What is Urinary Cancer?
Bladder is a flexible hollow pouch like structure present within the pelvis and it stores the urine prior to its excretion. Urine is prepared by the kidneys and is carried to the bladder through the ureters. This urine is stored in bladder and it is later discharged through a tube like structure known as the urethra.
This cancer is defined as a condition in which there is rapid and uncontrolled growth of cancerous cells within the urinary bladder. This condition usually starts from the lining of the bladder and later it spread into the muscular wall of the urinary bladder. Moreover, invasive urinary bladder cancer can spread to lymph nodes, kidneys, lungs, liver and other organs present in the pelvis.
Urinary bladder cancer, though rare (accounting only about 5% of all cancers), it affects males more frequently than females. The possible risk factors leading to such a condition include genetic or family history, chronic inflammation of the bladder, smoking, some medications for treating diabetes, exposure to harmful chemicals, prior chemotherapy or radiation treatment and others.
Some of the common symptoms of urinary bladder cancer involves pelvic pain, pain during urination, blood in urine. The patients also experience symptoms like frequent urination, sudden weight loss, swollen feet, appetite loss, back pain. People having such symptoms to consult their doctor, as soon as possible.
A systematic diagnosis is a required before starting the treatment of urinary bladder cancer. The patient’s medical history and family history is also asked by doctor regarding cases of bladder cancer. After this several laboratory tests and imaging tests are done. Once a patient is diagnosed as having bladder cancer, he/she is accordingly treated depending upon the severity of the condition.
Some of the treatments for urinary cancer are as following:-
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Surgery- In surgery the tumour and some surrounding healthy tissue is removed during an operation. There are different types of surgery for urinary bladder cancer. Surgical options to treat urinary bladder cancer includes:
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Transurethral bladder tumour resection (TURBT). This procedure is used for diagnosis and staging, also as treatment. During this procedure the surgeon inserts a cystoscope through the urethra into the bladder. Then the surgeon removes the tumour using a tool with a small wire loop, a laser, or fulguration. The patient is given an anaesthetic medication to block the awareness of pain, before the procedure begins.
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Cystectomy and lymph node dissection. In radical cystectomy, the whole bladder is removed and possibly nearby tissues and organs. In men, the prostate and urethra also may be removed. In women, the fallopian tubes, uterus, ovaries, and part of the vagina may be removed. For all patients the lymph nodes in the pelvis are also removed. This is called a pelvic lymph node dissection. An extended pelvic lymph node dissection is the accurate way to find cancer that has spread to the lymph nodes.
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Urinary diversion. When the urinary bladder is removed, then the doctor will create a new way to pass out urine from the body. One of the way to do this is to use a section of the small intestine or a colon to divert the urine to a stoma or ostomy (an opening) on the outside of the body. Then the patient must wear a bag attached to the stoma to collect and drain urine.
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Chemotherapy- In chemotherapy the drugs are used to destroy cancer cells, usually by ending the cancer cell’s ability to grow and divide. A chemotherapy schedule, typically consists of a specific number of cycles given over a set period of time. A patient receives 1 drug at a time or a combinations of different drugs given at the same time. There are two types of chemotherapy used to treat bladder cancer. The doctor recommends the type and when it is given depends on the stage of the cancer.
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Intravesical chemotherapy. Intravesical chemotherapy is usually given by urologist. During this therapy, drugs are delivered through a catheter that has been inserted through the urethra into the bladder. Local treatment only destroys the superficial tumour cells that come in contact with the chemotherapy solution. Mitomycin and thiotepa are the drugs used mostly for intravesical chemotherapy. Other drugs that are used include cisplatin, doxorubicin, gemcitabine, and valrubicin.
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Systemic chemotherapy- Systemic chemotherapy is usually prescribed by a medical oncologist, a specialist doctor in treating cancer with medication. This chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous tube placed into a vein using a needle or in a pill or capsule that is orally swallowed.
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Immunotherapy- Immunotherapy, also called as biologic therapy. It is designed to boost the body’s natural defence to fight against the cancer. This therapy uses materials made either by the body or in a laboratory to improve or restore immune system function.
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Radiation therapy- In this therapy high-energy x-rays or other particles are used to destroy cancer cells. The most common type of radiation treatment is called external-beam radiation therapy, which is given from a machine outside the body. When it is given using implants, it is called internal radiation therapy or brachytherapy.
How is the treatment done?
The treatment of urinary bladder cancer requires proper diagnosis in the first place. The doctor may check the medical history and family history of the patient to be sure whether the cause of this condition is due to genetic reasons.
A systematic diagnosis is a required before starting the treatment of urinary bladder cancer. The patient’s medical history and family history is also asked by doctor regarding cases of bladder cancer. After this several laboratory tests and imaging tests are done. Once a patient is diagnosed as having bladder cancer, he/she is accordingly treated depending upon the severity of the condition.
