Aashray urology institute

Bladder Cancer

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At Aashray, urinary cancers are treated with the help of the latest equipment and procedures to produce successful results.
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What Is A Bladder ?

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.

Bladder

What Is Bladder Cancer ?

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.

Bladder_cancer

What Are The Symptoms Of Bladder Cancer ?

Generally, people with bladder cancer have the following symptoms - 

  1. Gross hematuria (Visible blood or blood clots in the urine)
  2. Microscopic hematuria (blood in the urine is found by the urine test only)
  3. Pain or burning sensation during urination
  4. Frequent urination
  5. Feeling the need to urinate many times throughout the night
  6. Feeling the need to urinate, but not being able to pass urine
  7. Pain in the back, pelvis, lower back, or one side of the body
  8. Appetite loss
  9. Weight loss

What Are The Types Of Bladder Cancer ?

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-

1. Urothelial Carcinoma

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.

2. Squamous Cell Carcinoma

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.

Types of bladder cancer

3. Adenocarcinoma

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. 

  1. Sarcoma of the Bladder: This type of cancer develops into the fat or muscle layer of the bladder.
  2. Small Cell Bladder Cancer: This rare type of cancer has the most probability to spread to the other parts of the body.  

What Are The Risk Factors Of 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:

1. Smoking

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. 

2. Aging

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.

3. Gender

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.

causes-of-bladder-cancer

4. Certain Chemicals

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. 

5. Chronic Bladder Problems

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.  

6. Cancer Treatment

Previous cancer treatments like chemotherapy with cyclophosphamide can increase the risk of developing bladder cancer. 

7. History of 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. 

8. Arsenic

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.

How Bladder Cancer Is Diagnosed ?

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 as follow: 

Cytology

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. 

Imaging Tests

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. 

Biopsy

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.

diagnosis of bladder cancer

What Are The Stages Or Grades Of Bladder Cancer ?

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. 

  1. Clinical 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. 

  2. Pathological Staging

    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: 

  1. Stage Zero (stage 0): 

  2. Stages I through IV (1 through 4)

TNM System for Bladder Cancer: 

In this system, the doctor tries to get answers to the following questions based on the results of diagnostic tests. 

  1. A tumor (T): How large is the primary tumor? Where is it located?
  1. Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?
  1. Metastasis (M): Has cancer spread to other parts of the body? If so, where and how much?

1. A tumor (T)

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.

  1. TX: The primary tumor cannot be evaluated.
  2. T0 (T plus zero): There is no evidence of a primary tumor in the bladder.
  3. Ta: This refers to noninvasive papillary carcinoma. This type of growth often is found on a small section of tissue that easily can be removed with TURBT.
  4. Tis: This stage is carcinoma in situ (CIS) or a "flat tumor." This means that the cancer is only found on or near the surface of the bladder. The doctor may also call it non-muscle-invasive bladder cancer, superficial bladder cancer, or noninvasive flat carcinoma. This type of bladder cancer often comes back after treatment, usually as another noninvasive cancer in the bladder.
  5. T1: The tumor has spread to the connective tissue (called the lamina propria) that separates the lining of the bladder from the muscles beneath, but it does not involve the bladder wall muscle.
  6. T2: The tumor has spread to the muscle of the bladder wall.
  7. T2a: The tumor has spread to the inner half of the muscle of the bladder wall, which may be called the superficial muscle.
  8. T2b: The tumor has spread to the deep muscle of the bladder (the outer half of the muscle).
  9. T3: The tumor has grown into the perivesical tissue (the fatty tissue that surrounds the bladder).
  10. T3a: The tumor has grown into the perivesical tissue, as seen through a microscope.
  11. T3b: The tumor has grown into the perivesical tissue macroscopically. This means that the tumor(s) is large enough to be seen during imaging tests or to be seen or felt by the doctor.
  12. T4: The tumor has spread to any of the following: the abdominal wall, the pelvic wall, a man’s prostate or seminal vesicle (the tubes that carry semen), or a woman’s uterus or vagina.
  13. T4a: The tumor has spread to the prostate, seminal vesicles, uterus, or vagina. Surgical removal of the tumor may still be possible in this stage.
  14. T4b: The tumor has spread to the pelvic wall or the abdominal wall. Surgical removal of the tumor may not be possible in this stage.

2. Node (N)

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.

  1. NX: The regional lymph nodes cannot be evaluated.
  2. N0 (N plus zero): Cancer has not spread to the regional lymph nodes.
  3. N1: Cancer has spread to 1 regional lymph node in the pelvis.
  4. N2: Cancer has spread to 2 or more regional lymph nodes in the pelvis.
  5. N3: Cancer has spread to the common iliac lymph nodes, which are located behind the major arteries in the pelvis, above the bladder.


3. Metastasis (M) -

The "M" in the TNM system describes whether cancer has spread to other parts of the body, called distant metastasis.

  1. M0 (M plus zero): The disease has not metastasized.
  2. M1: There is distant metastasis.
  3. M1a: Cancer has spread only to lymph nodes outside of the pelvis.
  4. M1b: Cancer has spread to other parts of the body.

