Bladder Cancer

Bladder cancer is an abnormal growth of cells (tumor) that occurs in the urinary bladder cells.

Signs & Symptoms of Bladder Cancer

Some of the signs and symptoms of bladder cancer are as follows.

• Hematuria (blood in the urine)
• Painful urination
• Increased frequency of urination
• Back pain

When bladder cancer spreads to an advanced stage, it will cause the following symptoms:

• Bone pain
• Pelvic pain
• Swelling of the legs
• Unexplained weight loss

Causes of Bladder Cancer 

The exact cause of bladder cancer is unknown. The possible causes are as follows.

• DNA changes within the bladder cells: DNA is a chemical that controls how our cells function
• Genetic mutations: these can occur by turning on oncogenes (genes that help in the growth, division, and life of cells) or turning off tumor suppressor genes (genes that help control cell division, cause cells to die at the right time, or repair DNA mistakes). These gene mutations can be acquired due to risk factors or inherited from your family

Possible Bladder Cancer Treatment

Treatment for bladder cancer depends on the grade and stage of cancer. Some of the treatment options are as follows.

• Chemotherapy within the bladder (intravesical chemotherapy)- Treat bladder cancer that is confined to the bladder but may progress to other parts of the body.
• Chemotherapy for the whole body (systemic chemotherapy)- Used along with surgery or when surgery is not possible
• Radiation therapy- To destroy cancer-affected areas when surgery is not possible.
• Surgical treatment- Removal of cancer-affected areas.
• Immunotherapy- Therapy which fights cancer cells by triggering the body’s immune system.
• Targeted therapy- Used in advanced cancer stages when no other treatments have helped.

Risk Factors

Though the exact cause of bladder cancer is unknown, some of the risk factors are as follows.

• Smoking- Cigarettes contain harmful chemicals that may cause bladder cancer.
• Gender- Males are more vulnerable than females.
• Obesity- Being overweight predisposes you to the risk of bladder cancer.
• Chemical exposure- Exposure to certain chemicals either due to manufacturing jobs or occupational hazards can increase one’s risk.
• Radiotherapy- Previous treatment with radiotherapy for cancers close to the bladder.
• Chemotherapy- Previous treatment with particular chemotherapy medications.
• Catheter- Having a long-term tube within your bladder can result in nerve damage and paralysis, increasing your risk.
• Urinary tract infections (UTIs)- Having multiple U.T.I.s can increase your risk.
• Bladder stones- Having long-term bladder stones can increase one’s risk of bladder cancer.

Stages of Bladder Cancer

Bladder cancer can be in the early stages when it is only confined to the bladder or invasive when it penetrates the bladder wall and can spread to adjacent organs or lymph nodes. The staging system used for bladder cancer is the TNM staging which stands for Tumor, Node, and Metastasis. In this staging system, bladder cancer stages are as follows.

Tumor

• T2- Invasive bladder tumor that spreads beyond the bladder lining to the muscle.
• T4- Tumor spreads to other organs besides the bladder

Lymph node

• N0- Lymph nodes have no cancer
• N3- Multiple lymph nodes are affected by cancer with some reaching a size of more than 5 cm.

Metastasis

• M0- Metastasis has not occurred outside of the pelvis
• M1- Metastasis has occurred outside the pelvis to other parts of the body.

Typical Tests Required For Bladder Cancer 

Tests to diagnose bladder cancer consist of various investigations. 

A cystoscopy will be done in which a scope is inserted through your urethra into the bladder to look for signs of abnormalities. During this cystoscopy, your doctor may also remove a small amount of tissue from within the bladder to examine it for cancer cells. This is called biopsy or transurethral resection of bladder tumor (TURBT). 

Urine cytology may be done in which your urine is examined under a microscope for any cancer cells. Imaging tests may also be done to determine the extent of cancer’s spread and the stage that it is in. These imaging tests include computerized tomography (CT) urogram or retrograde pyelogram, magnetic resonance imaging (MRI), positron emission tomography (PET), bone scan, and chest X-ray.

Prevention of Bladder Cancer

The prevention of bladder cancer involves various approaches aimed at reducing the risk of developing this disease.

Primary Prevention

The primary prevention strategy for bladder cancer is to reduce the modifiable risk factors.

• Smoking- Smoking is the cause of half of the bladder cancers
• Chemicals- Limit your workplace’s exposure to chemicals or take precautions when using them.
• Fluids- Make sure to stay hydrated.
• Consumption of fruits and vegetables- helps protect one against bladder cancer.

Secondary Prevention

To prevent bladder cancer recurrence, targeting the risk factors that can be worked on is the best method.

