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Bladder Cancer Treatment in India

Bladder Cancer

The bladder is an expandable, hollow organ in the pelvis that stores urine before it leaves the body during urination. This function makes the bladder an important part of the urinary tract. The urinary tract is also made up of the kidneys, ureters, and urethra. Bladder cancer begins when healthy cells in the bladder lining, most commonly urothelial cells, change and grow uncontrollably, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread.

Types of Bladder Cancer

The type of bladder cancer depends on how it looks under the microscope. The three main types of bladder cancer are:

  • Urothelial carcinoma. Urothelial carcinoma accounts for about 90% of all bladder cancers. It begins in the urothelial cells found in the lining the bladder. Urothelial carcinoma is the common term for this type of bladder cancer; however, it was previously called transitional cell carcinoma or TCC.
  • Squamous cell carcinoma. Squamous cells develop in the bladder lining in response to irritation and inflammation. Over time these cells may become cancerous. Squamous cell carcinoma accounts for about 4% of all bladder cancers.
  • Adenocarcinoma. This type accounts for about 2% of all bladder cancers and develops from glandular cells.

·         Papillary cancer

Papillary bladder cancer is a form of early bladder cancer. It appears as mushroom-like growths or is leaf-shaped like seaweed (fronds). Some people may have both papillary cancer and CIS.

·         Carcinoma in situ (CIS)

This is a type of non-invasive bladder cancer that appears as a flat, red area in the bladder. CIS can grow quickly, and if it’s not treated effectively, there’s a high risk that CIS will develop into an invasive bladder cancer.

Causes of Bladder Cancer

  • Tobacco use. The most common risk factor is cigarette smoking, although smoking cigars and pipes can also raise the risk of developing bladder cancer. Smokers are four to seven times more likely to develop bladder cancer than nonsmokers.
  • The likelihood of being diagnosed with bladder cancer increases with age. More than 70% of people with bladder cancer are older than 65 years old.
  • Men are three to four times more likely to develop bladder cancer than women, but women are more likely to die from bladder cancer than men. Before smoking rates for women increased, men were five to six times more likely to develop bladder cancer than women.
  • Chemicals used in the textile, rubber, leather, dye, paint, and print industries; some naturally occurring chemicals; and chemicals called aromatic amines can increase the risk of bladder cancer.
  • Chronic bladder problems. Bladder stones and infections may increase the risk of bladder cancer. Bladder cancer may be more common for people who are paralyzed from the waist down and have had many urinary infections.
  • Cyclophosphamide (Cytoxan, Clafen, Neosar) use. People who have taken the chemotherapy drug cyclophosphamide have a higher risk of developing bladder cancer.
  • Personal history. People who have already had bladder cancer once are more likely to develop bladder cancer again.
  • People who have some forms of this parasitic disease, which is found particularly in parts of Africa and the Mediterranean region, are more likely to develop bladder cancer.
  • Arsenic exposure. Arsenic is a naturally occurring substance that can cause health problems if consumed in large amounts. When found in drinking water, it has been associated with an increased risk of bladder cancer..

Symptoms of Gallbladder Cancer

  • Blood or blood clots in the urine
  • Pain or burning during urination
  • Frequent urination
  • Feeling the need to urinate many times throughout the night
  • Feeling the need to urinate, but not being able to pass urine
  • Lower back pain on one side of the body

Symptoms that may indicate more advanced bladder cancer include:

  • Pain in the lower back around the kidneys (flank pain).
  • Swelling in the lower legs.
  • A growth in the pelvis near the bladder (pelvic mass).

Other symptoms that may develop when bladder cancer has spread include:

Stages of Bladder Cancer

Stage 0a: This is an early cancer that is only found on the surface of the inner lining of the bladder. Cancer cells are grouped together and can often be easily removed. The cancer has not invaded the muscle or connective tissue of the bladder wall. This type of bladder cancer is also called noninvasive papillary urothelial carcinoma (Ta, N0, M0).

Stage 0is: This stage of cancer, also known as flat or carcinoma in situ, is found only on the inner lining of the bladder. It has not grown in toward the hollow part of the bladder, and it has not spread to the thick layer of muscle or connective tissue of the bladder (Tis, N0, M0). This is always a high-grade cancer (see Grades, below).

