Bladder Cancer Treatment and Surgery in India

Overview

Bladder cancer, or cancer of the bladder, is cancer that forms in the tissues of the bladder. The bladder is an organ that stores urine. The majority of bladder cancers are transitional cell carcinomas - the cancer starts in cells of the inner-lining of the bladder. Bladder cancer tends to affect older adults, but can develop in any age group. The disease is highly treatable at an early stage, when fortunately most diagnoses are made. Nevertheless, bladder cancer has a high rate of recurrence (coming back), even if treated early on. That is why survivors should undergo regular follow-up screening tests.

What is a Bladder Cancer?

Bladder cancer refers to any of several types of malignant growths of the urinary bladder. It is a disease in which abnormal cells multiply without control in the bladder. The bladder is a hollow, muscular organ that stores urine; it is located in the pelvis. The most common type of bladder cancer begins in cells lining the inside of the bladder and is called transitional cell carcinoma (sometimes urothelial cell carcinoma). Most bladder cancers are transitional cell carcinomas (cancer that begins in cells that normally make up the inner lining of the bladder).

What are the Types of Bladder Cancer?

The following are the common types of Bladder Cancer, depending on the type of cell where the cancer begins:

• Urothelial carcinoma: is a new term for this type of bladder cancer. It was previously called transitional cell carcinoma or TCC. Urothelial carcinoma accounts for about 90% of all bladder cancers and begins in the urothelium. A tumor of this type may be described further using one of the four subcategories explained below.
  
  
• Non-muscle-invasive/superficial urothelial carcinoma: This subtype of urothelial carcinoma is limited to the urothelium and is non-muscle-invasive, meaning it has not spread to the muscle layer. It may spread into the lamina propria beneath the transitional cells. This is sometimes called invasive, though it is not the deeply invasive type that can spread to the muscle layer.
  
  
• Muscle-invasive urothelial carcinoma (often called invasive urothelial carcinoma): This subtype of urothelial carcinoma spreads to the bladder's muscularis propria and sometimes to the fatty layers or surrounding tissue outside the muscle.
  
  
• Papillary urothelial carcinoma: Papillary is a word that describes a growth that is like a small polyp or flower-shaped cluster of cancer cells. A noninvasive papillary tumor grows into the hollow center of the bladder on a stalk. Invasive papillary urothelial carcinoma can spread into the lamina propria or muscle layer.
  
  
• Flat urothelial carcinoma: Noninvasive flat urothelial carcinoma (also called carcinoma in situ, or CIS) grows in the layer of cells closest to the inside of the bladder and appears as flat lesions on the inside surface of the bladder. Invasive flat urothelial carcinoma may invade the deeper layers of the bladder, particularly the muscle layer.
  
  
• Squamous cell carcinoma: This type accounts for about 4% of all bladder cancers and starts in squamous cells, which are thin, flat cells.
  
  
• Adenocarcinoma: This type accounts for about 2% of all bladder cancers and begins in glandular cells.

What are the Causes of Bladder Cancer?

We do not know exactly what causes bladder cancer; however, a number of carcinogens have been identified that are potential causes, especially in cigarette smoke. Research is focusing on conditions that alter the genetic structure of cells, causing abnormal cell reproduction. We do know that the following factors increase a person's risk of developing a bladder cancer:

• Smoking: Smoking is the single greatest risk factor for bladder cancer. Smokers have more than twice the risk of developing bladder cancer as nonsmokers.
  
  
• Chemical exposures at work: People who regularly work with certain chemicals or in certain industries have a greater risk of bladder cancer. Organic chemicals called aromatic amines present in dye industry are particularly linked with bladder cancer. Other industries prone to this include rubber and leather processing, textiles, hair coloring, paints, and printing.
  
  
• Diet: People whose diets include large amounts of fried meats and animal fats are thought to be at higher risk of bladder cancer.
  
  
• Aristolochia Fangchi: This herb is used in some dietary supplements and Chinese herbal remedies. People who took this herb as part of a weight loss program had higher rates of bladder cancer and kidney failure than the general population. Scientific studies on this herb have shown that it contains chemicals that can cause cancer in rats.

What are the Symptoms of Bladder Cancer?