• Diet- Consuming a diet rich in fruits, vegetables, milk, and milk products and reducing micronutrient deficiency can reduce your bladder cancer risk.
• Fluid intake- Increasing fluid intake can help prevent bladder cancer.
• Sleep- Getting adequate rest and sleep can help reduce bladder cancer recurrence.
• Stress- Reducing stress and anxiety can help prevent bladder cancer recurrence.

Alternate Name: Bladder Carcinoma

Differential Diagnosis

As blood in the urine is the most common symptom of bladder cancer, it has a variety of differential diagnoses. Other diseases with similar symptoms to bladder cancer are urinary tract infections, hemorrhagic cystitis, prostatitis, benign prostatic hyperplasia, nephrolithiasis, renal cell cancer, other pelvic cancers, and diverticulitis. However, diagnostic investigations will help confirm the diagnosis of bladder cancer, separating it from the other differential diagnosis.

Epidemiology

• Gender- Men are more likely to be affected than women.
• Age- Mostly seen in individuals above the age of 55 years with an average age of 73 years for a diagnosis.
• Race- European descent individuals are at a higher risk of bladder cancer than their African counterparts, given that they are less exposed to chemicals.

Expected Prognosis

The prognosis of bladder cancer depends on the type, stage and grade of cancer. However, it is seen that after one year of diagnosis, 75 out of 100 individuals survive this cancer. After five years of diagnosis, 55 out of 100 individuals survive. The survival rate of individuals diagnosed after ten years with bladder cancer is 45 out of 100.

Natural Progression

The natural progression of bladder cancer will depend on the grade. If it is high-grade cancer, then it will spread fast and grow quickly if no treatment is given. Even low-grade bladder cancer will progress to a more advanced stage and grade of bladder cancer without treatment.

Pathophysiology

When DNA mutations occur, bladder cancer occurs. Due to these mutations, the cells continue to multiply instead of dying after a specific amount of time. This results in uncontrolled cell growth, which results in a tumor. When it forms inside the urinary bladder, this tumor invades and destroys normal tissue in the body. Over time, these cancerous cells spread via blood or lymphatics to other parts of the body resulting in metastasis.

Possible Complications

Bladder cancer can spread to adjacent organs. The cancer cells may also travel via the pelvic lymph nodes and spread to other organs like the lungs, liver, and bones. Other complications include anemia, erectile dysfunction in males, sexual dysfunction in females, urinary incontinence, swelling of the ureters, and urethral stricture (narrowing).

Frequently Asked Questions

1. What are the best hospitals for bladder cancer treatment in Mumbai?

Nanavati Max Hospital in Mumbai is considered one of the best hospitals for bladder cancer treatment in the city, offering a range of advanced treatments and experienced specialists.

2: What are common treatment options for bladder cancer in Mumbai?

There are multiple treatment modalities for bladder cancer at Nanavati Max Super Speciality Hospital, Mumbai. They include:

• Surgery: To remove tumours or, in advanced cases, the entire bladder.

• Chemotherapy: Employing drugs to kill or inhibit cancer cells.

• Radiation Therapy: Using high-energy rays to target and eradicate cancer cells.

• Immunotherapy: Boosting the body's natural defences to combat cancer.

• Targeted therapy: Designed to target specific molecules and pathways involved in cancer growth.

The treatment blueprint is tailored, factoring in the cancer's stage and grade, the patient's existing health conditions, and personal choices.

3: Is it possible to lead a normal life after bladder cancer treatment?

Absolutely. Many patients of Nanavati Max Super Speciality Hospital lead healthy and regular lives after bladder cancer treatment, particularly if the malignancy was diagnosed and addressed in the early stages. However, the treatment's nature, the cancer's stage and grade, and the individual's overall health dictate the prognosis.

4: What's the typical treatment time frame for bladder cancer in Mumbai?

The treatment span for bladder cancer depends on the cancer's variant and stage, coupled with the selected therapeutic route. Generally, treatments can span from a few weeks to several months, with protocols like surgery, chemotherapy, and radiation therapy often necessitating multiple cycles spread over time.

5: Are there any bladder cancer clinical trials on offer in Mumbai?

Indeed, Mumbai often hosts clinical trials on bladder cancer. These trials are rigorous evaluations of pioneering treatment strategies, drugs, or techniques, aspiring to refine or invent therapeutic avenues. Eligibility for such trials is determined by a criteria, offering patients a chance to tap into advanced treatments.

6: How does the cost structure for bladder cancer treatment in Mumbai look?

Bladder cancer treatment's financial layout in Mumbai is shaped by multiple elements: the malignancy's stage, treatment choices, the healthcare institution's reputation, and ancillary charges. For a precise cost breakdown, engaging directly with the hospital or health institution is recommended.