Your cancer

Living with the disease

Bladder cancer

What is it ?

The WHO reported over 573,000 new cases of bladder cancer in 2020. The bladder is a hollow organ, its purpose is to store urine produced by the kidneys between 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 tumor called a urothelial carcinoma. In most cases, these tumors form in the bladder, but they can also occur in the upper excretory tracts situated between the kidney and the bladder (the renal calyces, the pyelon and the ureter).

Bladder cancer

In the majority of cases, the cancer is in localized form, with no invasion of the muscle. In the other cases, the condition is metastatic (i.e., the spreads to the lymph nodes, lungs, bones, etc).

 

Although urothelial carcinoma is the most common type, other histologies (i.e., the type of tissue affected by the condition), including epidermoid carcinomas or neuroendocrine carcinomas exist.

The symptoms

Hematuria
(i.e. the presence of 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 pay particular attention to these symptoms.

Screening

There is no validated form of screening available for bladder cancer today. In the event of occupational risk, the employer may elect to conduct urine analyses for monitoring purposes.

Diagnostic Process

The initial diagnostic examination is an echography of the bladder and the entire urinary tract. It is straightforward and non-invasive.
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 abnormal 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 use

(more than half of the cases)

Occupational exposure to certain chemical substances*

*aromatic amines used to manufacture cosmetics, pharmaceutical products, pesticides and plastics, and in the rubber industry; also present in tobacco

*Polycyclic aromatic hydrocarbons used in the production of tar, tires and textiles

(Si une exposition professionnelle, même ancienne, est suspectée, une consultation spécialisée en maladies professionnelles est recommandée)
Previous radiotherapy treatment of the pelvis, or chemotherapy involving cyclophosphamide
Recurrent cystitis, particularly in women
Urinary bilharziosis
(parasite infection)
for squamous cell carcinoma

Treatments

Treatment will vary depending on the cancer’s stage.
Initial treatment of localized tumors without muscle infiltration involves an endoscopic resection of the lesion via the transurethral route (using a natural passage). Intravesical instillations of chemotherapy (mitomy-cin C) or immunotherapy (BCG) may be suggested as complementary treatments.
The standard treatment of tumors which have infiltrated the muscle is “neoadjuvant” chemotherapy followed by surgery. Some patients may receive a combination of partial surgery, chemotherapy and radiotherapy to preserve the bladder.

The primary treatment of metastatic tumors is polychemotherapy.

If there is a favorable response to primary chemotherapy, immunotherapy using Avelumab is recommended for a year following the completion of chemotherapy.

If chemotherapy is not effective or if there is a relapse, immunotherapy using Pembrolizumab may be suggested.

New therapeutic classes, including conjugated antibodies and targeted therapies (for tumors with genetic anomalies) are being reviewed by medical authorities.

Smokers should consider the benefits of stopping.

A multimodal care program

Localized bladder cancer treatment involves the full range of oncological practitioners: urological surgeons, medical oncologists and radiotherapists. At localized stages, a number of modes of therapy will be combined: surgery + medical treatment by immunotherapy or chemotherapy +/- radiotherapy. It is essential to complete a full course of treatment to diminish the chances of relapse.

Molecular biology

Urothelial carcinoma tends to have a high number of genetic mutations (non-hereditary, specific to the tumor). A number of treatments are being developed to target the most frequently occurring anomalies.

Intitulé du poste :
Spécialité :
Lieu d'exercice :
Publications :