Bladder Cancer Treatment in Delhi, India

There are three different types of bladder cancer, including:

1. Transitional Cell Carcinoma

   These are the most common type of bladder cancer. It occurs in the transitional cells found in the inner layer of the bladder. It is also known as urothelial carcinoma. However, the transitional cells are also present in other parts of the urinary tract, including the ureter, the ureters, and the urethra. So, it is essential to check for tumours in these places. 

2. Squamous Cell Carcinoma

   Squamous cell carcinoma is a rare type of bladder cancer. It occurs when squamous cells are formed in the bladder due to a long-term infection, inflammation, or extended use of a urinary catheter. 

3. Adenocarcinoma

   This type of bladder cancer occurs in cells that make up mucus-secreting glands, known as glandular cells, in the bladder.

It is not easy to diagnose bladder cancer. People suffering from it may have blood in their urine but no pain while urinating. Therefore, one should pay attention to symptoms like blood in urine, painful urination, pain in the abdominal area, frequent urination, and more.

Bladder cancer has different stages and grade systems. These are used to denote how far cancer has spread into the body. Starting with the grades, these include:

1. T (tumour) - This denotes how far the tumour has grown through the bladder.
2. N (Lymph Nodes) - This denotes that cancer has spread into lymph nodes near the bladder.
3. M (Metastasized) - This denotes that the disease has spread into organs or lymph nodes of other parts of the body.

Once the doctor has determined the grade, they will use this information to give the overall cancer stage. The range starts from Stage I and goes to Stage IV:

1. Bladder Cancer Stage I

   Cancer has grown through the inner lining of the bladder. However, it has not reached the bladder or not has it spread to the lymph nodes.

2. Bladder Cancer Stage II

   In this stage, cancer has spread to the bladder's muscle wall.

3. Bladder Cancer Stage III

   Cancer has spread to the fatty tissue layer that surrounds the bladder. It may also have spread to the prostate, uterus, or vagina. However, it has not spread to nearby lymph nodes or organs.

4. Bladder Cancer Stage IV

   This is the most aggressive stage where cancer has spread to the lymph nodes or have spread to other parts of the body.

The exact cause of bladder cancer is not known at the moment. However, researchers have found out that it appears when there is abnormal cells growth. The cells might develop a mutation in the DNA and grow out of control, causing a tumour. The tumour can invade and destroy normal body tissues, and they may also break away and spread through the body.

Certain factors may increase the risk of bladder cancer. These includes:

• Cigarette smoking is considered one of the most significant risk factors for bladder cancer
• Exposure to cancer-causing chemicals
• Certain chemotherapy drugs
• Chronic bladder inflammation
• Being male
• Eating high-fat diet
• Having a family history of bladder cancer
• Being old age (people over the age of 55)
• Infection with a parasite known as Schistosoma haematobium

There are no known ways to prevent bladder cancer, but one might take preventive measures to reduce the risk.

• One can quit smoking
• take caution around chemicals
• Eat a healthy diet with an ample amount of antioxidants

The first step for diagnosis and staging of the disease is known as Transurethral resection of bladder tumour (TURBT). During this procedure, a surgeon inserts an electric wire loop through a cystoscope and into the bladder through the urethra. The electric current in the wire is used to burn away cancer. Alternatively, the surgeon might use a high-energy laser.

For Bladder Cancer STAGE 1 - (NMIBC ) the following treatments are done along with regular follow-ups:

Intravesical chemotherapy

This is a type of treatment that uses cytotoxic (anti-cancer) drugs to kill the growing cancer cells. During the process, the chemo drugs are put right into the bladder through a tube known as a urinary catheter. The tube is inserted through the urethra and into the bladder. The solution is left in the bladder for 60 minutes and then drained out through the catheter. Mitomycin is one of the most often drugs used in intravesical chemotherapy.

Immunotherapy

The treatment is done to strengthen the person’s own immune system to fight cancer. Immunotherapy is used to boost or stimulate the natural defences of the immune system. During the treatment, the doctor inserts BCG (Bacillus Calmette-Guerin) into the bladder through a catheter, which attracts the immune system to attack the cancer cells. 

For Bladder Cancer Stage II - MIBC the following treatments may be performed:

Neoadjuvant Chemotherapy

This is a type of chemotherapy that is aimed to shrink the cancerous tumour using chemo drugs before moving on to other treatments like surgery. Neoadjuvant chemotherapy helps the surgeon to remove large tumours with ease. 

Radical cystectomy

This surgical procedure removes all of the bladders. During the procedure, where the entire bladder and the surrounding lymph nodes are removed. In men, the surgeon also removes the prostate and seminal vesicles. In women, radical cystectomy involves removing the uterus, ovaries, fallopian tube, cervix and part of the vagina. 

Urinary diversion

Once the radical cystectomy is completed, the surgeon then performs urinary diversion to allow urine to exit the body. There are different types of urinary diversion, including ileal conduit urinary diversion, Indiana pouch reservoir, and neobladder. 

For metastatic disease, the following treatment is done: 

Palliative TURBT

The procedure is used to diagnose, stage and treat bladder cancer. During the procedure, the surgeon inserts a thin tube known as a cystoscope through the urethra and into the bladder. The surgeon then uses a special tool to remove the tumour along with some healthy tissues. The treatment also requires the following: 

• Radiation Therapy

  Radiation therapy uses X-rays and protons to kill the cancer cells present in the part of the body. During this therapy, the patient is laid down on a table. Then, large machines move around them, directing the beams to the specific points on the body. The length of radiation therapy varies with the stages of bladder cancer. 

• Chemotherapy

  This treatment is done with the help of chemo drugs to destroy cancerous cells in the body. In most cases, there is a combination of several chemotherapy drugs. The chemo drugs are given into veins.

For the advanced stage where the other treatments like chemotherapy and radiation therapy have failed, the following treatment is used: 

Targeted therapy:

Some targeted drugs are given to the patient during this therapy to target specific abnormalities present within the cancer cells. This therapy can be used in conjunction with chemotherapy to kill the cancer cells present in the bladder.

Our Bladder Cancer Department 

Max Institute of Cancer Care is one of the top centres for state-of-the-art cancer treatment. We have the largest and most experienced teams of specialists in India, with campuses in Delhi NCR, Uttarakhand, Punjab & Maharashtra. Our staff is skilled with top-notch standards to ensure quality care and speedy recovery.

Once the treatment is over, the patients will have the following survival rates based on the stages:

• People suffering from stage I bladder cancer have around 88 percent of survival rate
• People with Stage II have an approximately 63 percent of survival rate
• People with Stage III of bladder cancer have about 46 percent of survival rate
• People with Stage IV of bladder cancer have an approximately 15 percent survival rate.

Patients will be in intensive care after bladder cancer treatments. These include:

• Follow-up care, which can last for at least two years
• Frequent follow-up exams and tests at least for several years to look for signs of bladder cancer or side-effects of the treatments
• Frequent visits to psychologists, recreation therapists, dietitians, and more for a speedy recovery

1. What are the Common Urinary Problems in Elderly?
2. Tips for Preventing Prostate Cancer
3. Does Prostate Cancer Show No Symptoms?
4. Urologists: Who Are They and What Can They Do for Me?