When urothelial cells change and grow out of control, they form a mass called a tumor and that is bladder cancer. At Aashray, different treatment options like surgeries, systemic therapies are offered to treat bladder cancer.
The urinary tract includes two kidneys, two ureters, a bladder, and a urethra and the bladder is a hollow
organ in the pelvis whose main function is to store urine before it leaves the body through urination. Like
other parts of the urinary bladder tract, the bladder is lined with a layer of cells called the urothelium.
This layer of cells is separated from the bladder wall muscles, called the muscularis propria, by a thin,
fibrous band called the lamina propria.
When the healthy cells in the urothelium, also called urothelial cells, change and grow out of control, they
form a mass called a tumor and that is bladder cancer. This tumor could either be cancerous or benign. A benign
tumor is not cancerous or harmful and even though it can grow, it doesn’t spread out to other parts of the body.
Unlike a benign tumor, however, a cancerous tumor is malignant, which means that it is harmful to the body as
well as it can grow and spread easily to other parts of the body.
Generally, people with bladder cancer have the following symptoms -
The type of cancer is determined based on how the tumor’s cells look under the microscope. The following are
the 3 main types of bladder cancer-
It is the most common type of cancer and is also known as UCC or transitional cell carcinoma (TCC). It begins in the urinary tract when the urothelial cells are found in it.
This type of cancer occurs when squamous cells develop in the bladder lining due to irritation and
inflammation and these cells may become cancerous over time. This type of cancer is not that common;
however, it does account for 15% of bladder cancers.
This type of cancer develops from glandular cells and it again is an uncommon type of cancer. Adenocarcinoma accounts for about 2% of all bladder cancers.
There are some other types of cancers that are really rare like Sarcoma of the Bladder and Small Cell Bladder Cancer.
The risk factors of cancer may not always directly cause cancer but influence the development of it. The
following factors may raise a person’s risk of developing bladder cancer:
Smoking or tobacco use is the most common risk factor for bladder cancer as it increases the risk by accumulating harmful chemicals in the urine which may damage the bladder or its lining, resulting in cancer.
The risk of bladder cancer increases with the age. Even though it can happen to people at any age, most people with bladder cancer are older than 55.
Men are 4 times more likely to develop bladder cancer than women are. However, it is observed that women
generally experience delayed diagnosis of bladder cancer and more likely to die from it.
Some naturally occurring chemicals, aromatic amines as well as chemicals used in the textile, rubber, leather, dye, paint, and print industries can significantly increase the risk of bladder cancer.
People who have used/ are required to use urinary catheters, are struggling with problems like bladder stones, infections are more likely to get bladder cancer.
Previous cancer treatments like chemotherapy with cyclophosphamide can increase the risk of developing bladder cancer.
People who have a personal history or a family history of bladder cancer are more prone to develop it or have it again.
Arsenic can cause health issues if consumed in large amounts. It is a naturally occurring substance and when it
is found in drinking water or if the arsenic level is too high in the drinking water, it can increase the risk
of bladder cancer.
Many tests are suggested to detect and diagnose cancer as well as to find if it has spread to the other parts
of the body. These tests are suggested based on the factors like the suspected type of cancer, age, the overall
health of the patient, signs, symptoms, and results of initial health checkups or medical tests. The tests are
It is a type of urine test that can differentiate cancer from other conditions like kidney stones or infection that have similar symptoms. In this test, urine is studied under a microscope to look for cancer cells.
Different imaging tests like MRI, CT scan, PET scan, Ultrasound may be suggested to you to see the inside of the body, to check whether cancer has spread to other parts of the body, and in some cases, to determine the best suitable treatments.
It is the sure way to diagnose most types of cancer or to detect cancer in a particular part of the body.
During a biopsy, a small tissue is taken and sent to the laboratory to look for cancer cells.
Based on the diagnostic tests, the stage of cancer, that is where it is located or spread is determined. The
stages of bladder cancer are determined by either clinical staging or pathological staging.
It is based on the results of tests that are done before surgery which include health checkups, physical examinations, and several medical tests are imaging tests or scans, and biopsies.
It is based on the results or what is found after the surgery itself.
Staging helps the doctor to decide the best suitable course of treatment for you. The TNM staging system is
used to describe the stage of cancer and there are a total 5 stages. The stages for different types of cancer
are as follow:
In this system, the doctor tries to get answers to the following questions based on the results of diagnostic
Using the TNM system, the "T" plus a letter and/or number (0 to 4) is used to
describe the size and location of the tumor. Stages may also be divided into smaller groups that help describe
the tumor in even more detail. If there is more than 1 tumor, the lowercase letter "m" (multiple) is
added to the "T" stage category. If the “T” stage starts with a lowercase “c,” it means that the tumor
was staged clinically. If it starts with a lowercase “p,” it means that the tumor was staged pathologically. If
a patient’s tumor is removed, specific tumor stage information is listed below.
The “N” in the TNM staging system stands for lymph nodes. These small, bean-shaped organs help fight infection.
