Symptoms of Bladder Cancer

Haematuria (blood in the urine) is the most prevalent symptom and usually the first indicator of malignancy. It is usually painless and depending on the amount of blood in the urine, the urine may appear pale pink, brown, or crimson (occasionally). The blood may not be visible at times, and the urine may appear to be clear, but urinalysis may reveal minute amounts of blood (urine test). It is also possible that the blood will vanish for weeks after the initial sighting.

Urinary pattern changes include frequent urination (more than normal), burning or irritation during peeing, and unexpected desires to urinate even when the bladder is not full. These are the symptoms of bladder cancer in its early stages, and they may overlap with those of other illnesses such as urinary tract infection, bladder stones, kidney stones, or an enlarged prostate in men. In any situation, a visit to the doctor for a check-up is required.

Advanced stage symptoms include:

• Pelvic discomfort
• Inability to urinate
• Inflammation of the feet
• Bone ache
• Weight reduction that occurs unintentionally

What are some Bladder Cancer risk factors?

A person's risk of acquiring bladder cancer is increased by a few variables.

• Age: As you get older, your chances of developing bladder cancer increase. Approximately 90% of those diagnosed are above the age of 55.
• Smoking: Smoking is one of the most significant risk factors. Smokers are at least four times more likely than non-smokers to develop bladder cancer. Tobacco includes carcinogenic agents (cancer-causing substances) and is the cause of half of all bladder cancers.
• Men are three to four times as likely than women to have bladder cancer.
• Drinking water containing arsenic has also been related to an increased risk of bladder cancer. The likelihood of being exposed to arsenic is determined by where you live and the source of your drinking water.
• The second leading cause of blood cancer is exposure to specific chemicals. Bladder cancer is increased by some industrial chemicals used in the dyeing, textile, paint, leather tanning, and printing industries. Bladder cancer has also been related to some naturally occurring compounds, aromatic amines, and herbal products including aristolochic acid.
• People who have had a family member diagnosed with bladder cancer are more likely to develop the disease themselves. Changes in genes such as GST and NAT, which are involved in the breakdown of some toxins, have also been linked to an increased risk of bladder cancer.
• Long-term urinary tract infections (UTIs), kidney and bladder stones, and using bladder catheters for a long time have all been associated to the development of chronic bladder infection.
• Chemotherapy and radiotherapy-induced secondary disease: Long-term treatment with chemotherapy medicines might irritate the bladder. Bladder cancer is more likely in people who have been treated with this medicine.
• People who are exposed to radiation near the pelvic region during cancer treatment, such as bowel cancer, are more likely to develop bladder cancer.
• Schistosomiasis, which is caused by a parasitic worm going into the bladder and is mostly found in Africa and the Middle East, is also a risk factor.

Bladder Cancer Treatment Cost In India

• Chemotherapy: Starting USD 270 per session (Indian Rupees Approx. 19,000)
• Surgery: Starting USD 2700 (Indian Rupees Approx. 1,90,000)
• Radiation Therapy: Starting USD 3,100 (Indian Rupees Approx. 2,20,000)
• Trans-Urethral Bladder Tumour Resection (TURBT): Starting USD 3,600 (Indian Rupees Approx. 2,50,000)

Diagnosis of Bladder Cancer

The distinct indications of bladder cancer in the urine and bladder are investigated using a variety of assays and techniques. The following are examples of diagnostic assessments:

• Urinalysis is a simple test that looks for blood and other chemicals in a urine sample. This test employs chemical dipsticks that change colour in the presence of chemicals such as glucose, red blood cells (RBCs), and so on.
• Urine cytology is the study of a urine sample under a microscope to look for pre-cancerous or malignant cells. For this procedure, the urologist inserts a cystoscope into the opening of the urethra and into the bladder to examine the inner lining of the organ. A camera and a lens are linked to a narrow tube, it is what is called a cystoscope. To make the procedure comfortable and soothing, the patient is usually given a local anaesthetic cream to apply to the urethra.
• Biopsy: If abnormalities are discovered during a cystoscopy, the patient will be given a biopsy operation termed "Transurethral Resection" of a bladder tumour (TURBT). The tumour (abnormal region) must be removed, and the area must subsequently be tested for malignancy. Because cancer often spreads to multiple areas, multiple samples are taken for testing to see if the cancer has migrated to surrounding bladder muscles.
• Imaging Scans: For a more exact image of the bladder, these scans allow the specialist to determine whether cancer has progressed to tissues near the bladder, urinary tract, neighbouring lymph nodes, or other organs. Imaging tests include the following:
• A dye is used in an X-ray treatment to show the kidneys, ureters, and bladder, as well as malignancies in the urinary tract. IVP (intravenous pyelogram):
  • Scanning using a CT scanner
  • Ultrasonics
  • The magnetic resonance imaging (MRI)
  • Scanning of the Bone (to check for spread to the bone)

India's Bladder Cancer Treatment Options

Many treatment options for bladder cancer are accessible in India, depending on the point, and other criteria such as patient health and preferences are available.

Surgical removal of cancer cells and accompanying tissues is referred to as surgery. Various types of surgery are offered depending on the stage and extent of cancer. Surgical options for bladder cancer include:

• Trans-Urethral Bladder Tumour Resection (TURBT): This procedure is used to treat and diagnose bladder tumours. During this procedure, a cystoscope (a small tube with a light and a camera) is introduced into the bladder through the urethra. A small wire loop is attached to the end of the cystoscope and is used to remove abnormal tissues or burn the tumour with a laser or high-energy electricity (fulguration). The patient is given local anaesthetic for TURBT. In the early stages of non-muscle invasive bladder cancer, this is the most usual treatment option.
• Cystectomy: The bladder is removed entirely or in part. When there is invasive cancer, this procedure is used.
• Radical Cystectomy entails the removal of the whole bladder as well as surrounding lymph nodes. When cancer has invaded the muscle walls and is large, this surgery is used. The prostate and seminal vesicles are the adjacent organs removed in males with this procedure. The uterus, fallopian tubes, ovaries, and a portion of the vagina are among the organs removed in women. The surgeon then creates a new path for the body's urine to flow through.
• A segmental cystectomy is also known as a partial cystectomy. Only a part of the bladder is removed, together with the area of the muscle layer that has been invaded by cancer. The most significant benefit of this operation is that the patient retains his or her bladder and can urinate regularly following recovery.
• Urinary Diversion: Reconstructive surgery is used to develop an alternative method of storing and transporting pee. Various types of surgeries may be performed depending on the medical situation and the patient's preference. The three types are as follows:
• Incontinent Diversion: The surgeon removes a section of the intestine and connects it to the ureters to create a conduit for urine to exit the body. As a result, urine flows from the stoma, a hole in the skin in front of the belly, through this passageway from the kidneys to the outside world. The urine comes out in little amounts and is collected in a small bag placed over the stoma. In this process, there is no control over the flow of urine.
• Continent Diversion: A portion of the small or large intestine is utilised to produce a pouch that serves as a urinary reservoir within the body, with one end of the pouch attached to the stoma. A valve is created in the pouch, allowing urine to be stored. This method appeals to the patient because it eliminates the necessity for an external bag. Urine can be evacuated from the stoma with the use of a catheter.
• Neobladder: This is a new procedure in which the surgeon creates a new bladder (Neobladder) from a section of the intestine and connects it to the urethra. This method restores urination by rerouting urine back into the urethra. As a result, the patient will usually pass pee.

Chemotherapy is a treatment that uses medications to destroy cancer cells by preventing them from dividing and expanding. The technique can be done at the same time with a single anticancer agent or a combination of treatments (combination drug). Chemotherapy for bladder cancer involves 2 types:

• Intravesical Chemotherapy: This method is used to treat cancer in its early stages and involves injecting a chemotherapeutic agent directly into the bladder.
• Systemic Chemotherapy: For this treatment, the drugs are given as tablets or injected into a vein or muscle, where they enter the bloodstream and disseminate throughout the body.
• Radiation Therapy: This entails the use of high-energy x-rays to halt and destroy the growth of cancer cells. There are two types of radiotherapy:
• External Beam Radiation: This is the most popular type of radiation therapy, in which a system located outside the body is used to guide radiation directly to the tumour.
• Internal-Beam Radiation/Brachytherapy: This treatment uses radioactive implants, such as needles, seeds, or catheters, that can be put close or directly into the malignancy. Radiation therapy is typically used after surgery (TURBT) to kill any remaining cancer cells, as part of advanced-stage cancer pre-treatment, or to relieve symptoms like pain and bleeding caused by advanced bladder cancer.
• Biological therapy is also known as immunotherapy. This treatment is the administration of medicine to boost a person's immune system, allowing them to detect and battle cancer cells. It is necessary to employ compounds made by the body or in a laboratory to strengthen or target the immune system or restore function. The BCG vaccine is an example of biological agents used in immunotherapy after TURBT treatment. Other drugs utilised include atezolizumab, avelumab, and nivolumab. The drugs are given as intravenous (IV) infusions every 2 to 3 weeks.