Stage I: The cancer has grown through the inner lining of the bladder into the lamina propria. It has not spread to the thick layer of muscle in the bladder wall or to lymph nodes or other organs (T1, N0, M0).

Stage II: The cancer has spread into the thick muscle wall of the bladder. It is also called invasive cancer or muscle-invasive cancer. The tumor has not reached the fatty tissue surrounding the bladder and has not spread to the lymph nodes or other organs (T2, N0, M0).

Stage III: The cancer has spread throughout the muscle wall to the fatty layer of tissue surrounding the bladder. It may also have spread to the prostate in a man or the uterus and vagina in a woman. It has not spread to the lymph nodes or other organs (T3 or T4a, N0, M0).

Stage IV: Any of these conditions:

  • The tumor has spread to the pelvic wall or the abdominal wall but not to the lymph nodes or other parts of the body (T4b, N0, M0).
  • The tumor has spread to one or more regional lymph nodes but not to other parts of the body (any T, N1-3, M0).
  • The tumor may or may not have spread to the lymph nodes but has spread to other parts of the body (any T, any N, M1).

Recurrent cancer: Recurrent cancer is cancer that has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence

Diagnosis of Bladder Cancer

The following tests may be used to diagnose

  • Urine tests. The doctor tests a urine sample to find out if it contains tumor cells. If a patient is undergoing a cystoscopy, an additional test may be performed that involves rinsing the bladder and collecting the liquid through the cystoscope or through another small tube that is inserted into the urethra.
  • Cystoscopy. This is the key diagnostic procedure for bladder cancer. It allows the doctor to see inside the body with a thin, lighted, flexible tube called a cystoscope.
  • Transurethral resection of bladder tumor (TURBT). If abnormal tissue is found during a cystoscopy, the doctor will do a biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. This surgical procedure is called a transurethral bladder tumor resection or TURBT

The following imaging tests may be used to find out if the bladder cancer has spread and to help with staging.

  • Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows abnormalities or tumors. A CT scan can also be used to measure the tumor’s size.
  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a liquid to swallow.
  • Positron emission tomography (PET) scan. PET scan may help find bladder cancer that has spread better than a CT scan or MRI alone. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

Treatment of Bladder Cancer

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. There are different types of surgery for bladder cancer, and the most beneficial option usually depends on the stage and grade of the disease. Surgical options to treat bladder cancer include:

  • Transurethral bladder tumor resection (TURBT). This procedure is used for diagnosis and staging, as well as treatment. During TURBT, a surgeon inserts a cystoscope through the urethra into the bladder. The surgeon then removes the tumor using a tool with a small wire loop, a laser, or fulguration (high-energy electricity).
  • A radical cystectomy is the removal of the whole bladder and possibly nearby tissues and organs. For men, the prostate and urethra also may be removed. For women, the uterus, fallopian tubes, ovaries, and part of the vagina may be removed. In addition, lymph nodes in the pelvis are removed for both men and women. This is called a pelvic lymph node dissection. A thorough pelvic lymph node dissection is the most accurate way to find cancer that has spread to the lymph nodes. Rarely, for some specific cancers, it may appropriate to remove only part of the bladder, which is called partial cystectomy.
  • During a laparoscopic or robotic cystectomy, the surgeon makes several small incisions (cuts) instead of the one larger incision used for traditional surgery. The surgeon then uses telescoping equipment with or without robotic assistance to remove the bladder.
  • Urinary diversion. If the bladder is removed, the doctor will create a new way to pass urine out of the body. One way to do this is to use a section of the small intestine or colon to divert urine to a stoma or ostomy (an opening) on the outside of the body. The patient then must wear a bag attached to the stoma to collect and drain urine.

Chemotherapy: This therapy involves the combination of two or more drugs for destroying cancer cells in the case of bladder cancer. These drugs can be directly given to the bladder by passing a tube through the urethra or can also be given through a vein in the arm. Chemotherapy is also sometimes combined with radiation therapy.

Immunotherapy

Immunotherapy, also called biologic therapy, is designed to boost the body’s natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells