Bladder cancer generally presents in the ageing male, but in the last two decades, the incidence in young adults including ladies has risen alarmingly. Bladder cancer is one of the most lethal of all urological malignancies, second only to kidney cancer in terms of mortality. Smoking constitutes one of the most important risk factors for developing this cancer. Other risk factors include exposure to industrial chemicals, specially those involved in the petrochemical and plastics industry. The most common symptom is blood in urine, scientifically known as hematuria. Other symptoms can be of increased frequency of urination, pain while passing urine, and loss of appetite and weight. Advanced metastatic disease may present with bony pains, cough, breathlessness and blood in sputum.

Initial diagnosis is made with the help of a Ultrasound scan which can be easily done nowadays. Confirmation of the size and location of the tumor is done with the help of a dedicated CT scan. What follows next is an endoscopic surgery called Trans Urethral Resection of Bladder Tumor (TURBT) which removes all of the tumor from the bladder and provides tissue for histopathological examination and biopsy, which establishes the type, grade and stage of tumor. This surgery is done under anaesthesia and is done through the natural orifice of urine, and does not require any cuts or incisions. Patients are generally sent home one to two days after the surgery.

Further treatment depends on the stage of the disease as determined by the biopsy report. A PET scan is done (for muscle invasive disease) to assess if there are any distant metastases or if the tumor is just localized to the bladder. Initial stages, which is the non muscle invasive stage, require instillation of BCG or a chemotherapeutic agent in the bladder along with cystoscopic surveillance. This intravesical therapy prevents the tumor from recurring and progressing. The drug is initially instilled weekly for 6 weeks, which is the induction course, followed by monthly instillations, which is the maintenance regimen. The maintenance regimen goes on The more advanced stage, which is the muscle invasive, stage requires a radical surgery which involves removal of the whole bladder, besides the prostate in the males and uterus, cervix and fallopian tubes in females. The bladder is replaced by an orthotopic neo bladder or an ileal conduit which is made from the small intestine. Robotic surgery allows a minimally invasive approach for this major surgery wherein the patient does not have any big incisions on his abdomen and gets up and walks about the next day of the surgery as opposed to a traditional open approach which involves a large incision prolonging patient recovery. Patients not fit for anaesthesia and surgery are offered radiotherapy and chemotherapy with a curative intent. Follow up after surgery involves regular visits to your doctor for physical examination, routine blood tests and a cross sectional imaging such as a CT scan. Patients with metastatic disease are treated with systemic chemotherapy and immunotherapy.