NEW DELHI: Five years back, a 50-year-old woman was diagnosed with advanced bladder cancer. Reluctant about bladder removal, she opted for the creation of an artificial bladder. She underwent chemotherapy, followed by surgery and had an artificial bladder created. Today, the Kerala-based woman, who completed the treatment without any complications, remains well and cancer-free.
In another case, a 55-year-old Delhi resident who was detected with the same cancer, robotic surgery was performed as the disease had not yet spread elsewhere. The patient was back to daily routines within two weeks.
New treatment methods like artificial bladder created using one's tissues and robotic surgery are improving outcomes and standard of living. “Nowadays, this is done with robotic surgery, which reduces the morbidity of the procedure. These are advantages in the current era with new treatment methods like robotic surgery,” said Dr Ginil Kumar P, professor and HOD of Urology, Amrita Hospital, Kochi.
Bladder cancer is a common type of cancer detected in both men and women, but its prevalence is high in men. Though both men and women can get bladder cancer, it is prevalent in men nearly four times more compared to women, with incidence rates of 9.5 per lakh males and 2.4 per lakh females globally.
“With proper evaluation and early diagnosis, bladder cancer can be treated completely,” said Dr Vimal Dassi, director of the department of urology, uro-oncology, robotics and kidney transplant, Max Healthcare, Vaishali and Noida, Uttar Pradesh.
Bladder cancer begins in the cells of the bladder - a hollow muscular organ in the lower abdomen that stores urine. As per GLOBOCAN 2020, an online database providing global cancer statistics and estimates of incidence and mortality in 185 countries for 36 types of cancer, bladder cancer is ranked 17 in incidence and 19 in mortality in India.
“After prostate cancer, bladder cancer is commonly found among those above 60 years of age, especially men,” said Dassi.
“Though smoking increases the chances of bladder cancer, in India, a lot of bladder cancer is not directly linked to smoking, and even non-smokers can get bladder cancer,” said Ginil, who treated the Kerala-based woman. He added that genetic abnormalities can also cause aggressive bladder cancer. Other reasons for the disease are advanced age and exposure to certain chemicals.
“Occupational and environmental exposure, such as tobacco dyes, are the other factors that could lead to bladder cancer. Those working as rubber professionals, hairdressers, painters and leather workers are at increased risk of bladder cancer,” added Dassi.
There are two types of bladder cancer. The first is non-muscle invasive, in which the tumour is removed via transurethral route using a cystoscope - endoscopy is done through the urinary tract - followed by intravesical therapy.
The second is muscle-invasive bladder cancer or metastatic bladder cancer. It is advanced bladder cancer in which the tumour has invaded the bladder wall and spread outside the bladder. This requires surgery.
“Treatment modalities for urinary bladder cancer encompass a range of options tailored to individual cases. These may involve surgical interventions, chemotherapy, immunotherapy and radiation therapy. Selecting a particular treatment strategy depends on the stage of cancer, overall health status and specific patient considerations,” said Dr Satish Pawar, senior consultant and head of surgical oncology, CARE Hospitals, Banjara Hills, Hyderabad.
While Cisplatin or carboplatin are the main chemotherapy drugs, there are various newer drugs and immunomodulatory agents for advanced cancer cases where patients do not respond to routine chemotherapy drugs.
“A significant breakthrough was when the Food and Drug Administration (FDA) approved Enfortumab vedotin (Padcev) and Pembrolizumab (Keytruda) on December 15 as newer drugs for first-line treatment for those in advanced cases,” said Dassi.
However, patients with metastatic bladder cancer are often elderly and unfit to receive chemotherapy. In such clinical scenarios, immunotherapy such as Atezolizumab/Pembrolizumab as monotherapy can be a reasonable option. “Immunotherapy drugs have better safety profile than chemotherapy and can be easily tolerated in patients who are ineligible for platinum-based chemotherapy,” said Dr Randeep Singh, senior consultant and director of medical oncology, Narayana Super Speciality Hospital, Gurgaon.
“The primary treatment of early urinary bladder cancer is surgery involving partial or complete removal of bladder along with lymph nodes in the same region (radical cystectomy),” said Singh.
“Robotic surgery offers many advantages such as reduced blood loss, minor scars, quicker recovery, improved outcomes and enhanced visualisation of the surgical field, coupled with patient satisfaction in the treatment of bladder cancer,” added Dr Mohan Keshavamurthy, senior director, of Fortis Hospitals, Bengaluru, and chairman, renal sciences speciality council, Fortis Healthcare.
Dr Akash Shah, consultant, urological and robotic oncoSurgeon, HCG Cancer Center, Borivali, Mumbai, said vigilance towards painless blood in urine, frequent urination, urgency or burning micturition are symptoms not to be ignored. “Apart from medical interventions, lifestyle modifications like quitting smoking, avoiding workplace irritants and maintaining hydration can mitigate risks.”