. This board is made up of practitioners

Treatment of testicular cancer

Testicular cancer is usually treated with surgery. The testicle must be removed (orchiectomy) to remove the cancer (Fig. 1). The tissue may be examined during surgery to confirm the diagnosis and stage. Additional surgery, drug treatment (chemotherapy), or radiation therapy also may be needed. Fig. 1: Orchiectomy—incision in the groin area. Surgery to remove the

Hormonal therapy in metastatic prostate cancer

Hormonal therapy is a treatment option for metastatic prostate cancer. It aims to slow down the growth of the tumours. The growth of prostate cancer cells is dependent on male sex hormones called androgens. Testosterone is the most important androgen. Androgens are mainly produced in the testicles. Hormonal therapy either stops the production of androgens,

Drug treatment for metastatic kidney cancer

Drug treatment is a common option for metastatic kidney cancer. There are several types of treatment: Antiangiogenic therapy, commonly described as targeted therapy Immunotherapy Chemotherapy, in combination with immunotherapy These drugs influence the mechanisms that tumours use to grow. All decisions about the right therapy for you are taken after careful consideration of your general

Treatment of metastatic kidney cancer

Kidney tumours can spread to other organs or distant lymph nodes. This is called metastatic disease. In metastatic disease, the kidney tumour is referred to as the primary tumour and the tumours in other organs are called metastases. Your doctor may recommend to treat metastatic disease with surgery, usually in combination with antiangiogenic therapy, also

Treatment of locally-advanced kidney cancer

What is locally-advanced kidney cancer? Locally-advanced kidney cancer refers to a tumour which has spread to or beyond the blood vessels, tissue, organs, or lymph nodes surrounding the kidney. It may be a stage III or IV tumour, depending on how far outside the kidney the tumour has spread. If you are diagnosed with locally-advanced

Treatment of localised kidney cancer

What is localised kidney cancer? Localised kidney cancer refers to a tumour which is limited to the kidney and has not extended to other parts of your body. It may be a stage I or II tumour, depending on its size (Fig 1 and 2). If you are diagnosed with localised kidney cancer, your doctor

Active surveillance kidney cancer

Active surveillance is a form of treatment for localised kidney cancer in which the doctor actively monitors the tumour. It is recommended if surgery is not the best option for you and you have a tumour in your kidney which is smaller than 4 cm. Some of the reasons why your doctor may say you

Treatment of recurrent prostate cancer

It is possible that prostate cancer comes back after you have been treated. This is known as recurrence. The cancer may come back in the prostate, in tissue around the prostate or pelvic lymph nodes, or in other parts of the body. The follow-up treatment pathway depends on where the cancer is. Your doctor will

Treatment of castration-resistant prostate cancer

What is castration-resistant prostate cancer? Castration-resistant prostate cancer is a type of prostate cancer that usually develops during treatment for metastatic disease. Hormonal therapy either stops the production or blocks the action of androgens. This is known as castration. When effective, hormonal therapy stops the growth of the tumour. This effect will not last and

Treatment of metastatic prostate cancer

What is metastatic disease? Prostate cancer can spread to other organs or lymph nodes outside the pelvic area. This is called metastatic disease. The tumours in other organs or lymph nodes are called metastases. Your doctor may recommend treating metastatic disease with hormonal therapy. It is important to realise that metastatic disease cannot be cured.

Treatment of locally-advanced prostate cancer

What is locally-advanced prostate cancer? Locally-advanced prostate cancer refers to a tumour which has spread outside of the prostate. It may be a T3 or T4 tumour, depending on where and how far outside of the prostate it has grown. T3 means that the tumour has grown just outside the prostate or to the seminal

Treatment of localised prostate cancer

What is localised prostate cancer? Localised prostate cancer refers to a tumour which is limited to the prostate and has not extended to other parts of your body. It may be a T1 or T2 tumour, depending on its size and where it is located in the prostate. T1 means that the tumour is too

Treatment of recurrent bladder cancer

Local recurrence Local recurrence takes place in the soft tissue where the bladder has been before removal or at the site of the lymph nodes that were removed. This is due to the fact that even after removal of the local pelvic lymph nodes, some nodes are left in place. Most local recurrences appear within

Treatment of metastatic bladder cancer

Prognostic factors and treatment decisions If your bladder cancer has spread to another body organ (Fig. 1), treatment is unlikely to cure you. Treatment options are limited to controlling the spread of disease (metastasis) and reducing symptoms. Fig. 1: Metastatic spread. Treatment options for metastatic bladder cancer Chemotherapy In 90-95% of bladder cancer cases the