Diagnosis of bladder cancer involves pelvic examination and digital rectal examination. If the doctor finds any tumour then he/she may recommend or further laboratory and imaging tests. Such laboratory tests include urine tests and cystoscopy. If the doctor finds a tumour during such a test, then he/she may recommend for a surgery known as (TURBT) transurethral resection of bladder tumour, where the tumour and also a part of the bladder muscle near it is removed. A sample of the tumour is sent for biopsy in order to check whether it is cancer. The various imaging tests used for the diagnosis of bladder cancer include magnetic resonance imaging (MRI), computed tomography (CT) scan, ultrasound imaging, bone scan, chest scan, intravenous pyelogram and retrograde pyelogram. Once the patient is diagnosed after physical examinations as having bladder cancer, he/she is treated depending upon the severity of the condition. The treatment of bladder cancer involves surgery, immunotherapy, chemotherapy and radiation therapy. Surgery involves removal of the tumour and a part of the muscles near it and this method is referred to as transurethral resection of bladder tumour (TURBT). Another method called “cystectomy” involves partial or complete removal of the bladder. Other treatments like immunotherapy, chemotherapy and radiation therapy aim at killing the harmful cancerous cells. It is important to remember that there is no complete cure for bladder cancer. Treatment can be done only to prevent or reduce the possible symptoms that the patient suffers from, during this condition.
The doctor will work with the patient to decide what treatment to provide based on the type and stage of the bladder cancer, the symptoms, and overall health.
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Treatment for stage0 and stage1
Treatment for stage0 and stage1 urinary bladder cancer may include surgery to remove the tumour from the bladder, chemotherapy, or immunotherapy, which involves taking a medication that causes your immune system to attack the cancer cells. -
Treatment for stage 2 and stage 3
Treatment for stage 2 and stage 3 bladder cancer includes removal of part of the bladder in addition to chemotherapy, also may be removing whole bladder which is called radical cystectomy, after the surgery the doctor creates a new way for urine to exit the body. Radiation therapy , chemotherapy or immunotherapy that can be done to shrink the tumour before surgery, to treat the cancer when surgery isn’t an option, to kill remaining cancer cells after surgery, or to prevent recurring of cancer. -
Treatment for stage 4 bladder cancer Treatment for stage 4 bladder cancer includes chemotherapy without surgery to relieve symptoms and extend life of radical cystectomy and removing of the surrounding lymph nodes, following a surgery is done to create a new way for urine to exit the body. Radiation therapy, Chemotherapy and immunotherapy after a surgery is done to kill remaining cancer cells or to relieve symptoms and extend life clinical trial drugs
Who is eligible for the treatment?(When is the treatment done ?)
Persons having symptoms like blood in urine (haematuria), pelvic pain, pain during urination, frequent urination, swelling of feet, loss of appetite, sudden weight loss, back pain and is diagnosed to be suffering from bladder cancer, is considered to be eligible for this treatment. Persons, having such symptoms, should inform the doctor as soon as possible and should take treatment procedures.
Who is not eligible for the treatment?
Anyone, who is normal and is not suffering from the symptoms of urinary cancer, is not eligible for this treatment.
Are there any Side Effects?
The treatment for urinary cancer also has its side effects as similar to other cancer treatments. The intensity of these side effects varies according to the treatment procedure. The side effects for surgical treatments like radical cystectomy and segmental cystectomy involve interruption of the patient’s sexual function, sudden menopause and inability to get pregnant (in women), increased frequency in urination and inability to hold urine for a long time.
The side effects of treatment involving immunotherapy, chemotherapy and radiation therapy includes vomiting, nausea, discomfort during urination, vaginal dryness in women, diarrhoea, erectile dysfunction in men, hair loss, appetite loss, weakness, soring of mouth, fever and others. It is recommended that the patients should consult with the doctor, if they happen to suffer from any of these side effects, during the course of treatment.
What are the post-treatment guidelines?
The treatment for urinary cancer requires few months or even years for the completion of treatment. After treatment the patient still needs to go through several follow up examinations in interval of every few months for a number of years.
The patient should attend all the follow up treatments and go for regular chemotherapy and radiation therapy along with other treatments. This is to check the possibilities of reoccurrence of cancer, and also the probable side effects of such treatments. Almost all the cancer treatments have their side effects and so it is important that the patient must inform the doctor regarding this issue and seek the necessary remedial measures.
How long doesit take to recover?
Unfortunately, there is no cure for urinary cancer, but the symptoms of this can be managed by surgery, radiation therapy and chemotherapy. The patients, who have been diagnosed as having this problem, their life span mainly depends upon the severity of the condition and the type of treatment that the patient is undergoing. On an average, the treatment for bladder cancer may take few months or years for its completion.
What is the price of the treatment in India?
The price of the treatment for urinary cancer varies in different parts of India country. The treatment cost also vary depending upon the severity of the condition and the type of treatment that the patient is undergoing. On an average, the price of treatment for urinary cancer ranges from Rs.12,50,000 to Rs.27,50,000.
Are the results of the treatment permanent?
No, the results of the treatment for urinary cancer are not permanent and there are chances that the cancer may reoccur after a certain period of time. Complete cure for this cancer is not available, therefore it is highly recommended that the patient should go for regular check-ups, radiation therapy, chemotherapy and other tests to check the progress of such a cancer.
What are the alternatives to the treatment?
Till date, there are no alternatives for urinary cancer. Surgery, immunotherapy, radiation therapy and chemotherapy are the best methods of treatment for bladder cancer. However, after surgery, treatment done with mistletoe extracts has been proven to be effective in reducing tumour recurrence. Mistletoe extracts act upon the proteins that affect cancer and it can be used for patients with malignancies, during the initial stages. Later stages of such cancers can be quite complicated and cannot be effectively cured.
