What is Urinary Bladder Cancer Treatment?
BDS (Bachelor of Dental Surgery), 6 years of experience
What is Urinary Bladder Cancer?
Urinary Bladder Cancer occurs when the cells in the urinary bladder (mostly the lining epithelium cells called the urothelial cells ) undergo mutations, they change and start growing uncontrollably. This forms a tumor, which can be cancerous ( grows and spreads to other parts of the body ) or can be benign ( grows and does not spread ).
Urinary bladder is a hollow organ in the pelvic region which stores the urine before it is released out of the body by the urethra, by urination. It is an important organ of the urinary tract, along with the kidneys, ureters and urethra.
Initially, there may be a pain in the stomach, but many people ignore it. Because of this, the problem may get complicated. People with bladder cancer have severe pain and discomfort in the abdomen, once the disease progresses.
Talking about the current status of bladder cancer in India, out of all the cancer incidents, every year 2 percent of cases present are with urinary bladder cancer. Many people experience complications of bladder cancer due to a lack of knowledge. Early diagnosis of signs and symptoms of bladder cancer can help in timely treatment.
In today’s article, we will discuss in detail about urinary bladder cancer and the treatments.
- What are the types of Urinary Bladder Cancer?
- What are the causes of Urinary Bladder Cancer?
- What are the symptoms of Urinary Bladder Cancer?
- How to diagnose Urinary Bladder Cancer?
- What are the grades of Urinary Bladder Cancer ?
- What are the treatments for Urinary Bladder Cancer?
- What is the aftercare for Urinary Bladder Cancer Treatment?
- What are the complications of Urinary Bladder Cancer Treatment?
- What is the cost of Urinary Bladder Cancer Treatment in India?
What are the types of Urinary Bladder Cancer?
The 3 main types of Urinary Bladder Cancer are-
- Urothelial carcinoma- This accounts for 90 percent of all the bladder cancers, mostly is found in adults and begins in the urothelial cells of the bladder.
- Squamous cell carcinoma- This occurs due to irritation or inflammation of the squamous cells lining the urinary bladder. This accounts for 4 percent of all the bladder cancers.
- Adenocarcinoma- This develops from the gland cells of the urinary bladder and accounts for 2 percent of all the bladder cancers.
Other types are-
- Sarcoma of the urinary bladder- This cancer begins in the fat cells and the muscle layers of the urinary bladder.
- Small cell urinary bladder cancer- It is a rare type of bladder cancer, and spreads rapidly to other body parts.
Urinary bladder cancer can also be divided as- Non-invasive (it forms only near the surface of the bladder and can be easily removed), Non muscle invasive (this is stage 1, has not grown inside muscle, is superficial variant ), and Muscle invasive (this type grows into the bladder muscle walls, into the fatty cell layer, and may have spread to the tissues and organs outside the urinary bladder ).
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What are the causes of Urinary Bladder Cancer?
Bladder cancer begins when cells in the bladder develop mutations in their DNA. The cell’s DNA contains instructions that tell the cell what to do. The changes tell the cell to multiply rapidly and survive when healthy cells die. Abnormal cells form a tumor that can invade and destroy normal body tissue. In time, abnormal cells can break away and spread through the body.
The following are the risk factors which may cause Urinary Bladder Cancer-
- Age – The risk of bladder cancer increases in people over the age of 65, the risk increasing to 70 percent.
- Gender- Men are at higher risk of developing bladder cancer, whereas females are at more risk of fatality from bladder cancer.
- Race- Black people have more risk of developing bladder cancer.
- Tobacco use – If a person consumes more tobacco, then they are at risk of bladder cancer. The chances of bladder cancer increases by 4 to 7 times in tobacco users. Cigarette, cigar and pipe smoking increases the risk.
- Exposure to chemicals – Bladder cancer can occur when a person comes in contact with chemicals. In such a situation, safety equipment should be used when working with chemicals. People working in industries of textiles, rubber, leather, dyes, paints, print industries, aromatic amines, etc are more prone to exposure and developing bladder cancers.
- Chronic bladder related problems- People who have chronic bladder infections ( eg- lower body paralysed patients who have urinary catheters placed ), urinary infections or bladder stones, etc have higher risks.
- Chemotherapy patients ( who have had treatments for other cancer in the past )
- Arsenic exposures– High amounts of arsenic exposures in the water, increases the risk of bladder cancer.
- Other causes- People who have genetic diseases like Lynch syndrome, parasitic diseases of the bladder, have family history of bladder cancer or have had bladder cancer in the past, etc have higher risks of urinary bladder cancer.
