New Delhi: BJP veteran and former deputy chief minister of Bihar, Sushil Kumar Modi, died of urinary bladder cancer at the All India Institute of Medical Sciences (AIIMS) in Delhi Monday.
Modi, 72, had been diagnosed with the condition only months ago. The episode has brought the focus on the aggressive form of cancer that is also one of the most expensive cancers to treat.
The worrying part is that while this type of cancer is not very common — it is the 17th most commonest malignancy in the country as per global cancer report Globocan 2020 — new research findings indicate that its prevalence is rising in India.
A scientific paper by the researchers from the premier cancer hospital and research institute Tata Memorial Centre that came out in 2021 noted that “there seems to be an increasing trend of this cancer in the developing countries, including India”.
Also, it noted that the 5-year absolute survival following diagnosis in the Indian population was lower than other Asian countries such as China and Singapore.
“Bladder cancer is a highly lethal malignancy and the increasing trends of bladder cancer are alarming, especially in the developing countries including India, and thus, there is a strong need to identify and implement effective prevention and treatment strategies,” the researchers had said.
ThePrint explains the symptoms, causes and management of the urinary bladder cancer and what makes it a dreadful malignancy.
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Prevalence, causes, symptoms & management
Dr Sanjai Addla, senior consultant, surgical oncology with Apollo Cancer Centre in Hyderabad, told ThePrint that the commonest form of bladder cancer is urothelial cancer, which originates in the urothelial cells that line the urinary system while less common type can include squamous cell carcinoma and adenocarcinoma.
The draft consensus document for management of urinary bladder cancer prepared by the Indian Council of Medical Research (ICMR) that came out last year says that its 5-year prevalence appears to be 3.57 per 1,00,000 population leading to about 11,000 deaths each year.
Also, as per the ICMR, the incidence of bladder cancer is higher in males compared to females with relative incidence being 4:1 in most urban population-based cancer registries in India. But the incidence varied across the country.
Among males, Delhi has the highest incidence rates, followed by Thiruvananthapuram and Kolkata and lowest rate is in Dibrugarh. When it comes to females, the rate is highest in Delhi followed by Mumbai and Mizoram.
Over time, bladder cancer incidence has increased in Delhi, Bangalore and Mumbai, while it has decreased in Chennai, the ICMR says.
Tobacco consumption is the most important risk factor in bladder cancer — the risk for smokers is 3–4-fold higher compared to non-smokers and is estimated to cause 31 percent of bladder cancer deaths among men and 16 percent among women.
Industrial exposure to aromatic amines and carbon black dust in rubber, leather and dye industries has also been associated with an increased risk, and these two factors mark the modifiable risk factors to prevent bladder cancer.
According to Dr Prem Kumar K., senior consultant uro-oncology with Fortis Hospital in Bengaluru, bladder cancer’s aggressiveness varies based on factors like cancer type, stage, and individual patient characteristics, often proving more aggressive if high-grade or spreading beyond the bladder.
According to experts the treatment options for bladder cancer may include surgery to remove the tumor or the entire bladder (radical cystectomy), chemotherapy, radiation therapy, immunotherapy (using drugs to help the immune system fight cancer), and targeted therapy (using drugs that target specific abnormalities in cancer cells).
“In high grade and late stage cancer, the management plan includes complete removal of the urinary bladder and the 5-year survival rate of such patients is 50 percent but in low grade, early stage bladder cancer the 5-year survival rate is 90 percent though the chances of recurrence of the malignancy is high,” Addla said. “The only good thing is that it has very clear symptoms.”
Dr. Sreenivas B.J., senior consultant medical oncologist, HCG Cancer care in Bengaluru underlined the main symptoms of the condition — blood in the urine, frequent and urgent urination, pain during urination, and lower back pain.
The challenge, as per the clinicians however, is that as many patients — who are mostly men between 60 and 70 years — ignore the symptoms or miss it for a long time, sometimes due to poor eyesight.
“If one gets blood in the urine, it needs to be examined thoroughly as there are over 30 percent chances that it could be due to bladder cancer,” Addla said.
Prevention strategies include avoiding tobacco, maintaining a healthy weight, staying hydrated by drinking plenty of fluids, eating a balanced diet rich in fruits and vegetables, limiting exposure to certain chemicals and toxins, and attending regular check-ups to monitor urinary symptoms and detecting any potential issues early.
What makes it lethal, expensive to treat
Dr Addla pointed out that the majority of Indian patients (over 60 percent) unlike the Western countries are present with high grade bladder malignancy, which are more aggressive and lethal. “The exact reason for this, however, remains unclear.”
Also, oncologists say that urothelial lining that develop malignancy in some people are present in the ureters, bladder, renal pelvis and the urethra — which is a fairly large area.
So once there is a malignancy anywhere in the urothelial cells, simply removing the tumour from the site could provide only temporary relief. “Majority of the urothelial carcinoma patients report recurrence of the malignancy even after the surgery and need frequent cancer surveillance and later management, which makes the condition very expensive to manage, ” Addla highlighted.
In comparison to prostate cancer, which is common cancer among older men, for instance, bladder cancer could be about 2-3 times more expensive to treat, leading to considerable financial burden for patients and their families.
(Edited by Tony Rai)
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