Lymph nodes near where cancer started, within the true pelvis (called hypogastric, obturator, iliac,
perivesical, pelvic, sacral, and presacral lymph nodes), are called regional lymph nodes. Lymph nodes in other
parts of the body are called distant lymph nodes.
The "M" in the TNM system describes whether cancer has spread to other parts of the body, called
Bladder cancers are also classified in terms of grade and those are determined by how cells looked under the
microscope. There are 2 types of grades - Low Grade or High Grade.
The course of the treatment is decided when the patient and doctor together discuss the options and go through
a process called “ shared decision making.” Treatment options are decided based on the goals of the treatment
and after taking into consideration factors like grade or stage of the tumor, type, severity, follow-up care,
patient’s health etc. the following are the general treatment options that are available for bladder cancer
During surgery, the tumor and some surrounding healthy tissues are removed. As there are many surgical options,
the right surgery for you will be decided based on the stage or grade of the tumor.
During this procedure, the whole bladder, nearby tissues & organs as well as lymph nodes in the
pelvis are removed. For men, this means the prostate and some part of the urethra may also be removed
and for women, this means the uterus, fallopian tubes, ovaries, and part of the vagina may also be
Urinary Diversion: In case the bladder is removed, the doctor will create a new way for a patient to pass urine
out of the body.
In some cases, the doctor will create a storage pouch or urinary reservoir inside the body, so the patient
won’t require to carry a bag. In such cases, that storage pouch, also called a neobladder, is connected to
the urethra to pass the urine out of the body.
In some cases, the doctor creates an internal pouch out of the small intestine and connects it to the skin
on the abdomen or belly button (umbilicus) through a small stoma, so patients do not require to carry a
One may experience side effects after the surgery and the removal of the bladder may affect one’s quality of life. So, it is extremely important to have an open discussion with your doctor and make an informed decision regarding the surgery. One may expect the following general side-effects post-surgery -
In this type of treatment, medications are used to destroy the cancer cells. These
medications are either taken from the mouth (as a pill or capsule) or given through the bloodstream (an
intravenous (IV) tube placed into a vein using a needle) to reach cancer cells throughout the body. There
several types of systemic therapies and these can be suggested one at a time, in combination, or as a part of
other types of therapies. The types of systemic therapies are as follow:
In chemotherapy, medications are used to destroy the cancer cells, stop their growth as well as keeping them from dividing and developing new ones. Chemotherapy usually consists of a schedule in which a number of cycles or sets are repeated in a specific time period. There 2 types of chemotherapy and they are as follow:
In this type of chemotherapy, a catheter is inserted through the urethra to deliver the drugs to the bladder. However, in this therapy, drugs cannot reach tumor cells in the bladder wall or that have spread to other organs, so, they only destroy the superficial tumor cells.
This is also known as chemotherapy for the whole body. The most common regimens for systemic, or whole-body, chemotherapy to treat bladder cancer include Cisplatin and gemcitabine, Carboplatin (available as a generic drug) & gemcitabine, MVAC (which combines 4 drugs: methotrexate (Rheumatrex, Trexall), vinblastine (Velban), doxorubicin, and cisplatin), Dose-dense (DD)-MVAC with growth factor support, Docetaxel or paclitaxel (available as a generic drug), and Pemetrexed (Alimta).
Side-effects depend on the type of the drug, different combinations as well as the dose; however, the following are the general side-effects one may expect post-chemotherapy:
In this type of immunotherapy, standard drugs like Bacillus Calmette-Guerin (BCG) are used individually or in combination with Interferon (Roferon-A, Intron A, Alferon). These are given through intravesical therapy, which is placed directly into the bladder through a catheter. It attaches itself
BCG is placed directly into the bladder through a catheter. This is called intravesical therapy. BCG attaches to the inside lining of the bladder and stimulates the immune system to destroy the tumor cells.
This is another type of immunotherapy that is sometimes combined with BCG (in rare cases, when BCG alone is
unable to treat cancer). This is rarely given or used as intravesical therapy.
In this type of radiation therapy, external radiation from machines outside the body is given.
In this type of radiation therapy, devices are placed inside the body, or radiation is given using implants.
Dr. Ashit Shah is a senior consultant Urologist heading Aashray Urology Institute. After completing his M.B.B.S. and M.S. in General Surgery, he was awarded Diplomate of National Board (D.N.B.) in Genito-Urinary Surgery by the National Board of Examinations, New Delhi. He earned his Diplomate in Laparoscopic Urology from Louis Pasteur University, Strasbourg, France in the year 2006. Dr. Shah has a special interest in Endo-Urology, especially Urolithiasis i.e. Urinary Stone Disease. Having spent more than 27 years in the profession of Urology, he has experience of over 75,000 urological consultations and more than 15,000 surgeries. Being counted amongst the torch bearers of ethical and transparent medical practice in the city of Vadodara, he was conferred ‘Inspiring Urologist Award’ for the year 2019 by The Economic Times.