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Bladder Cancer
Director
Prof. Pierre Blanchard
Contact
Phone: (0)1 42 11 47 99
Email
Understanding the Disease
Bladder cancer ranks seventh among the most common cancers, with approximately 13,000 new cases per year in France, making it the second most common urological cancer, after prostate cancer.
In 80 percent of cases, this cancer affects men, and smoking is the most common risk factor. It originates in cells of the bladder’s inner lining. A normal cell undergoes a transformation and then multiplies uncontrollably until it forms a tumor.
Bladder cancers primarily develop from cells in the organ’s lining, known as the epithelium. This is known as urothelial carcinoma, which accounts for the vast majority of bladder cancers. Urothelial cancer can also occur in the upper urinary tract (ureters, proximal renal cavities).
We distinguish between tumors that do not affect the bladder muscle, known as “non-muscle-invasive bladder tumors ” (NMIBC), also known as superficial tumors, from those that invade it, known as “muscle-invasive bladder tumors” (MIBC).
What is the bladder?
The bladder is a hollow, muscular organ of the urinary system. Located in the lower abdomen, it acts as a reservoir: it stores the urine produced by the kidneys, which is transported to it via the ureters.
When the bladder is full, it empties through the urethra as a result of the contraction of its muscular wall and the relaxation of the urinary sphincter. Bladder cancer most often develops in the bladder mucosa, the tissue that lines its inner wall.
Bladder Cancer by the Numbers
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13,074
new cases in France each year.
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81%
New cases are being diagnosed in men.
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70 years
median age at diagnosis
Figures: National Cancer Institute.
Prevention and Risk Factors
Bladder cancer is linked to several risk factors, some of which are well known. The main strategy for prevention involves addressing avoidable exposures, particularly tobacco and certain chemicals.
Tobacco use is the leading risk factor for bladder cancer. The toxic substances inhaled are excreted in the urine, which directly exposes the bladder wall.
Quitting smoking is therefore the most important preventive measure for reducing this risk.
The risk of bladder cancer also increases with prolonged occupational exposure to certain chemicals, particularly in certain industrial sectors.
Prevention relies on reducing such exposure and using appropriate protective equipment in the workplace.
Bladder cancer most often affects people over the age of 50, and primarily affects men. Age is therefore a significant risk factor, linked to prolonged exposure to various potential carcinogens over the course of a person’s life and the gradual accumulation of their effects on cells.
Symptoms
The most common symptom of bladder cancer is blood in the urine, known as hematuria. Other persistent symptoms may be cause for concern and require a visit to the doctor, such as frequent urges to urinate and a burning sensation during urination.
Bladder cancer often has no symptoms in its early stages. In many cases, it is discovered when urinary symptoms—which may seem minor—appear, making it important to pay attention to them, especially when they persist or occur for no obvious reason.
Certain signs should therefore prompt a visit to the doctor so that the necessary tests can be performed and a diagnosis made as early as possible.
Diagnosis – Hematuria Evaluation in 1 Day
Several tests are needed to diagnose bladder cancer: an ultrasound of the urinary tract, a urine test (urinary cytology) to check for the presence of cancer cells, and a cystoscopy, which involves examining the inner wall of the bladder and taking tissue samples if necessary.
Blood in the urine? Gustave Roussy and Bicêtre Hospital offer a rapid diagnostic test to screen for a possible tumor of the urinary tract.
Hematuria refers to the presence of blood in the urine (red urine) and is never normal. There are several possible causes, but it can sometimes indicate the presence of tumor cells in the urinary tract, particularly in the bladder. This is why it is important to establish a diagnosis quickly, so that any tumor can be treated as early as possible.
Consequently, Gustave Roussy, in collaboration with urologists at Bicêtre Hospital, has established a one-day hematuria evaluation program, enabling a rapid diagnosis of a potential tumor and, if necessary, the prompt initiation of treatment. This service is provided by a multidisciplinary medical team comprising oncologists, urologists, radiologists, and pathologists, who will work with the patient to make the necessary decisions to reach a diagnosis and, if appropriate, recommend treatment.
Patients—particularly those exposed to tobacco smoke—who notice blood in their urine may seek care at the hematuria clinic. However, before considering serious causes, it is necessary to rule out more benign causes (urinary tract infection, urinary stones, parasitic disease, or a recent lumbar or pelvic injury).
In cases of hematuria, the patient’s physician will therefore be asked to complete an online questionnaire (downloadable below) and to provide the results of the initial tests typically ordered by a general practitioner (urinalysis).
