Urinary Cancer- Procedures, Side effects, Recovery time, Costs and alternatives

Bladder is a flexible hollow pouch like structure present within the pelvis and ‎it stores the urine prior to its excretion. Urine is prepared by the kidneys and ‎is carried to the bladder through the ureters. This urine is stored in bladder ‎and it is later discharged through a tube like structure known as the urethra.‎

This cancer is defined as a condition in which there is rapid and uncontrolled ‎growth of cancerous cells within the urinary bladder. This condition usually ‎starts from the lining of the bladder and later it spread into the muscular wall ‎of the urinary bladder. Moreover, invasive urinary bladder cancer can spread ‎to lymph nodes, kidneys, lungs, liver and other organs present in the pelvis.‎

Urinary bladder cancer, though rare (accounting only about 5% of all ‎cancers), it affects males more frequently than females. The possible risk ‎factors leading to such a condition include genetic or family history, chronic ‎inflammation of the bladder, smoking, some medications for treating ‎diabetes, exposure to harmful chemicals, prior chemotherapy or radiation ‎treatment and others.‎

Some of the common symptoms of urinary bladder cancer involves pelvic ‎pain, pain during urination, blood in urine. The patients also experience ‎symptoms like frequent urination, sudden weight loss, swollen feet, appetite ‎loss, back pain. People having such symptoms to consult their doctor, as soon ‎as possible.‎

A systematic diagnosis is a required before starting the treatment of urinary ‎bladder cancer. The patient’s medical history and family history is also asked ‎by doctor regarding cases of bladder cancer. After this several laboratory ‎tests and imaging tests are done. Once a patient is diagnosed as having ‎bladder cancer, he/she is accordingly treated depending upon the severity of ‎the condition.‎

Some of the treatments for urinary cancer are as following:-‎

1. • Surgery- In surgery the tumour and some surrounding healthy tissue ‎is removed during an operation. There are different types of surgery ‎for urinary bladder cancer. Surgical options to treat urinary bladder ‎cancer includes:‎
   • Transurethral bladder tumour resection (TURBT). This ‎procedure is used for diagnosis and staging, also as treatment. ‎During this procedure the surgeon inserts a cystoscope through ‎the urethra into the bladder. Then the surgeon removes the ‎tumour using a tool with a small wire loop, a laser, or fulguration. ‎The patient is given an anaesthetic medication to block the ‎awareness of pain, before the procedure begins.
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   • Cystectomy and lymph node dissection. In radical cystectomy, ‎the whole bladder is removed and possibly nearby tissues and ‎organs. In men, the prostate and urethra also may be removed. In ‎women, the fallopian tubes, uterus, ovaries, and part of the ‎vagina may be removed. For all patients the lymph nodes in the ‎pelvis are also removed. This is called a pelvic lymph node ‎dissection. An extended pelvic lymph node dissection is the ‎accurate way to find cancer that has spread to the lymph nodes.‎
   • Urinary diversion. When the urinary bladder is removed, then ‎the doctor will create a new way to pass out urine from the body. ‎One of the way to do this is to use a section of the small intestine ‎or a colon to divert the urine to a stoma or ostomy (an opening) ‎on the outside of the body. Then the patient must wear a bag ‎attached to the stoma to collect and drain urine.‎
2. • Chemotherapy- In chemotherapy the drugs are used to destroy cancer ‎cells, usually by ending the cancer cell’s ability to grow and divide. A ‎chemotherapy schedule, typically consists of a specific number of ‎cycles given over a set period of time. A patient receives 1 drug at a time ‎or a combinations of different drugs given at the same time. There are ‎two types of chemotherapy used to treat bladder cancer. The doctor ‎recommends the type and when it is given depends on the stage of the ‎cancer.‎
   • Intravesical chemotherapy. Intravesical chemotherapy is ‎usually given by urologist. During this therapy, drugs are ‎delivered through a catheter that has been inserted through the ‎urethra into the bladder. Local treatment only destroys the ‎superficial tumour cells that come in contact with the ‎chemotherapy solution. Mitomycin and thiotepa are the drugs ‎used mostly for intravesical chemotherapy. Other drugs that are ‎used include cisplatin, doxorubicin, gemcitabine, and valrubicin.
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   • Systemic chemotherapy- Systemic chemotherapy is usually ‎prescribed by a medical oncologist, a specialist doctor in treating ‎cancer with medication. This chemotherapy gets into the ‎bloodstream to reach cancer cells throughout the body. Common ‎ways to give chemotherapy include an intravenous tube placed ‎into a vein using a needle or in a pill or capsule that is orally ‎swallowed.‎
3. Immunotherapy- Immunotherapy, also called as biologic therapy. It is ‎designed to boost the body’s natural defence to fight against the cancer. ‎This therapy uses materials made either by the body or in a laboratory ‎to improve or restore immune system function.
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4. Radiation therapy- In this therapy high-energy x-rays or other ‎particles are used to destroy cancer cells. The most common type of ‎radiation treatment is called external-beam radiation therapy, which is ‎given from a machine outside the body. When it is given using ‎implants, it is called internal radiation therapy or brachytherapy.‎