Treatment of muscle-invasive bladder cancer

What is muscle-invasive bladder cancer? About a quarter of patients diagnosed with bladder cancer have a muscle-invasive form that has grown into the muscular part of the bladder wall (stages T2–T4). This type of cancer has a higher chance of spreading to other parts of the body (metastatic) and needs a different and more radical

Treatment of non-muscle invasive bladder cancer

What is non-muscle-invasive bladder cancer? Non–muscle-invasive bladder cancer, also called superficial bladder cancer, is a superficial cancer that has not grown into deeper layers of the bladder wall (Fig. 1). There are three subtypes based on how they grow: Stage Ta tumours are confined to the bladder lining. Stage T1 tumours have invaded the connective

Side effects of cancer drugs

The side effects you might have vary from person to person and depend on the cancer drugs you are taking. Side effects can happen as a direct result of medical treatment. All drugs used to treat cancer cause side effects. It can be easy to confuse drug side effects with symptoms of cancer. Symptoms happen

Coping with cancer

What is the impact of cancer on my life? Getting diagnosed with cancer has a great impact on your life and the lives of your loved ones. It can cause feelings of anxiety, uncertainty, fear, or even depression. Undergoing treatment for cancer is intense and will affect your work and social life. You may worry about

Urine biomarkers for bladder cancer

What is a biomarker? Biomarkers are substances that doctors can measure in the body to help them tell if a patient has a disease, how a disease is developing or if a treatment is working. Urine biomarker tests for bladder cancer Early detection of bladder cancer can improve the chance of successful treatment. Therefore, doctors

Prostate cancer

Primary urethral cancer

Penis cancer

Kidney cancer

Testicular cancer

A growth called a tumour that starts in the testicle and can spread throughout the body.

Advanced cancer

A tumour that grows into deeper layers of tissue, adjacent organs, or surrounding muscles.

Superficial cancer

A tumour that grows on the tissue surface without growing into deeper layers or adjacent organs. This type of cancer represents an early stage.

Secondary cancer

A tumour that grows from the metastasized cells of primary cancer.

Primary urethral cancer

A malignant tumour in the urethra.

Primary cancer

The first type of cancer to develop, the cancer of origin.

Localized cancer

Cancer that remains in the location where it started.

Cancer

Abnormal cell growth in the skin or organ tissue.

Urinary tract cancer

Bladder, kidney and urethral cancer.

Localized kidney cancer

A kidney cancer where the tumour is limited to the kidney and has not spread.

Localized prostate cancer

A prostate cancer where the tumour is limited to the prostate and has not spread.

Locally-advanced kidney cancer

A cancer where the tumour has grown out of the kidneys into surrounding tissue and invaded veins, the adrenal gland, or lymph nodes.

Locally-advanced prostate cancer

A prostate cancer where the tumour has spread outside of the prostate and into surrounding tissue.

Castration-resistant prostate cancer

A type of prostate cancer that needs lower levels of androgens to continue to grow.

Robot-Assisted Partial Nephrectomy (RAPN) video

This animation shows how a robot-assisted partical nephrectomy (RAPN) is performed. Partial nephrectomy is used to treat kidney cancer that has not spread to other tissue. It is recommended whenever possible. The aim is to remove the part of the kidney with abnormally growing cells (tumour) but to leave as much as possible of the

FAQs on COVID-19: Miscellaneous questions

On this page you will find FAQs about COVID-19 and miscellaneous matters. If you have any additional questions, please submit these on our page FAQs about COVID-19. 1 Q: Can I successfully continue my treatments during COVID-19 or can I safely delay some regularly scheduled treatments? A: Depending on the stage of your cancer, you

Meet our team of experts

Our multidisclipinary team of experts is in place to find the best answers to your COVID-19 urology-related questions. We want to express our gratitude to them for donating their time and making this important project possible. We will share the Q&As on our FAQs page that will be continually updated as our medical experts find

FAQs about COVID-19

Meet our team of experts On this page you will find frequently asked questions about the Coronavirus COVID-19. Please take into account that local rules and measures may vary per country, region and hospital. All answers and interpretation of answers are very dependent on the country or region you live in. We are dedicated to

Coronavirus COVID-19

On this page, you can find links to other reliable websites and general information about the Coronavirus COVID-19. Please take into account that local rules and measures may vary per country and per hospital. FAQs page - COVID-19 Call for questions COVID-19 Resources for urologists A systematic review on COVID-19 and its potential urological manifestations

