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What is Bladder Cancer?

Bladder tumors can be benign or malignant. That’s why we often talk about polyps, tumors or cancer. Indeed, there is a wide range of bladder tumors that range from the mildest to the most dangerous. For this reason, it is imperative to microscopically examine all tumors of the bladder to establish an accurate diagnosis that will determine the type of treatment.

In the vast majority of cases, these tumors develop from the cells of the inner lining of the bladder which begin to proliferate: they are called urothelial.

With 7100 new cases estimated in 2010 in Canada, bladder cancer is the 6  cancer most frequently diagnosed in this country. In France, according to data from 2012, it is the 5th most common cancer and 2nd cancer of the urinary tract after prostate cancer. It usually occurs in people 60 years of age and older.

The bladder is a hollow organ located in the lower belly. Its function is to store the urine produced by the two kidneys whose role as filters allows the body to eliminate some waste in the form of urine. Urine is delivered to the bladder through 2 tubes: the ureters. The bladder fills up gradually and when it is full, the muscles of the wall of this balloon-shaped organ contract to expel the urine through another tube:  the urethra. This is called urination.

Urine production being continuous, without the bladder reservoir function, we would have to eliminate it permanently.

Different cancers of the bladder

There are two main types of bladder tumors today: tumors that do not infiltrate bladder muscle (TVNIM), formerly known as superficial tumors, and tumors that infiltrate hollow muscle bladder (TVIM), previously called invasive tumors. Their approach, treatment and evolution are different.

Possible evolution

Tumors that do not infiltrate the bladder muscle (TVNIM) are characterized by a high rate of recurrence (60 to 70% in the first year), which means that after treatment, once the tumor is destroyed, the person being treated should be followed and regularly test for several years, or even for life. A rather small fraction (10 to 20%) can also evolve into invasive forms and metastases.

When the tumor extends to the muscle of the bladder (TVIM), there is a risk of invasion of certain organs in the vicinity or propagation elsewhere in the body (ganglions, bones, etc.) by the blood, to the origin of metastases.

The risk of recurrence and the prognosis are influenced by several factors, including the type of tumor, its stage of development and its size, the number of lesions, the condition and the age of the person affected.

Symptoms of Bladder Cancer

  • In 80% to 90% of cases, the appearance of blood in the urine (hematuria) is the first sign of bladder cancer. The observed color can go from bright red to orange-brown. Sometimes blood in the urine can only be detected with a microscope (microscopic hematuria).
  • More rarely, it can be urinary burns, a more frequent need to urinate or more urgent.
These symptoms do not necessarily indicate the presence of a malignant tumor. Indeed, they may be signs of other more common problems, such as a urinary tract infection. If such symptoms occur, it is essential to consult a doctor to prescribe tests to determine the origin of the symptoms.

People at risk

  • People who had another cancer of the urinary system.
  • The  men  are more at risk than women;
  • People who have a permanent infection of the bladder with a parasite, bilharzia.

The opinion of experts

As part of its quality approach, Passeportsanté net invites you to discover the opinion of a health professional.

The prognosis of “superficial” bladder cancer (TVNIM) is generally excellent. The 5-year survival rate after treatment is in the range of 80% to 90%. But these tumors have a strong tendency to recur, hence the importance of close medical follow-up in all people with bladder cancer. To put the odds on its side, this periodic monitoring must be done for the rest of life. Various medical examinations (cystoscopies and cytologies) must be performed at regular intervals. These make it possible to quickly detect a recurrence of the tumor and to treat it as quickly as possible. This reduces the risk of the tumor becoming “infiltrating”, in which case the prognosis is less favorable.

Finally, the best way to prevent bladder cancer is to stay away from smoking or quitting.

Summary

 Risk factors of Bladder Cancer

  • Smoking: more than half of bladder cancer cases are attributable to it. The smoking (cigarettes, pipes or cigars) are nearly three times more likely than nonsmokers to be suffering from the cancer of bladder.
  • Prolonged exposure to certain industrial chemicals (tars, oil and pitch coal, carbon combustion soot, aromatic amines and N-nitrodibutylamine). Workers in the dyeing, rubber, tar or metallurgy industries are particularly at risk. Bladder cancer is one of the three occupational cancers recognized by the World Health Organization. All bladder cancer must seek a professional origin.
  • Certain drugs containing cyclophosphamide, used especially in chemotherapy, can cause urothelial cancers.
  • The radiation therapyin the pelvic area (the pond). Some women who have undergone radiotherapy for cervical cancer may have a bladder tumor afterwards. Prostate cancer treated with radiotherapy may also increase the risk of bladder cancer, but only after a delay of 5 years.