The treatment of urinary bladder cancer requires proper diagnosis in the ‎first place. The doctor may check the medical history and family history of ‎the patient to be sure whether the cause of this condition is due to genetic ‎reasons.‎

A systematic diagnosis is a required before starting the treatment of urinary ‎bladder cancer. The patient’s medical history and family history is also asked ‎by doctor regarding cases of bladder cancer. After this several laboratory ‎tests and imaging tests are done. Once a patient is diagnosed as having ‎bladder cancer, he/she is accordingly treated depending upon the severity of ‎the condition.‎

Diagnosis of bladder cancer involves pelvic examination and digital rectal ‎examination. If the doctor finds any tumour then he/she may recommend or ‎further laboratory and imaging tests. Such laboratory tests include urine tests ‎and cystoscopy. If the doctor finds a tumour during such a test, then he/she ‎may recommend for a surgery known as (TURBT) transurethral resection of ‎bladder tumour, where the tumour and also a part of the bladder muscle ‎near it is removed. A sample of the tumour is sent for biopsy in order to ‎check whether it is cancer. The various imaging tests used for the diagnosis of ‎bladder cancer include magnetic resonance imaging (MRI), computed ‎tomography (CT) scan, ultrasound imaging, bone scan, chest scan, ‎intravenous pyelogram and retrograde pyelogram. Once the patient is ‎diagnosed after physical examinations as having bladder cancer, he/she is ‎treated depending upon the severity of the condition.‎ The treatment of bladder cancer involves surgery, immunotherapy, ‎chemotherapy and radiation therapy. Surgery involves removal of the ‎tumour and a part of the muscles near it and this method is referred to as ‎transurethral resection of bladder tumour (TURBT). Another method called ‎‎“cystectomy” involves partial or complete removal of the bladder. Other ‎treatments like immunotherapy, chemotherapy and radiation therapy aim at ‎killing the harmful cancerous cells. It is important to remember that there is ‎no complete cure for bladder cancer. Treatment can be done only to prevent ‎or reduce the possible symptoms that the patient suffers from, during this ‎condition.‎

The doctor will work with the patient to decide what treatment to provide ‎based on the type and stage of the bladder cancer, the symptoms, and overall ‎health.‎