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What are the symptoms of Urinary Bladder Cancer?
The symptoms of bladder cancer can appear very late in the disease and in some cases they are similar to other bladder conditions. The signs and symptoms of bladder cancer can be different for everyone, which are as follows-
- Blood ( excessive ) or clots of blood in the urine
- Painful and burning sensation while urinating
- Frequent and uncontrolled urge to urinate
- Urge to urinate more frequently at night
- Pain in abdomen and lower back ( generally on one side )
- Having the urge to urinate but not able to pass urine
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However, if there is blood in the urine, the color can be brown or red. Sometimes the change in urine color is not visible ( when the blood clots are very small ).
One must contact the doctor in cases when the symptoms become severe, like-
- blood in urine is excessive ( Gross hematuria )
- the urgency to urinate frequently ( rate increases )
- painful urination ( pain becomes severe and continues for longer durations )
- excessive lower abdomen pain and lower back pain ( does not resolve with pain killers )
How to diagnose Urinary Bladder Cancer?
To diagnose bladder cancer, doctors first perform a physical exam, asking about the symptoms, past medical and family history. Apart from this, doctors take a sample of your bladder cells to examine any lumps or abnormal growths, which is the most important test to diagnose urinary cancer.
Doctors may also recommend some other tests, which are as follows-
- Urine test – Urine test is done to detect blood, bacteria, and abnormal cells in the urine. The urine sample is tested under the microscope (urinary cytology ) and also molecular analysis to detect the cancer cells may be done.
- Cystoscopy – Cystoscopy is the diagnostic test to confirm the urinary bladder cancer. Through this procedure, doctors examine the inside of the bladder. For examination, a tube is inserted into the bladder with a camera mounted on its head called a cystoscope. This is a small procedure, done to identify and locate any tumor in the bladder, which requires biopsy or surgery.
- Intranerve urogram – In this procedure, a special type of dye is injected into the blood so that a picture can be taken with the help of X-rays. However, later it is passed out through urine.
- Biopsy/ Transurethral resection of bladder tumor (TURBT)– In this procedure, a sample of abnormal tissue is taken and examined to find out whether it is cancerous or not. A piece of bladder layer may be sampled and examined so that the spread of cancer can be detected. A part of the tumor and the muscle around the tumor is biopsied, which is then studied under the microscope. TURBT helps to diagnose bladder cancer, identify the type , analyse how deeply the cancer cells have grown, etc.
Once the initial tests are done and urinary bladder cancer has been diagnosed, the following imaging tests are done to identify the spread of the cancer-
- CT or CAT scans- This helps to identify the tumor size, enlarged local lymph nodes using X rays. Contrast dye is injected into veins or given orally, to get a better picture in CT scan. One must inform the doctor about any drug allergies before the dye is given.
- MRI scans- Here the magnetic fields are used to get detailed pictures of the urinary bladder and surrounding structures. This also helps to locate the tumor, know the size of tumor, and whether the tumor cells have spread to nearby lymph nodes , by injecting a dye ( different from the CT scan dye ).
- PET scans or PET-CT scans- This gives the images of the inside of the body by first giving a radioactive substance (injected) to the patient and then scanning the body. PET scans help to detect cancer spread better than CT or MRI scans.
- Ultrasound- This uses soundwaves to get images of the bladder, ureters, kidneys, to check if the cancer has blocked the kidneys or ureters.
- Bone scans and Chest X rays are done incases when the urinary bladder cancer has spread to other organs ( like bone, lungs, blood, etc ) or the lymph nodes.
What are the grades of Urinary Bladder Cancer?
The bladder cancer is classified into 2 grades, based on the cancer cells under the microscope-
- Low Grade Bladder cancer- This grows less actively, and has less chance of spreading into the bladder muscle walls. The cells under the microscope look almost similar to the normal cells ( well differentiated ).
- High Grade Bladder cancer- The cells are highly abnormal under the microscope ( poorly differentiated ), they grow rapidly and aggressively spread to the bladder muscle wall, and to the nearby organs and tissues.
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What are the treatments for Urinary Bladder Cancer?
The treatment of bladder cancer is based on the stage, grade and type of cancer as well as the patient’s health. Treatment for urinary bladder cancer can be of the following types-
Surgery- This is done to remove the cancer cells and is done by the following methods-
- Transurethral resection of bladder tumor ( TURBT )- This is done to remove the cancer cells from the inner layers of the bladder, when cancer has not invaded the muscle layer. Either an electric wire loop or laser beam high energy is used to burn or cut away the cancer tissue. The procedure is done via urethra.
