Your cancer

Living with the disease

Bladder cancer

What is it ?

The bladder is a hollow organ, the function of which is the storage of urine produced by the kid-neys between each micturition. Consequently, the mucous cells of the bladder wall are repeatedly exposed to urine and its sometimes toxic constituents. In response to this exposure, a cell may degenerate and multiply in an uncontrolled manner, thereby forming a tumour: a urothelial carci-noma. In most cases, these tumours form in the bladder, but can also occur in what are described as the upper excretory tracts (the renal calyces, the pyelon and the ureter), situated between the kidney and the bladder.

Bladder cancer

With around 80 000 new cases discover in the USA every year, bladder cancer is the 7th most common cancer. It is less common in women, but is frequently more aggressive. The average age of occurrence is 70 years. In 50 - 70% of cases, this cancer pre-sents in a localized form, with no invasion of the muscle. However, approximately 30% of patients present with localized tumours which also invade the muscle. In 5 - 10% of cases, the condition is generally metastatic, i.e. featuring cancerous lesions in remote locations from the bladder (in the ganglions, lungs, bones, etc.).

 

Although urothelial carcinoma is the most common form, other histologies also occur (i.e. the type of tissue affected by the condition), including epidermoid carcinomas or neuroendocrine car-cinomas.

Symptoms

haematuria
(i.e. the presence of red blood, frequently accompanied by clots, in the urine).
Other persistent symptoms may lead to a diagnosis, including a burning sensation upon passing urine, or a frequent desire to urinate in the absence of the identification of any urinary infection.
Patients who smoke should be particularly alert to these symptoms.

Screening

Today, there is no validated form of screening available for bladder cancer. In the event of an oc-cupational risk, the works medical service may elect to conduct urine analyses for monitoring pur-poses.

Diagnostic Process

Initial diagnostic examination involves echography of the bladder and the entire urinary tract. This is a straightforward and non-invasive examination.
In order to provide a clearer view of the upper excretory tracts, a uroscan may also be completed. The results of imaging are combined with a specific urine analysis, described as urinary cytology. This examination, which is also non-invasive, involves the identification of the presence of abnor-mal cells in a urine sample, using a microscope.
Formal confirmation of the diagnosis is obtained by cystoscopy. This involves a direct examination of the bladder using an endoscope (similar to a camera) which is inserted via natural tracts, and is undertaken by a urologist. Cystoscopy also permits the extraction of tissue samples for the con-firmation, or otherwise, of the cancerous nature of anomalies detected by echography and/or by urinary cytology.
If the tumour is invasive (i.e. has infiltrated the muscle of the bladder), the review may be com-pleted by a full scan (TAP: thorax, abdomen and pelvis).

Risk factors

here are some risk factors for kidney cancer which cannot be changed:

Tabacco

(60% of the case)

Occupational exposure to certain chemical substances*

*aromatic amines employed in the manufacture of cosmetics, pharmaceutical products, pesti-cides and plastics, and in the rubber industry, and which are also present in tobacco

*Polycyclic aromatic hydrocarbons employed in the tar industry, in tyres and in textiles

if occupational exposure, including historical exposure, is suspected, a specialized consultation for occupational diseases is recommended
Previous radiotherapy treatment of the pelvis, or chemotherapy involving cyclophosphamide;
Recurrent cystitis, particularly in women
urinary bilharziosis
(parasite infection)
for squamous cell carcinoma

Treatments

Depending upon the stage of cancer, the treatment offered will differ:
For localized tumours, with no muscle infiltration: initial treatment involves endoscopic resection of the lesion via the transurethral route (using a natural passage). A complementary treatment may be associated with endoscopic resection: intravesical instillations of chemotherapy (mitomy-cin C) or immunotherapy (BCG).
For tumours which have infiltrated the muscle, the standard treatment is surgery, preceded by “neoadjuvant chemotherapy”, in the absence of any contraindications. Various surgical techniques are available. In selected patients, a strategy for the preservation of the bladder, involving a com-bination of partial surgery, chemotherapy and radiotherapy, may be envisaged.

For metastatic tumours, primary treatment is based upon polychemotherapy.

In the event of a good response to primary chemotherapy, immunotherapy using Avelumab is shortly expected to qualify for reimbursement in France, to be continued for one year after the end of chemotherapy.

In the event of unsuitability for chemotherapy, or a relapse further to the latter, immunotherapy using Pembrolizumab may be offered.

Finally, new therapeutic classes are currently in the course of licensing which will expand the range of therapies available, including conjugated antibodies (c.f. dedicated report) or, in certain cases (where the tumour features genetic anomalies which are specific to the latter), targeted therapies.

In patients who are smokers, stopping smoking is always beneficial.

A multimodal care program

Localized bladder cancer treatment involves the full range of oncological practitioners: urologi-cal surgeons, medical oncologists and radiotherapists. At the localized stages of the condition, for both non-invasive and invasive tumours, the success of treatment is based upon the combi-nation of a number of modes of therapy: surgery + medical treatment by immunotherapy or chemotherapy +/- radiotherapy. The completion of a full course of treatment is essential to the optimization of chances of remission. The objective of these treatments is not only the treat-ment of the visible lesion, but also the prevention of the occurrence of any relapses.

Molecular biology

On the grounds of its exposure to numerous mutagenic agents contained in the urine, urothelial carcinoma ranks among those cancers which feature the greatest number of genetic mutations (non-hereditary, and specific to the tumour). A number of treatments are in the course of de-velopment, in order to target the most frequently occurring anomalies.