Urinary bladder cancer treatment in India – choosing the right options

Imagine this. Everything is coming along fine in your life until you visit the washroom one day and suddenly discover that there is blood in urine. You feel no pain, no weakness, no fever. More likely than not, you ignore this – try to pass it off as a mild ‘infection’ and get on with your life. Until, after a few weeks, it happens again; And again. You visit your neighborhood physician who orders a few tests and an ultrasound exam. When the results come in you are shocked to discover that you have a mass in the urinary bladder, which is highly likely to be cancer.

Unfortunately, this is a common sequence of events for almost half a million people worldwide who are diagnosed to have urinary bladder cancer every year. The biggest impediment to effective and complete cure for bladder cancer is delay in diagnosis. The initial symptoms are all too often ignored by patients and doctors alike, while a curable cancer inexorably grows and spreads unnoticed to become life threatening. Bleeding in urine is a dangerous symptom and must not be ignored!

Smoking is the most common cause of urinary bladder cancer with about 50% of these tumors attributable to this single cause. Other causes – mostly unknown – account for the other half, and include exposure to certain chemicals and chronic infections of the bladder. Smoking is also a very important cause of recurrence of this disease in those who have already received treatment for urinary bladder cancer. Kicking the habit is essential to decrease the chances of bladder cancer coming back after initial treatment.

Urinary bladder cancer treatment in India is now quite standardized. Once a growth in the urinary bladder seen on ultrasound, the next step is to do a ‘cystoscopy’ which involves putting a thin telescope through the urinary passage into the urinary bladder under anesthesia. The tumor is visualized with a camera and is cut out and removed with specialized instruments. This procedure is called transurethral resection of bladder tumor (TURBT). This procedure not only removes the tumor but also provides vital information about the type (grade) and degree of spread (stage) of the cancer.

Depending upon the microscopic features of the tumor, bladder cancer can be either low grade (less aggressive) or high grade (more aggressive). This has important implications on further treatment. In terms of staging, it is vital to assess whether the bladder cancer is ‘superficial’, involving only the superficial (innermost) layers of the bladder or ‘muscle invasive’, which implies an infiltration of the cancer into the deep muscle layer of the urinary bladder.

For ‘superficial’ bladder cancer, the standard treatment involves regular follow up with repeated ‘cystoscopy’ examinations and the use of medications instilled directly into the bladder through the urinary passage at regular intervals. For ‘muscle invasive’ bladder tumors, the most effective treatment is to perform major surgery to remove the urinary bladder completely (radical cystectomy) and create a new bladder or tube using segments of intestine (urinary diversion, orthotopic neobladder or ileal conduit). While this has traditionally been performed via open surgery, urinary bladder cancer treatment in India is now getting revolutionized with the advent of robotic surgery.

Robotic surgery for bladder cancer offers a faster recovery, lesser blood loss, lesser pain and a possibility of a lower complication rate. Cancer control and cure rates are similar to open surgery.

In summary, smoking is the most common cause of urinary bladder cancer and blood in urine, its most common symptom. After initial removal via TURBT, subsequent treatment depends on the grade and stage of the disease. If required in a particular situation, robotic surgery for bladder cancer can improve outcomes and may be the next big revolution in urinary bladder cancer treatment in India.

This blog has been written by Dr. Gagan Gautam, Head of Urologic Oncology & Robotic surgery at Max Institute of Cancer Care, New Delhi, India. Dr. Gautam is a specialist doctor for prostate, kidney and urinary bladder cancer treatment in India and is the country’s leading expert in robotic surgery for these diseases. Max Institute of Cancer Care, a part of Max hospitals, Saket, New Delhi is a tertiary referral center regarded by many as the best hospital for bladder cancer treatment in India. It is equipped with state of the art facilities for radiation, chemotherapy and surgery for bladder cancer – including the Da Vinci Xi HD robotic surgical system. It is situated 20 minutes away from New Delhi’s international airport.

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