After reviewing the questionnaire, if the medical team deems it necessary, an appointment will be scheduled for the patient. Several tests will be performed at Gustave Roussy in a single morning, including:
A physical examination.
A CT scan of the urinary tract.
A urine test to detect abnormal cells.
And possibly other tests (such as a bladder ultrasound).
This initial evaluation may therefore take several hours.
Following these tests, the case will be discussed collectively during a multidisciplinary consultation meeting, which will take place that same afternoon.
If a tumor is suspected, an appointment will be scheduled with a urologist at Bicêtre Hospital the following week to perform a cystoscopy: this is a sterile endoscopic procedure used to visualize the walls of the bladder. It involves inserting a flexible (in men) or rigid fiberscope through the urethra—usually under local anesthesia—to allow for a precise examination of the entire bladder and, therefore, a direct view of any tumors.
If a tumor is confirmed, the urologist will schedule a second appointment to remove the tumor in the operating room. An appointment with an anesthesiologist will also be scheduled. Once the tumor has been removed and the microscopic analysis completed, the case will be reviewed a second time to determine the next steps in your care (additional treatment or monitoring).
The patient’s treatment will be provided by Gustave Roussy’s multidisciplinary urological oncology team, which consists of:
Urological surgeons.
Medical oncologists.
Radiation oncologists.
Radiologists.
Nuclear medicine physicians.
Pathologists.
Supporting physicians.
Medical assistants.
Paramedical staff: nurses.
A multidisciplinary team meeting (MDT) is held every week.
To schedule an appointment, please:
Fill out the preliminary questionnaire (Word document) [note: document to be inserted]
and email it to urologie@gustaveroussy.fr
Coverage
Gustave Roussy provides care for patients with bladder cancer. This care (diagnosis and treatment) requires the collaborative effort of several physicians from various disciplines: medical oncologists, surgeons (urologists), radiation oncologists, radiologists, and pathologists, working in collaboration with primary care physicians.
Every major decision is made by the various healthcare professionals during multidisciplinary team meetings (MDTs). In some cases, the patient’s presence at a meeting may be required.
Treatments
Several types of treatment can be used to treat bladder cancer, depending on the stage of the cancer: surgery, chemotherapy, immunotherapy, or radiation therapy.
Depending on the case, their purpose may be to:
- Remove the tumor or metastases.
- Reduce the risk of recurrence.
- Slow the growth of the tumor or metastases.
- Treat symptoms caused by the disease.
Cancer confined to the mucosa, the innermost layer of the bladder wall:
- Transurethral resection of the bladder (TURB).
- Chemotherapy drug such as MYTOMYCIN.
- Immunotherapy drug such as BCG.
Cancer that has spread to the muscles:
- Total cystectomy (removal of the bladder).
- Chemotherapy (neoadjuvant: before surgery, or adjuvant: after surgery).
- Concomitant chemoradiotherapy (if cystectomy is not feasible or not desired by the patient).
Cancer that has metastasized beyond the bladder:
- Chemotherapy is the primary treatment. The most commonly used regimen is based on cisplatin, combined with three other drugs: methotrexate, vinblastine, and doxorubicin (MVAC regimen).
- Palliative radiation therapy may be administered depending on the patient’s symptoms.
- Immunotherapy.
Research
We are currently exploring several strategies to improve the management of urothelial cancer at all stages of the disease.
One of these approaches involves the use of immunotherapy, which aims to stimulate the patient’s immune system so that it can more effectively recognize and destroy tumor cells. These immunotherapies, which are administered intravenously, are currently being evaluated either alone or in combination with other treatments (chemotherapy, other immunotherapies, radiation therapy, targeted therapy) in patients with metastases, as well as in patients without metastases—for example, before or after surgery—to reduce the risk of recurrence.
Contact
Chair of the Urology Committee:
Prof. Pierre Blanchard
Contact
Phone: +33 (0)1 42 11 47 99
Email
Appointments and Second Opinions
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Les cancers masculins
Les hommes constituent la population la plus touchée par le cancer. Environ 240 000 d’entre eux apprennent chaque année qu’ils en sont atteints, et 90 000 en décèdent. Des chiffres qui placent la maladie au premier rang des causes de décès prématurés les concernant.
Frequently Asked Questions
The most common symptom is blood in the urine, which may or may not be accompanied by pain. Other symptoms may include a frequent urge to urinate or a burning sensation during urination.
Treatment depends on the stage of the disease. It most often involves surgery to remove the tumor, sometimes combined with other treatments such as chemotherapy, immunotherapy, or radiation therapy.
This cancer mainly affects people over the age of 50, particularly men. Smoking is the primary risk factor, as is certain occupational exposure to chemicals.