Grades

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. 

  1. Low Grade: When compared with normal or healthy tissues, this type of cancer has cells tissues that come closer to those. Also, if the tissue has different cell grouping like healthy tissues, then also it is called a low-grade tumor. Low-grade tumors comparatively grow more slowly. 
  2. High Grade: If the tissue has a different or abnormal appearance when compared to normal or healthy tissues, then it is a high-grade tumor. High-grade tumors are also called poorly differentiated tumors. This type of tumor comparatively grows faster and is likely to invade the bladder’s muscular wall and spread to the other tissues and organs. 


What Treatment Options Are Available For Bladder Cancer?

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 - 

1. Surgery:

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. 

  1. Transurethral Bladder Tumor Resection (TURBT):

    • This surgery is generally used for diagnosis. staging, and treatment. In this procedure, anesthesia is given, after that, a viewing scope (cystoscope) is inserted into the bladder through the urethra, and with the help of that guiding scope and tools, the tumor is removed.
  2. Radical Cystectomy And Lymph Node Dissection:

    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 removed. 

Transurethral Bladder Tumor Resection (TURBT)
  1. Laparoscopic Or Robotic Cystectomy:

    • In this surgery, telescopic equipment is inserted through incisions, and with or without the help of robotic assistance, the bladder and some surrounding tissues are removed. As opposed to making a large incision (that is used for traditional open surgery), in this procedure, several small incisions are made. 

What To Expect After Surgery ?

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.

  1. Wearing a bag:

    • In some cases, when the bladder is removed, the doctor will use a section of the small intestine or colon to divert urine to a stoma or an opening on the outside of the body and in such cases, the patient will require to wear a bag attached to the stoma to collect and drain urine.
  2. Neobladder:

    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. 

  3. Indiana Pouch Reservoir:

    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 bag. 

Side-Effects:

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 - 

  1. Like any other major surgery, risks of bleeding, anesthesia, and infection 
  2. Discomfort at surgery site
  3. Prolonged healing time
  4. Urine leaks
  5. Injury or damage to nearby organs
  6. Inability to urinate or empty the bladder
  7. Erectile dysfunction (in the case of men)
  8. Loss of sexual feeling (or orgasm)
  9. Damage to nerves in the pelvis 
  10. Weakness

2. Systemic Therapy: 

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:


  1. Chemotherapy:

    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: 

    Local or Intravesical Chemotherapy -

    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.  

    Systemic Chemotherapy -

    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).

    After The Chemotherapy:

    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: 

    1. Fatigue 
    2. Risk of infection  
    3. Blood clots and bleeding
    4. Loss of appetite  
    5. Taste changes
    6. Nausea and vomiting 
    7. Hair loss 
    8. Diarrhea


  1. Immunotherapy:

    • Immunotherapy is also called biologic therapy. This therapy uses materials made either by the body or in a laboratory to improve, target, or restore immune system function to overall boost the body’s natural defenses to fight cancer and this immunotherapy can be given locally or throughout the body.

    Local Therapy:

    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. 

    Side effects - 

    1. Fevers, chills, fatigue (flu-like symptoms) 
    2. Burning sensation in the bladder, 
    3. Bleeding 


    Interferon:

    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. 


    Targeted Therapy:

    • In this type of treatment, the growth and spread of cancer cells and damage to healthy cells are blocked or limited via targeting cancer’s specific genes, proteins, or the tissue environment that aid in the growth and survival of cancer cells.  

    Radiation Therapy:

    • In radiation therapy, high-energy rays or other such particles are used to destroy cancer cells and inhibit their growth. The following are the types of radiation therapy:
    1. External Beam Radiation Therapy:

      In this type of radiation therapy, external radiation from machines outside the body is given. 

    2. Internal Radiation Therapy:

      In this type of radiation therapy, devices are placed inside the body, or radiation is given using implants.

    Side-Effects of Radiation Therapy: 

    1. Skin reactions
    2. Fatigue
    3. Loose bowel movements
    4. Bladder irritation
    5. Bleeding from the bladder
    6. Frequent urination with urgency

What To Expect During Follow-Up ?

The follow-ups are especially important in cases of cancers to manage side-effects and monitor the overall health, recovery progress as well as check for any signs that cancer has come back. So, follow-up care and active monitoring are essential. These include regular physical examinations, medical tests, cystoscopy, urine cytology, and routine blood & urine tests. 

Cancer rehabilitation and survivorship care are recommended, and this could mean any of a wide range of services that help people regain control over many aspects of their lives and remain as independent and productive as possible and these services may include physical therapy, career counseling, pain management, nutritional planning, financial counseling, and/or emotional counseling. 

Book Appointment

If you have any questions or doubts about any Bladder Cancer treatment available at Aashray Urology Institute, book a consultation with Dr. Ashit Shah and he will expertly guide you on the same. 
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Dr. Ashit Shah

Dr. Ashit Shah

Meet the doctor

Dr. Ashit Shah

MB, MS, DNB(Urology), DLU(France)

Dr. Ashit Shah

Dr. Ashit Shah

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.

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