Bladder tumors are responsible for nearly 5000 deaths per year. Their incidence is increasing in women, due to the growth of female smoking. What is the first symptom of bladder cancer and how is this cancer treated? How to diagnose it early? Responses from the French Urology Association on the occasion of Bladder Cancer Month in May.
SUMMARY :
THE bladder cancertouch 13,000 new patients every year in France. Among these cases, 25% are cancers infiltrating the muscle and/or metastatic and 75% are non-invasive. Bladder cancer is also responsible for approximately 5,000 deaths each year in France. VSIt is the second most common urological cancer after prostate cancer.
Until now, it affected four times more men than women, but its epidemiology is increasing in women due to the increase in female smoking. The primary cause of bladder cancer is indeed tobacco, as recalled by Dr Benjamin Pradère, urologist and member of the cancerology committee of the French Association of Urology, on the occasion of Bladder Cancer Month. bladder, in May 2023.
The average age of diagnosis is 70 years. But due to smoking, more and more cases are being diagnosed at younger ages as well.
Bladder cancer: what symptoms?
The main bladder cancer symptom is the appearance of a more or less heavy bleeding in the urine (what is called hematuria), so as soon as you notice bleeding during urination, it is important to consult your doctor.
“A urinary bleeding, we consider it” insists Dr. Pradère. “Spotting blood in his urine is abnormal and should not be underestimated because this cancer is particularly aggressive and must be diagnosed early to have a good prognosis.
“50% of infiltrating tumors lead to death. And this, despite advances in surgery, chemotherapy, radiotherapy and immunotherapies. Infiltrating diseases remain serious diseases. This is why it is important to diagnose bladder cancer early and before it becomes infiltrating”.
Other symptoms can also alert, even without bleeding:
Bladder cancer: how is it detected?
Patients at risk as patients who smoke are monitored by their doctor who may order a special urine test (called urine cytology) to look for abnormal cells in the bladder.
Other patients sometimes arrive by another means: on the occasion of a scanner or an ultrasound for another problem, an anomaly in the bladder is detected.
Bladder cancer: how is the diagnosis made?
Urinalysis with cytology : the inner layer of the bladder wall desquamates naturally and the dead cells are evacuated in the urine. Urinary cytology makes it possible, from a simple urine sample, to study the normal or cancerous appearance of these cells.
Ultrasound or especially uroscanner will make it possible to check the bladder and the urinary tract up to the kidneys. But the ultrasound will not see some small polyps or flat polyps that may be present in the bladder and less able to explore the upper urinary tract (ureter and kidney)
Cystoscopy is the most effective test for making a diagnosis. It is performed with a camera introduced inside the bladder under local anesthesia to see precisely what is happening and in particular to facilitate observation of the internal walls. If a polyp is visualized: it will be resected (removed under general anesthesia or spinal anesthesia) to allow microscopic analysis (pathological) to know the type, stage and grade.
>> When the diagnosis of cancer is made : in 75% of cases, it is a non-infiltrating bladder tumor (located to the wall of the bladder) but in 25% of cases, it is a tumor with muscle infiltration, or even which has spread to organs near or more distant from the bladder (metastasis).
Bladder cancer: what are the risk factors?
The tobacco : it is the first of the risk factors. Smokers are 5 times more likely to develop bladder cancer than non-smokers. It is a cancer that occurs after twenty years of exposure to tobacco.
Occupational risks: occupational exposure to certain aromatic hydrocarbons used for example in the textile industry, or tires, known to be carcinogenic. Today these risk factors are monitored but cancer can appear 20 years after the start of exposure.
Certain genetic diseases such as Lynch syndrome, a genetic mutation responsible for certain cancers.
A parasitic infection: in some countries, especially in Africa, parasitic worms present in fresh water can penetrate the skin and colonize the urinary tract: this is schistosomiasis.
Pelvic radiotherapy : patient having been treated for cancer by radiotherapy (prostate cancer, rectum, etc.).
Chronic bladder inflammation can also be a risk factor, but this mainly concerns paraplegic patients or patients with catheterization.
Bladder cancer: how to prevent it?
