When urothelial (internal lining of urinary system) cells change and grow out of control, they form a mass in the urinary bladder (also called tumor) and that is bladder cancer. At Aashray, different treatment options like endoscopic, laparoscopic, open 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 bladder tumor. 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 develops from the urothelial cells present in the urinary tract.
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 Carcinoma.
This type of cancer develops from the fat or muscle layer of the bladder.
This rare type of cancer has a very high probability to spread to the other parts of the body.
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 age. Even though it can happen to people at any age, most people with bladder cancer are older than 55 years.
Men are 4 times more likely to develop bladder cancer than women. However, it is observed that women generally experience delayed diagnosis of bladder cancer and are 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 as follow:
USG of the Urinary system may point to the presence of bladder cancer in most cases.
Different imaging tests like MRI, CT scan or PET scan may be suggested to you to check how far has the cancer spread in and around the bladder or to the other parts of the body. This can aid in the best suitable treatment options.
In this test, urine is studied under a microscope to look for cancer cells. This test can give a rough idea about the possibility of urinary cancer.
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 like imaging tests or scans, and biopsies.
It is based on the results of biopsy of the specimen and findings at surgery.
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 tests.
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 to look for infiltration in biopsy. 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 removed. This is a major surgery with significant morbidity and occasional mortality.
Urinary Diversion: In case surgery is carried out to remove the bladder either by open or laparoscopic/robotic method the doctor will create a new way for 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 bag. A catheter can be inserted into the pouch to drain urine.
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 -
b. 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.
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 tube placed into a vein using a needle) to reach cancer cells throughout the body. There are 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 & gemcitabine, MVAC (which combines 4 drugs: methotrexate, vinblastine, doxorubicin, and cisplatin), Dose-dense (DD)-MVAC with growth factor support, Docetaxel or paclitaxel, and Pemetrexed.
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:
2. Internal Radiation Therapy :
In this type of radiation therapy, devices are placed inside the body, or radiation is given using implants.
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.
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.