Patient Advocacy

Introduction Looking beyond the scientific and educational needs of healthcare professionals (HCPs), it is EAU’s aim to play a more important role with regards to strengthening patient advocacy. This is accomplished by taking a variety of proactive steps to work together with patient advocate groups. Foundational elements of the EAU’s aim are recognising and cultivating

Anxiety and Depression

It’s common for people to experience anxiety or depression due to prostate cancer; and it’s not confined to only the man with the disease. Prostate cancer can have a negative psychological impact on the caregiver/wife or partner of the man with prostate cancer, as well as his family members and close friends. A cancer diagnosis

Side effects of treatments

Side effects of treatments Coping with hair loss and thinning Sexual side effects of RPLND Side effects of cancer drugs Side effects of hormone therapy in men Side effects of hormone therapy in women Side effects of radiotherapy

News items

Get the Most From Your Doctor's Visit Cancer survivorship An improved approach to prostate cancer Anxiety and Depression Sexual health European Code Against Cancer PRESS RELEASE: Alarmingly Low Awareness of Urology Across Europe

Leaflets

Urologic conditions Download information for patients about urologic conditions. Click on the links below to read or download the patient information leaflet. Benign prostatic enlargement Bladder cancer Congenital Malformation in the Urinary Tract Cryptorchidism Erectile dysfunction Kidney cancer Kidney and ureteral stones Male hypogonadism Male infertility Nocturia Overactive bladder syndrome Penile curvature Penis cancer Phimosis

Male infertility

What is male infertility? Male infertility means not being able to father children. Infertility is the inability of a sexually active, non-contracepting couple to achieve spontaneous pregnancy in one year. If the cause of the fertility problem is found in the man, this is male infertility. Male infertility is found in approximately half of all childless

Male hypogonadism

What is male hypogonadism? Male hypogonadism means the testicles do not produce enough of the male sex hormone testosterone. When levels are low, men might have decreased sex drive, less muscle mass, erectile dysfunction, and fatigue. Hypogonadism has a negative effect on organ function and quality of life. Testosterone is responsible for male reproductive and

Erectile dysfunction

What is erectile dysfunction? Erectile dysfunction (ED) is a common male sexual disorder. It is the inability to get or keep an erection that allows for satisfying sexual activity. It can happen occasionally or regularly, with or without any clear reason. Some men with ED are not able to get an erection at all. ED

Benign prostatic enlargement

What is the prostate? The prostate is a gland located in the lower urinary tract, under the bladder and around the urethra (Fig. 1). Only men have a prostate. It produces the fluid which carries semen. The prostate has smooth muscles which help to push out the semen during ejaculation. A healthy prostate is about

Cryptorchidism or undescended or hidden testicles

What is cryptorchidism? The failure of the testicles (or “testes”) to descend into the scrotum (the skin sac below the penis) is called “cryptorchidism”. It is also called having hidden or undescended testicles. The condition is generally uncommon but often affects boys born prematurely. As a male foetus grows, the testicles appear in the abdomen

Tests

Testing is part of the procedure to make a diagnosis for urologic disease. There are many different tests or scans to find out if you have a disease or cancer, the type of disease or cancer, and the stage of the disease or cancer. The type of test used depends on the symptoms. Your doctor

Treatments

There are numerous treatments for urologic cancers and other diseases. On this page you will find an overview of the treatments from A-Z and the treatments per disease. Go directly to Treatments A-Z Treatments per disease Treatments A-Z A Ablation therapy Active surveillance Anti-androgen therapy Anti-angiogenic therapy Autologous Fascial Sling Artificial compression devices in men

Orchidopexy (surgery to move the testicle into the scrotum)

The main treatment for cryptorchidism is surgery to move the testicle into the scrotum (orchidopexy). This surgery is nearly 100% successful. If a testicle has not fully descended by the age of 6 months, surgery should be performed within the subsequent year. Delaying treatment can increase the risk of testicular cancer or infertility later in

Orchiectomy (surgery to remove the testicle)

Testicular cancer is usually treated with surgery. The testicle must be removed (orchiectomy) to remove the cancer. The tissue may be examined during surgery to confirm the diagnosis and stage. Additional surgery, drug treatment (chemotherapy), or radiation therapy also may be needed. All testicular cancers are treated with surgery, with very few exceptions. An incision

Chemoradiation

Radiation therapy combined with sensitising chemotherapy is a reasonable alternative for patients who refuse or are not candidates for bladder removal. Evaluation of this approach will consider general fitness (life expectancy), kidney function, prior radiation, prior abdominal operations, and history of other cancers. A consultation with a radiation oncologist is advisable prior to deciding on this treatment.