• Treatment for stage0 and stage1‎
  Treatment for stage0 and stage1 urinary bladder cancer may include surgery ‎to remove the tumour from the bladder, chemotherapy, or immunotherapy, ‎which involves taking a medication that causes your immune system to attack ‎the cancer cells.‎
• Treatment for stage 2 and stage 3‎
  Treatment for stage 2 and stage 3 bladder cancer includes removal of part of ‎the bladder in addition to chemotherapy, also may be removing whole ‎bladder which is called radical cystectomy, after the surgery the doctor ‎creates a new way for urine to exit the body. Radiation therapy , ‎chemotherapy or immunotherapy that can be done to shrink the tumour ‎before surgery, to treat the cancer when surgery isn’t an option, to kill ‎remaining cancer cells after surgery, or to prevent recurring of cancer.‎
• Treatment for stage 4 bladder cancer Treatment for stage 4 bladder cancer includes chemotherapy without ‎surgery to relieve symptoms and extend life of radical cystectomy and ‎removing of the surrounding lymph nodes, following a surgery is done to ‎create a new way for urine to exit the body. Radiation therapy, ‎Chemotherapy and immunotherapy after a surgery is done to kill remaining ‎cancer cells or to relieve symptoms and extend life clinical trial drugs

Persons having symptoms like blood in urine (haematuria), pelvic pain, pain ‎during urination, frequent urination, swelling of feet, loss of appetite, sudden ‎weight loss, back pain and is diagnosed to be suffering from bladder cancer, is ‎considered to be eligible for this treatment. Persons, having such symptoms, ‎should inform the doctor as soon as possible and should take treatment ‎procedures.‎

Anyone, who is normal and is not suffering from the symptoms of urinary ‎cancer, is not eligible for this treatment.‎

The treatment for urinary cancer also has its side effects as similar to other ‎cancer treatments. The intensity of these side effects varies according to the ‎treatment procedure. The side effects for surgical treatments like radical ‎cystectomy and segmental cystectomy involve interruption of the patient’s ‎sexual function, sudden menopause and inability to get pregnant (in women), ‎increased frequency in urination and inability to hold urine for a long time.

‎The side effects of treatment involving immunotherapy, chemotherapy and ‎radiation therapy includes vomiting, nausea, discomfort during urination, ‎vaginal dryness in women, diarrhoea, erectile dysfunction in men, hair loss, ‎appetite loss, weakness, soring of mouth, fever and others. It is ‎recommended that the patients should consult with the doctor, if they ‎happen to suffer from any of these side effects, during the course of ‎treatment.‎

The treatment for urinary cancer requires few months or even years for the ‎completion of treatment. After treatment the patient still needs to go through ‎several follow up examinations in interval of every few months for a number ‎of years.

The patient should attend all the follow up treatments and go for ‎regular chemotherapy and radiation therapy along with other treatments. ‎This is to check the possibilities of reoccurrence of cancer, and also the ‎probable side effects of such treatments. Almost all the cancer treatments ‎have their side effects and so it is important that the patient must inform the ‎doctor regarding this issue and seek the necessary remedial measures.‎

Unfortunately, there is no cure for urinary cancer, but the symptoms of this ‎can be managed by surgery, radiation therapy and chemotherapy. The ‎patients, who have been diagnosed as having this problem, their life span ‎mainly depends upon the severity of the condition and the type of treatment ‎that the patient is undergoing. On an average, the treatment for bladder ‎cancer may take few months or years for its completion.‎

The price of the treatment for urinary cancer varies in different parts of India ‎country. The treatment cost also vary depending upon the severity of the ‎condition and the type of treatment that the patient is undergoing. On an ‎average, the price of treatment for urinary cancer ranges from Rs.12,50,000 ‎to Rs.27,50,000.‎

No, the results of the treatment for urinary cancer are not permanent and ‎there are chances that the cancer may reoccur after a certain period of time. ‎Complete cure for this cancer is not available, therefore it is highly ‎recommended that the patient should go for regular check-ups, radiation ‎therapy, chemotherapy and other tests to check the progress of such a ‎cancer.‎

Till date, there are no alternatives for urinary cancer. Surgery, ‎immunotherapy, radiation therapy and chemotherapy are the best methods ‎of treatment for bladder cancer. However, after surgery, treatment done with ‎mistletoe extracts has been proven to be effective in reducing tumour ‎recurrence. Mistletoe extracts act upon the proteins that affect cancer and it ‎can be used for patients with malignancies, during the initial stages. Later ‎stages of such cancers can be quite complicated and cannot be effectively ‎cured.‎