Occupational bladder cancers are now more easily preventable because companies can use substitute products, and occupational medicine monitors exposed patients.
But 40% of bladder cancers are due to smoking: the only prevention is to quit smoking. “Preventing this cancer also means raising awareness about this disease because, while most patients are aware of lung cancer, they are unaware that the risk of bladder cancer increases with the number of years of smoking and the amount of cigarettes smoked per day” explains Dr. Priscilla Léon, urological surgeon and member of the bladder cancer sub-committee of the French Association of Urology.
Bladder cancer: how is it treated?
“The treatment of bladder cancer is primarily surgical.“explains Dr. Léon. “If the polyp is small, superficial and single, an endoscopic resection is performed. If the polyps are more numerous or larger, to complete the benefit of the surgery, we also proceed to instillations of product in the bladder (called intravesical instillations) once a week for 6 or 8 weeks to reduce the risk of recurrence or progression.”
The removed tissues are analyzed to determine the stage and grade of the tumour. In the case of infiltrating tumours, the surgeon proceeds to the total removal of the bladder (cystectomy). The operation is performed under general anesthesia and requires the incision of the abdominal wall. Sometimes certain neighboring organs must also be removed: prostate and seminal vesicles in men, ovaries, uterus and part of the vagina in women.
“Cystectomy is also performed when superficial tumors recur despite instillation treatments too quickly and / or frequently at stages or forms that begin to be dangerous. Because it should be known that bladder cancer is a cancer that frequently recur especially if the tobacco exposure continues” adds Dr. Léon.
After the operation, enterocystoplasty is practiced in the vast majority of cases: the surgeon creates an artificial bladder (neo-bladder) from a segment of intestine, which is connected to the ureters upstream and to the urethra downstream. It can be practiced in both men and women.
The other possibility is a ureterostomy : it aims to evacuate urine through an orifice created in the abdomen and connected to a stoma made with a piece of intestine (bricker).
In certain particular cases the organ (bladder) can be preserved/left in place and the treatment is then based on a trimodal treatment: surgery for resection of the polyp(s) at most, radiotherapy, combined chemotherapy.
“Whatever the type of cancer, the care is very personalized with adapted and tailor-made therapy to best meet the care needs of the patients. In terms of side effects, the more aggressive the disease, the more treatments are accompanied by adverse effects with serious consequences on the lives of patients. Hence the importance of early diagnosis” insists Dr Pradère.
Bladder cancer: what follow-up?
Bladder cancer follow-up is essential because 50 to 70% of non-invasive tumors recur. “Quitting smoking is the key. Smoking cessation is essential to limit the risk of recurrence” insists the urologist.
When the risk of recurrence is low and the tumor was superficial, a cystoscopy is performed at 3 and 12 months after the operation, then once a year for at least 5 years, (more if the patient has not succeeded in quitting smoking, until smoking cessation).
When the risk of recurrence is high (particularly in patients who smoke), monitoring by cystoscopy and urinary cytology amounts to 3-6 months and 12 months during the first year, then every 6 months during the second year. In the event of normal examinations, monitoring returns to an annual rhythm for the following 15 years.
After a cystectomy, monitoring is based on blood tests and clinical examinations, combined with a CT scan of the chest, abdomen and pelvic region, every 6 months for the first two years and then once a year for 15 years.
Bladder cancer: what is the life expectancy?
In the majority of cases, bladder cancer is detected at an early stage. According to INCA figures, the number of deaths is estimated at 4112 annual cases in men and 1223 cases in women.
Bladder tumors are responsible for 3% of cancer deaths. Their incidence is increasing by approximately 1% per year, with greater growth in women than in men.
Advances in immunotherapy offer encouraging and promising prospects for lowering the recurrence rate and increasing survival in addition to existing surgery, radiotherapy and chemotherapy.
Our Experts :
- Dr. Priscilla Léon, urological surgeon and member of the bladder cancer subcommittee of the French Association of Urology (AFU)
- Dr Benjamin Pradère, urologist and member of the AFU Cancer Committee (Bladder Cancer Month, May 2023)