- Cystectomy- Here either part of the bladder ( partial cystectomy ) is done to remove that part of bladder that has cancer tissue or, the entire bladder along with nearby lymph nodes ( radical cystectomy ) is removed. In men, prostate gland and seminal vesicles are also removed, while in females uterus, ovaries, etc may also be removed along with radical cystectomy.
This is done – a) by making one long incision in the lower abdomen , or b) by making multiple small incisions ( robotic surgery .
- Neobladder reconstruction – This is done after the bladder is surgically removed, where the piece of the intestine may be used to create a small sphere shaped reservoir, called the neobladder. This is placed inside the body, attached to the urethra, allowing people to empty urine normally.
- Ileal Conduit- Here the tube-like conduit is made out of the intestine, connected to the ureters, that drains the urine out of the kidneys into a small pouch that hangs on the abdomen.
Chemotherapy- This is done by using the drugs to kill the cancer cells. Two or more drugs may be used in combination, before, after or instead of surgery as treatment.
These a drugs can be given by these 2 methods-
- Through the veins- This is done before bladder removal surgery, or even after the surgery to kill any remaining cancer cells. This can also be done along with radiation therapy.
- Directly injecting the drugs into the urinary bladder- Here a tube is inserted through the urethra into the bladder, chemo drugs are put inside the bladder for set time periods, and then the drugs are drained out. This can be used to treat superficial variants of bladder cancer.
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Radiation Therapy- Here high energy beams of X rays and protons are directed around the body, to deliver these X rays at the precise points. A machine moves around the body that kills the cancer cells. This can be used in combination with chemotherapy , if surgery is not the option.
Immunotherapy- In this therapy, the immune system of the body is used to fight the cancer cells. These can be done by 2 methods-
- Directly into the bladder where the vaccine known as BCG is used, that causes the immune system to get activated and fight the cancer cells. This is used when small bladder cancers have spread into the muscle layers of the bladder.
- Intravenously, which is done when the bladder cancer spreads in the body or recurs after the primary treatment.
Targeted therapy- This is done in advanced cases, where the specific cancer cell weakness is identified, targeted and attacked to kill the cancer cells.
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What is the aftercare for Urinary Bladder Cancer Treatment?
The follow up steps to be followed after Urinary Bladder treatment are-
- Take all the prescribed medications on time. Report if any medicine causes any side effects. Take the vitamins and herbs medicines on time.
- Stop smoking
- Workplace must be made safer, i.e. prevent any further chemical or fumes exposures.
- Rest well, sleep at least 6-8 hours each night adequately.
- Follow a balanced diet chart, take more fruits, green vegetables, vitamins, etc.
- Avoid caffeine in coffee, tea, sports drinks as it makes the person urinate more.
- Take 6-8 glasses of water daily, take juices and milk.
One must contact emergency care if-
- pain gets severe and does not go away with medications
- frequent vomitings
- loss of appetite
- fever
- chest pain
- difficulty in breathing
- unable to pass urine
- blood in urine
- dizzy
- blood in cough
- legs become warm, painful, swelled and red
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What are the complications of Urinary Bladder Cancer Treatment?
The complications due to various urinary bladder cancer treatments include-
- leaking urine ( unable to hold urine )
- difficulty to empty bladder
- frequent UTI episodes that cause- cloudy urine, fever ( high grade), chills, fatigue.
- severe lower abdomen pain, back pain
- bladder spasm, cramps, discomfort in pelvic area
- urine leakage upon sneezing or coughing
- frequent urination urge
- blood in urine
- painful and burning sensation while urinating
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What is the cost of Urinary Bladder Cancer Treatment in India?
The total cost of urinary bladder cancer treatment in India can range from around INR 2,00,000 to INR 6,00,000. However, the cost of the procedure may vary across different hospitals. There are many big hospitals and specialized doctors in India for urinary bladder cancer treatment. The cost varies across different hospitals.
If you are coming from abroad, in addition to the expenses of urinary bladder cancer treatment, there will be a cost of staying in a hotel, cost of living, and cost of local travel. Apart from this, after the procedure, the patient is kept in hospital for 5 days and in the hotel for 15 days for recovery. So, the total cost of urinary bladder cancer treatment in India comes to be around INR 4,00,000 to INR 8,00,000.
We hope that we could answer your questions regarding urinary bladder cancer treatment through this article.
If you want more information and treatment of urinary bladder cancer, you can contact a Surgical Oncologist.
We only aim to provide you with information through the article. We do not recommend any medicine or treatment to anyone. Only a doctor can give you the best advice and correct treatment plan.
