Dr Vipin Tyagi
Rafiq Sheikh, a 55 year old man from Kashmir was diagnosed with a muscle invasive bladder cancer. Sheikh, a chain smoker, went to a urologist upon noticing blood in his urine which was often accompanied with accute pain.
Bladder cancer cases are commonly seen in individuals who are 50 years or above and are compulsive smokers. Smoking and use of tobacco increases the risk factor for bladder cancer and because there are more smokers in Kashmir, hence many people in the Valley are diagnosed with this severe condition.
When an individual smokes, their body excretes some of the harmful chemicals in the urine which damages the lining of their bladder and which is why smokers are three to four times more likely to get the disease than nonsmokers. Besides, men are more likely to develop bladder cancer than women, and family history of cancer or individuals who would have ever had bladder cancer before are more likely to get it again.
Symptoms
Some of the common symptoms of bladder cancer, which can be subdivided into noninvasive, superficial, and invasive, with the former having much better treatment outcomes than the latter, includes blood in urine, painful urination, pain in pelvic region, etc. Many a times patient may not even notice any visible change in urine. Blood in urine too may be detected during a microscopic exam of the urine. People with bladder cancer might also experience symptoms such as back pain, frequent urination, etc.
Diagnosis
There are various tests and procedures used to diagnose bladder cancer, like cystoscopy, biopsy, urine cytology and imaging tests such as computerised tomography (CT) urogram or retrograde pyelogram, etc.
X-ray images taken during the test too provide a detailed view of urinary tract.
These tests allow your urologist to identify the stage and grade of tumour.
However, the stages of bladder cancer include: Stage 1 which occurs in the bladder’s inner lining but hasn’t invaded the muscular bladder wall.
Stage 2 in which cancer has invaded the muscular bladder wall but is still confined to the bladder. During Stage 3, cells spread through the bladder wall to surrounding tissue. And, in Stage 4 cancer cells start spreading to the lymph nodes and other organs, such as bones, liver or lungs, etc.
Whereas bladder tumour grades, depending on how aggressively they grow, may either be low-grade or high-grade tumours.
Treatment
Bladder Cancer treatment is largely based on a number of factors such as type of cancer, grade and stage of the cancer, etc. Surgery is one of the best and effective way to treat bladder cancer patients. Though, unlike traditional open surgery in which there’s notable tissue and nerve damage, significant blood loss, and an increased risk of post-operative infections and complications, minimally invasive robotic surgery proves to be more beneficial. This surgery provides a urologist a high definition 3-D view which makes it easier for him to perform the surgery. Also, the robotic surgery offers less blood loss with faster recovery time and shorter hospital stay of 8-10 days, depending on what grade cancer it is and also if the cancer is superficial or muscular invasive. If the cancer is at superficial level, definitely it’s easier to treat but if it is muscle invasive then depending on the size of tumour either a small part or the entire bladder has to be removed followed by which an artificial neobladder is reconstructed.
Besides, this minimally invasive robotic surgery is fast becoming the preferred answer for bladder cancer surgery as it is best suited for obese patients diagnosed with bladder cancer too because usually such patients tend to get infections like hernia, etc. which further complicates the case.
Also, based on the biopsy reports chemotherapy is frequently recommended to the bladder cancer patients. It is primary treatment for superficial bladder cancer, where the cancer cells have affected only the lining of the bladder. But, in case the bladder cancer is muscle invasive it may be used before bladder removal surgery to increase the chances of curing the cancer but may also be used to kill cancer cells that might remain post surgery. But, even when fully recovered, follow-up of such bladder cancer patients is of utmost importance and should not be avoided.
(The author is Consultant Urgologist Sir Ganga Ram Hospital, New Delhi)
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