A symptom is something the patient feels or reports, while a sign is something other people, including a doctor, may detect. For example, pain may be a symptom while a rash could be a sign. The most common signs and symptoms are:

• Hematuria: Blood in urine (by far the most common symptom). It may appear Coca-Cola colored, or bright red in the urine. It could also appear in a microscopic examination of the urine.
• More frequent urinations than usual
• Urinary tract infection
• Sudden urges to urinate
• Pain when urinating; usually a burning sensation

The patient may also experience the following symptoms, but they are less common:

• Pain in the pelvis
• Back pain
• Bone pain
• Unexplained weight loss
• Swelling of the legs

Any blood in urine should be reported to your doctor immediately. However, it most likely is not bladder cancer. Less than 1 in 1,000 cases of Hematuria (blood in urine) are caused by bladder cancer. Nevertheless, this does not mean you should ignore it. Blood in urine may be a sign of several other medical conditions, as well as bladder cancer.

What is the Diagnosis for Bladder Cancer?

The following are the tests which are used to diagnose Bladder Cancer:

Urine Sample: If the patient had detected blood in urine the doctor will ask for a urine sample, which will be tested for abnormal cells; this called a urinary cystography. Although this test is useful it can sometimes give false-positive results, and vice-versa - detect abnormal cells when there is not cancer, or not detect abnormal cells when cancer is present. A doctor cannot make a diagnosis just from a urine test. The urine sample will also be tested for bacteria.

• Physical examination - the doctor will carry out a physical examination. This may include an examination of the rectum and vagina for women, and just the rectum for men.

If the doctor requires more data, or if bladder cancer is suspected, the GP will probably refer the patient to a urologist. A urologist, or urological surgeon, is a doctor who specializes in just diseases of the urinary organs in females, and the urinary organs and sex organs in males. The urologist may recommend the following tests:

• Imaging Tests: These tests allow the doctor to observe the structures of the urinary tract. The patient may receive a dye which is either injected into a vein or swallowed. An intravenous pyelogram is an X-ray imaging test that sees the dye highlighted in the bladder, ureters and kidneys. A CT (computerized tomography) scan is a series of X-ray images that allows the doctor to have a better look at the urinary tract and surrounding tissues.
  
  
• Cystoscopy: A long-thin flexible tube, a cystoscope, is inserted through the patient's urethra and into the bladder. The device has a lens telescope or microscope, and a fiber-optic lighting system which allows the health care provider to observe the inside of the bladder and urethra. The patient will receive a local anesthetic before this procedure begins. The urologist looks out for any abnormal areas that could be caused by bladder cancer.
  
  
• Biopsy: A more rigid type of cystoscope may be used to take a sample of bladder tissue. The tissue will be observed under a microscope to see whether it is cancerous. This procedure is sometimes called TURBT (transurethral resection of bladder tumor). TURBT is sometimes used to treat bladder cancer. The patient is usually given a general anesthetic.

If results come back positive - if cancerous cells are detected in the bladder lining, the patient may have to undergo further tests to determine whether the cancer is limited to its area of origin, or has spread. These tests might include:

• Chest X-rays
• CT Scan
• MRI Scan
• Bone Scan

What are the Stages of Bladder Cancer?

The stage of Bladder cancer is largely determined by how "deeply" the tumor has invaded. The following list describes its various stages.

• Stage 0: Cancer cells found on the inner surface of the bladder. This is the earliest stage of bladder cancer and is known as superficial cancer or carcinoma in situ (CIS).
  
  
• Stage I: Cancer cells have penetrated the inner lining of the bladder but have not yet reached the muscle layer.
  
  
• Stage II: Cancer cells have spread into the muscle layer.
  
  
• Stage III: Cancer cells have spread beyond the bladder muscle and into the outer layer of tissue surrounding the bladder.
  
  
• Stage IV: Cancer cells have spread towards the abdominal or pelvic wall. In men, the cancer cells may spread to the prostate. In women, the cancer cells may spread to the uterus or vagina. Cancer cells may have also spread to the lymph system and metastasized to other parts of the body.
  
  

How to Prepare for Bladder Cancer Surgery?

Before having Bladder Cancer surgery, find out all you can about the benefits, risks, and side effects of the operation. You may want to ask your doctor the following questions. The answers may help you feel more comfortable with your decision.

• What kind of bladder cancer do I have?
• What is the stage of the disease? Has the cancer spread?
• What is the grade of the tumor?
• What are my treatment choices? Which do you recommend for me? Why?
• What are the expected benefits of each kind of treatment?
• What are the risks and possible side effects of each treatment?
• What is the treatment likely to cost? Is this treatment covered by my insurance plan?
• How will treatment affect my normal activities?

What are the Common Procedures for Bladder Cancer Surgery?