Penectomy

If a tumour has grown into surrounding tissue, removing it surgically is the best chance of cure. If the tumour is in your penis tissue, some or all of your penis might need to be removed to get rid of the cancer. A recommendation of penectomy raises many questions. Talk with your doctor about your

Sexual health

Sexual Health: Maintaining Closeness after Prostate Cancer A prostate cancer diagnosis can be overwhelming and devastating for men and their partners. Since the prostate is part of the sexual system, treatment of prostate cancer may result in sexual dysfunction. Sexual dysfunction is often identified as the most common long term side effect after prostate cancer

New hormonal agents

Hormonal therapy with abiraterone acetate The body needs an enzyme called CYP17 (17α-hydroxylase) to produce testosterone. CYP17 is found in the testicles, adrenal glands, and prostate cancer cells. The new hormonal agent abiraterone acetate blocks CYP17 so that no testosterone is produced. Treatment with abiraterone acetate aims to slow the growth of the tumour and

Anti-androgen therapy

When you have been treated with either surgical or chemical castration, your doctor may recommend additional treatment with anti-androgen therapy. The most common anti-androgen drug to manage castration-resistant prostate cancer is bicalutamide. Treatment with this drug aims to slow down the growth of the tumour. It will not relieve your symptoms. Side effects may include

Photodynamic diagnosis

Photodynamic diagnosis (PDD) is available at some centres. PDD makes cancer cells visible under violet light. This makes abnormal growths (tumours) easier to find and remove. More complete removal reduces the risk of cancer coming back. PDD is used in urology to test for bladder cancer. A catheter is inserted through the urethra and into

Narrow-band imaging

Narrow-band imaging (NBI) shines light at specific blue and green wavelengths on tissue inside the body. This light makes the difference between healthy tissue and cancer tissue easier to see so cancer cells can be found and removed. In urology, NBI is used on the inner lining of the bladder, the urinary tract and the

Antiangiogenic therapy

What is antiangiogenic therapy? Antiangiogenic therapy is a treatment option for metastatic kidney cancer. These are a group of drugs which slow down tumour growth or possibly even shrink the tumour. They prevent the formation of new blood vessels which feed the cancer and allow it to grow. The formation of vessels is called neoangiogenesis,

Embolisation

Embolisation is a treatment option for locally advanced kidney cancer. In this procedure a blood vessel is deliberately blocked to cut off the blood supply to cancerous tumours. Your doctor may recommend embolisation if you are unfit for surgery and the tumour causes symptoms like bleeding or pain. This treatment is only recommended if surgery

Ablation therapy

What is ablation therapy? Ablation therapy is a type of minimally invasive surgery doctors use to destroy abnormal tissue, like small tumours, that occur with kidney cancer and prostate cancer. The goal is to remove as many cancer cells as possible. This therapy kills cancer cells by heating them or freezing them. The following types

Other resources

About this page This page lists resources you may find useful when learning about urological conditions, treatment, clinical research and patient groups. EAU Patient Information does not necessarily endorse, or necessarily have influence over, any of the sites listed on this web page. Cancer patient groups Belgium European Cancer Patient Coalition (ECPC). Belgium Website Europa

Project partners

EAU Patient Information is a collaborative undertaking with numerous project partners contributing to its success. Asklepios Kliniken Around 150 medical facilities in 14 states and more than two million treated patients place Asklepios firmly in the group of Germany's pre-eminent clinic operators. EAU Guidelines Office The EAU Guidelines Office is responsible for the production of

TURBT video

Transurethral resection of bladder tumour (TURBT) is the surgical removal (resection) of bladder tumours. This procedure is both diagnostic and therapeutic. It is diagnostic because the surgeon removes the tumour and all additional tissue necessary for examination under a microscope (histological assessment). TURBT is also therapeutic because complete removal of all visible tumours is the

Cystectomy video

Cystectomy is the surgical removal of the urinary bladder. Your doctor has several reasons for recommending removal of the whole bladder: Presence of a muscle-invasive tumour Presence of a tumour that grows aggressively (high grade), that has multiple cancerous areas (multifocal), or that is superficial, but has recurred after chemotherapy or immunotherapy Failure of or