Bladder cancer in women: symptoms, what chances of survival?

Bladder cancer is the 7th most common cancer in France. S‘it affects men 4 times moreits impact increases by 1% per year among women. “The average age at diagnosis is 60 years whether for women or men. It is rarely diagnosed earlier because its development is linked to a certain duration of exposure to carcinogens” informs our interlocutor, Dr. Géraldine Pignot, Urological Surgeon, Practitioner of Cancer Centers at Institut Paoli Calmettes. Often confused with a urinary infection, Bladder cancer is diagnosed at a more advanced stage in women, leading to a poorer prognosis.

Have we identified any specific risk factors in women?

“There is underinformation about this cancer which, historically it is true, was a cancer mostly attributed to men. Today, women are increasingly affected by this cancerwith shapes sometimes more aggressive or diagnosed later“, observes Dr Pignot, This increase in incidence is explained in particular by the rise in smoking (active and passive) at home. “It is also believed that there may be risk factors environmental – perhaps incorrectly identified – or a role of hormones potentially involved in the development of bladder cancer in women“, she emphasizes.

What are the symptoms suggestive of bladder cancer in women?

Classically, “the ppresence of blood in the urine (hematuria) is inaugural symptom of disease in the man whereas in women, we rarely have hematuria at the start of cancer“, specifies Dr Pignot. In women, we tend to have irritative symptoms of the bladder:

• Frequent urge to urinate (pollakiuria)
• Of the pain when urinating, ranging from discomfort to intense burning sensation (dysuria)
• The complaint of having to wake up at night due to an urge to urinate (nocturia)

“In general, the diagnosis of a bladder tumor is made late in relation to the onset of symptoms in women. Therefore, cancer is often detected at a more advanced stage. This is particularly due to the fact that the symptoms in women are not quite the same as the symptoms in men and that they often make us think of a urinary infection“.

► In a woman who has over 50, especially if she smokesand who has urinary symptoms that may suggest an infection but with atypical characteristics (when no germs/bacteria are found in the urine), the doctor should consider sending him to a urologist so that he can carry out an examination called cystoscopy, in which, under local anesthesia, a small camera is inserted into the urethra to explore the inside of the bladder. “It takes 5 minutes and ensures that the inside walls of the bladder are healthy“, explains Dr Pignot. The general practitioner will also prescribe an ultrasound, but this examination can miss more infiltrative forms of the disease. In addition to cystoscopy, we need to do almost complete resection of the bladder lesion (under general anesthesia) to analyze it and determine its severity (stage and grade).

“There is a risk of metastases to the lungs, liver, lymph nodes or bones”

Today cystoscopy is an essential examination, commonly practiced but it remains invasive, expensive and polluting (the equipment used must be single-use or chemically sterilized). What’s more ,some tumors are flat and are not easily detectable with the naked eye. As for urinary cytology (which consists of rlook for abnormal cells under a microscope from a simple urine sample) regularly used, it does not make it possible to identify all cancers because it is sometimes complicated to read for an anatomical pathologist. To facilitate the early detection and monitoring of bladder cancers, VitaDX has developed software with artificial intelligencealready used by several anatomopathology laboratoriess In France. This AI, which has learned to recognize tumor cells, significantly helps the pathologist’s diagnosis and can be an alternative to certain control bladder endoscopies which are numerous for a patient followed for bladder cancer.“, explains Marie Dehem, Operations Director of VitaDX who developed the device VisioCyt®. “This does not yet replace cystoscopy, but a trial has started at the Paoli Calmettes Institute to evaluate its performance with the aim, perhaps in the long term, of having an examination as efficient as cystoscopy.“, continues Dr Pignot.

What is the treatment for bladder cancer in women?

There are two types of bladder tumors:

► Superficial tumors which affect the first layers of the bladder and which can be “removed by scraping (resection) and injecting products into the bladder to prevent cancer cells from regrowing“, describes Dr. Pignot.

► Infiltrating tumors located in the depth of the bladder muscle, much more aggressive, which require removing the bladder. “Of course, after the removal of the bladder, we have techniques for internal reconstruction of the bladder. It was long believed, wrongly, that it was not possible to reconstruct a new bladder in women with the intestine and that it was necessary to make a stoma with an external bag. What is wrong. In women, it is possible to reconstitute a new bladder by remodeling part of the intestine. The data showed that we have excellent results in terms of disease control, quality of life, recovery of continence and sexuality.“, explains Dr. Pignot.

What are the chances of survival?

“Studies have proven that bladder cancer is more aggressive in women and therefore with a more pejorative prognosis, in particular because it is diagnosed later. Any delay in diagnosis will have a major impact in terms of prognosis“, replies our specialist.

Yes, replies our interlocutor. “We usually say that once a bladder tumor is diagnosed, it must be taken care of. within 3 months because there is a risk of metastases to lungs, liver, lymph nodes or bones. We really have an emergency of care starting from the diagnosis, hence the interest in making an early diagnosis and implementing appropriate treatment quickly.“. 75% of bladder tumors are diagnosed at a localized and therefore curable stage.

Thanks to Dr Géraldine Pignot, Urological Surgeon, Cancer Center Practitioner at Institut Paoli Calmettes.