Prevention

Basic preventive measures
  • Not smoking or quitting significantly reduces the risks;
  • People exposed to carcinogenic chemicals while working must comply with safety protocols. Screening tests must be performed 20 years after the start of exposure to these products.

Diagnosis and extension report of Bladder Cancer

Diagnostic report

Apart from the clinical examination, several investigations are useful for the diagnosis:

  • Examination of urine to eliminate an infection (ECBU or cyto-bacteriological examination of the urine).
  • Cytology looking for abnormal cells in the urine;
  • Cystoscopy: direct examination of the bladder by introducing a tube containing optical fibers into the urethra.
  • Microscopic examination of the removed lesion (pathological examination).
  • Fluorescence examination.

Assessment of extension

This assessment aims to find out if the tumor is only located in the bladder wall or if it has spread elsewhere.

If it is a superficial tumor of the bladder (TVNIM), this extension assessment is in principle not justified except the realization of a urological scanner to look for other disorders of the urinary system. .

In the case of a more invasive tumor (TVIM), the reference examination is a CT scan of the chest, abdomen, and pelvis (lower abdomen where the bladder is located) to determine the impact of the tumor, as well as its extension to the ganglia and other organs.

Other explorations may be necessary depending on the case.

Principles of Treatment of Bladder Cancer

The treatment of bladder tumors depends on their characteristics. It is therefore always necessary, at least, to surgically remove the tumor, so that it can be examined under a microscope. Depending on its stage (infiltration or not of the muscular layer), its grade (more or less “aggressive” character of the tumor cells), the number of tumors, the best therapeutic strategy is implemented, taking into account also the characteristics and choices of the affected person. In France, the treatment of bladder canceris decided following a multidisciplinary consultation meeting during which several specialists (urologist, oncologist, radiotherapist, psychologist, etc.) speak. The decision results in the establishment of a Personalized Care Plan (PPS). All cancer is considered a long-term condition which allows reimbursements at higher rates by Medicare. In case of occupational exposure to a toxic substance, the declaration of an occupational disease also gives rise to specific rights

Given the often high risk of recurrence or aggravation, regular medical follow-up is required after treatment. Control examinations are therefore commonly practiced.

Treatment of Superficial Bladder Tumors (TVNIM)

  • Transurethral resection of the bladder (RTUV). The purpose of this surgery is to remove the tumor through the urethra, while maintaining the bladder. It consists of inserting a cystoscopeinto the urethra, to the bladder, to remove the cancer cells using a small metal loop.
  • Instillation in the bladder. The goal of this treatment is to avoid recurrence of bladder cancer. It involves introducing into the bladder substances aimed at destroying cancer cells or stimulating local immunity. With a probe, a substance is introduced into the bladder: immunotherapy (tubercle bacillus vaccine or BCG) or chemical molecule (chemotherapy). BCG therapy can be repeated or sometimes administered as maintenance therapy.
  • Removal of the entire bladder (cystectomy) in case of failure of previous treatments.

Treatment of TVNIM

  • Total cystectomy. This is to remove the entire bladder. The surgeon also glands and surrounding organs (prostate, seminal vesicles in men, uterus and ovaries in women).
  • Removal of the bladder is followed by reconstructive surgery, which involves restoring a new circuit to evacuate urine. If there are various ways to do this, the two most common methods are to collect urine in a pocket on the outside of the body (diverting urine to the skin) or to replenish an internal artificial bladder (neovessie). Using a gut segment.

Other treatment

– Depending on the case, other treatments may be offered: chemotherapy, radiotherapy, partial surgery, etc.
All can cause more or less significant side effects.

Complementary approaches

Notice . Check out our Cancer fact sheet for all the complementary approaches that have been studied with people with this disease, such as acupuncture, visualization, massage therapy and yoga. These approaches may be appropriate when used in addition to, but not substituting for, medical treatments.

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