Treatment for Bladder Cancer depends on the type of cancer, how advanced it is, the patient's general health, and his/her preferences. The following are the surgical options

Early-stage Bladder Cancer

• TURBT (Transurethral Resection of Bladder Tumor) - this procedure is used when the cancer is confined to the inner layers of the bladder. The surgeon passes a wire loop through the patient's urethra and into the bladder. The loop burns away cancer cells by means of fulguration (electric current). The patient may feel some pain and have blood in his/her urine for a few days. During surgery, a Foley catheter is placed in your bladder to drain the urine.  After surgery, your urine may be bloody and there may be some clots in it.  Continuous bladder irrigation (CBI) may be needed to clear your urine if you have a lot of clots.  With CBI, a special Foley catheter is used to irrigate or flush the bladder continuously while your urine and the CBI fluid empty into a drainage bag.  If you are not able to urinate on your own after the Foley catheter has been removed, you may need to go home with your catheter.
  
  
• Segmenta Cystectomy (Partial Cystectomy) - a portion of the bladder that contains cancer cells is surgically removed. This procedure is an option of the cancer is limited to just one part of the bladder that can be surgically removed without seriously affecting bladder function. The patient will receive a general anesthetic and remain in hospital for between seven to ten days. There is a risk of bleeding and infection. There may also be bleeding. As the procedure reduces the size of the bladder the patient will need to urinate more often after it.

Invasive Bladder Cancer (Later Stage)

• Radical Cystectomy - the whole bladder is surgically removed, as well as nearby lymph nodes. For males this also includes the removal of the prostate and seminal vesicles, which will cause infertility. For females this also includes removal of the uterus, ovaries (causing infertility) and part of their vagina. The younger woman will experience premature menopause. There is a risk of infection, blood clots, bleeding and bowel obstruction.  With the entire bladder removed the surgeon needs to create a new route for the urine to leave the body. A urinary conduit (a tube) using a piece of the patient's intestine can be created, which goes from the kidneys to the outside of the body where the urine drains into a urostomy bag. The bag is worn on the patient's abdomen. Alternatively the surgeon may use a section of intestine to create a small internal reservoir for urine; this is called a cutaneous continent urinary diversion. The reservoir can be drained by inserting a catheter into a hole in the abdomen.  The surgeon can also create a neo-bladder from a piece of intestine. This internal reservoir is connected to the urethra, so that the patient can urinate in a normal way. Sometimes a catheter may be needed.

What is the Post-Operative Care after Bladder Cancer Surgery?

The patients undergoing a Bladder Cancer Surgery should take of the following things under post operative care:

• Do not smoke: The best way to try to prevent bladder cancer is not to smoke. If you already smoke, quit. Ask your caregiver to help you stop smoking.
  
  
• Make your workplace safer: Follow good safety practices if you work with a class of chemicals called aromatic amines. Industries where these chemicals are commonly used include the makers of rubber, leather, printing materials, textiles, and paint products.
  
  
• Diet: Eat a variety of healthy foods including breads, cereals, rice and pasta. Include vegetables and fruits, milk, yogurt, and cheese. Also eat meat, poultry (chicken), fish, dry beans, eggs, and nuts. Ask your caregiver how many servings of fats, oils and sweets should be included in your diet.
  
  
• Drinking liquids: Drink 8 to 10 (eight-ounce size) cups of healthy liquids each day. For most people, healthy liquids are water, juices, and milk. Limit the amount of caffeine in your diet.

Why Bladder Cancer Surgery in India?

Of late India has become the most preferred destination for Bladder Cancer Surgery. Many foreign patients especially from the west come to India for a nice blend of top-class medical expertise at attractive prices. The global patients get treated at world renowned hospitals of India with latest facilities and globally benchmarked healthcare services administered by surgeons and physicians trained in international medical practices.

Bladder Cancer Surgery in India is provided at hospitals having a team of highly-trained doctors of international repute and research analysts working together to develop newer treatment approaches and using them for effective patient cure and care. With the use of advanced medical technology and newly invented techniques, the recovery time after surgery is shortened and within very short period time frame, patients becomes fit and return back to work.

Indian hospitals provide patients with the best results and care by ensuring that everything they encounter is of the highest quality. The Bladder Cancer Surgery in India is available at various hospitals in the following cities with latest amenities and state-of-art-facilities.

What is the Cost of Bladder Cancer Surgery in India?

India offers outstanding Bladder Cancer Surgery at 60-80% less than prevailing USA or UK rates. Even with travel expenses taken into account, the comprehensive medical tourism packages still provide a savings measured in the thousands of dollars for major procedures. A cost comparison of various medical treatments can give you the exact idea about the difference: