Cancer of the urinary bladder is one of the common cancers affecting both men and women.The most common symptom is bleeding in the urine (hematuria).Cigarette smoking is the most significant risk factor with smokers being 3 – 4 times more likely to get the disease than nonsmokers. It usually occurs in persons above 50 years of age. However, it is also sometimes seen in younger men and women.
The aggressiveness of bladder cancer is determined by “Stage” and “Grade”. Stage is the extent to which the cancer has invaded the wall of the urinary bladder. On the basis of stage, bladder cancer can be sub-divided into ‘superficial’ and ‘muscle invasive’ with the former having much better treatment outcomes than the latter. Grade is of two types and is determined by microscopic examination of the cancerous growth after its removal. ‘High grade’ signifies a more aggressive cancer, with a greater ability to grow and spread, as compared to ‘Low grade’.
The initial treatment for bladder cancer is transurethral resection of bladder tumor (TURBT), which removes the growth from the bladder and provides information regarding stage and grade of the tumor. This operation is done through the normal urinary passage with special instruments. This does not result in any ‘cut’ on the body, usually takes 15 – 45 minutes, and entails a stay in the hospital of 24 – 48 hours.
Low-grade superficial tumors (Ta) are treated with TURBT followed by an optional instillation of a single dose of a chemotherapy medication in the bladder to reduce recurrence rates. These tumors have high recurrence rates but a very low chance of progression to higher stages.High-grade and higher stage superficial tumors have greater chances of recurrence and progression and may need additional treatment in the form of special medications (BCG, Mitomycin C etc.)that are put in the bladder at regular intervals through a catheter. Patients unresponsive to these may be best treated by radical cystectomy (removal of urinary bladder).
Radical cystectomy (bladder removal) is a major operation, which provides the best chances of cure in patients with muscle invasive disease.Chemotherapy is used in patients with metastatic disease (disease which has spread to other parts of the body) or in combination with bladder removal in patients with high stage disease.
Robotic surgery is fast becoming the gold standard technique for removal of the bladder. It results in lesser blood loss, faster recovery, lesser pain and according to some latest research, a decreased chance of complications as compared to open surgery. It is now possible to safely perform all aspects of this surgery, including the creation of a new bladder with robotic surgery itself – without the need of a big open cut (incision).