Less publicized than Pink October (breast cancer) or Blue March (colorectal cancer), the month of May has for several years been the occasion for awareness campaigns about bladder cancer, relatively common and very little known to the general public.
The fifth cause of cancer
Fifth cancer in France, second urological cancer after that of the prostate. Bladder cancer remains little known to the public. “From 13,000 to 20,000 new cancers are diagnosed each year, for around 5,000 deaths” , underlines Lori Cirefice, president of the Cancer Bladder France patients association.
Often more serious in women
“More than 50% of cases are diagnosed through another symptom” , assures Professor Benjamin Pradere, member of the oncology committee of the French Association of Urology (AFU). It affects men four times more but the proportion of women is increasing, linked to the increase in female tobacco consumption since the 1980s. Cancer is often more serious in women, because it is diagnosed later. The average age of diagnosis is around 60 years old.
“Red urine, I’m moving”
This is the slogan adopted for this fourth “bladder month” campaign. “Hematuria, blood in the urine, this is really the first symptom that should alert you. » First reflex, do a cytobacteriological urine examination (ECBU), to check if the inflammation is linked to bacteria (cystitis). “Too often, if the ECBU is negative, there is no additional research,” deplores Professor Yann Neuzillet (Foch hospital).
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The main risk factors
“The first factor is indeed tobacco”, insists Professor Pradié. It is involved in more than half of male cases and 40% of female cases. Other occupational exposures, notably those to polycyclic hydrocarbons, mean that sectors such as the steel industry, the textile industry or cosmetics are more affected. “These products are less present than thirty years ago, but patients exposed at the time still have an increased risk. » Exposure to certain pesticides also plays a role: “We see more bladder cancers in large agricultural regions,” recognizes Professor Pradié. “We also have young patients who smoke cannabis,” points out Professor Yann Neuzillet. Cutting products, necessarily uncontrolled, can be highly carcinogenic.
Why this sensitivity to “environmental” factors?
“The role of urine is to expel toxins from the blood. It is stored in this reservoir which is the bladder, explains Professor Pradier. The more toxins there are and the longer they remain in this container, the greater the risk of inflammation and cancer. »
Two forms of cancer
The bladder is made up of a membrane (the chorion) surrounded by muscles. If the muscle is not infiltrated, the prognosis is much better (80% five-year survival compared to 50%). In case of metastases, this figure decreases to 5%.
The diagnosis
It is done by “endoscopic resection” (an endoscopy probe will remove the tumor) which will be analyzed by a pathologist. Currently, there are no biomarkers allowing early diagnosis without intervention.
The classic treatment
It mainly consists of the instillation of chemotherapy products directly into the bladder. In cases of advanced cancer, removal of the bladder may be necessary, which has serious consequences on the patient’s comfort of life.
Innovative treatments
As in many cancers, immunotherapy is moving the needle. New protocols combining chemo, monoclonal antibodies and immunotherapy are giving promising results, but have not yet been validated in France.“According to a study published in October, one of these protocols increases the survival of people newly diagnosed with advanced or metastatic cancer by 50%” , points out the Cancer Bladder France association, which campaigns for earlier access to these new therapies.
Towards less restrictive monitoring
Follow-up after treatment is restrictive, with regular fibroscopies (introduction of an optical fiber through natural channels). Several companies have developed biomarking products to detect the reappearance of tumor DNA in urine. These tests are not yet systematically supported. A French study is underway to assess whether they can replace fibroscopy.
