Much less known than prostate cancer, bladder cancer affects smokers and men more, but does not spare women, specialists warn. “This cancer, relatively common and sometimes aggressive, is too little known,” according to Benjamin Pradère, president of the French urology association (AFU), promoter of a “bladder month”.
Each year in France, between 13,000 and 20,000 new cases are reported, mainly affecting men over 60 years old. Bladder cancer causes around 5,000 deaths each year.
“Red urine, I’m moving!” »
In the absence of a valid systematic screening method, red flags are crucial. “Red urine, I’m moving!” », urges the slogan of the awareness campaign, in reference to the first and most common symptom. Recurrent cystitis – without infection detected when looking for microbes in the urine – or urination problems can also be a warning.
Women increasingly affected
Bladder cancer “affects men more often but it is often more serious in women, because symptoms can be misinterpreted and delay the diagnosis,” points out Benjamin Pradère.
A scenario experienced by Catherine, a fifty-year-old Alsatian: “After a bypass [chirurgie bariatrique, NDLR], I often had blood in my urine. The treating doctor thought it was related to the operation. It didn’t work. I was sent to see a gynecologist, who thought about micro periods because I had an IUD,” she says.
“It dragged on, until contractions and constant pressure on the bladder. Return to the gynecologist, ultrasound, always the hypothesis of micro periods, or urinary infections. After a year, I couldn’t stop myself from going to the bathroom. An MRI finally showed a large mass in the bladder,” recalls Catherine.
Living with a pocket
Then, everything happened: “eight hours of operation” to remove the mass, announcement of an infiltrating cancer, removal of the bladder, uterus and lymph nodes, chemotherapy and immunotherapy.
The former childminder has since had to learn to live with a bag to replace her bladder. Never being safe from an “escape”, she “carries around with spare clothes and protection”. “Daily life is fine, but a little too much physical effort triggers stomach cramps,” adds Catherine, who advises “women especially” to consult if they have the slightest doubt.
Around “a quarter of patients are women” and their “proportion is increasing”, according to the president of the Cancer Vessie France patient association, Lori Cirefice.
Proven link with smoking
Among the risk factors, tobacco comes first. The body expels toxins present in the blood via urine, stored in the bladder before evacuation. “This link between smoking and bladder cancer is little known,” explains Lori Cirefice.
In Europe, the frequency of this cancer has increased in recent years “not only due to an increase in detections, but also an increase in smokers”, according to Benjamin Pradère.
Also be careful with cannabis, warns Yann Neuzillet, surgeon and member of the AFU oncology committee: “young patients arrive for consultation after having been exposed to improbable carcinogens through cannabis consumption […] sometimes intersected with anything, tires, cement…”.
The antibody trail for advanced stages
More widespread, “certain exposures, particularly occupational, can lead to bladder cancer: rubber, dyes, paints, cosmetics, certain hydrocarbons, pesticides in large agricultural regions,” underlined the president of the AFU.
Although these carcinogens are less present than 20 or 30 years ago in the world of work, people previously exposed remain at risk. “I was told that my cancer could come from cigarettes, but I also worked in a lot of factories – aluminum rims, baby wipes, cereals, heating and air conditioning for cars – so we will never know,” slips Catherine.
In the therapeutic arsenal, several innovations revolve around immunotherapy, which consists of strengthening the body’s defenses against disease. For patients at a locally advanced stage or with metastases, antibodies targeting certain molecules of cancer cells (“antibody drug conjugates”, ADCs) also seem promising, in combination with chemotherapy and immunotherapy, according to recent studies.
