Bladder cancer

A common urologic cancer

Bladder cancer is the second most common urologic cancer after the prostate cancer.

Risk factors and most frequent symptoms

Main risk factors : smoking and professional exposure to carcinogenic substances.

The most common symptom for bladder tumors (also known as bladder polyps) is the presence of blood in the urine ("hematuria"). There are other types of symptoms such as the frequent and urgent need to urinate. This disorder can also be discovered fortuitously through an imaging test.

Bladder polyps can be superficial or invasive, benign or malignant.

The diagnosis

If one of these symptoms is faced, the urologist will carry out a cystoscopy under local anesthesia. Cystoscopy uses a thin camera introduced through the urethra to look inside the bladder.

This examination lasts less than 10 minutes and cannot be performed in case of untreated urinary tract infection. The assessment is completed by a urine analysis and a scanner.

The discovery of a bladder polyp requires to program its ablation in order to analyze it and determine its exact nature.

The surgery process for resection

This procedure called “endoscopic resection of bladder cancer” is performed under general or spinal anesthesia depending on the choice made during the anaesthetic consultation.

After ensuring the sterility of the urine, the urologist will go through the natural route without incision to access the bladder and resect the entire polyp using a camera.

In case the polyp is difficult to visualize, it is possible to increase the precision of the intervention with the help of fluorescence (HEXVIX) which turns the abnormal cells in pink color.

Microscopic examination of the polyp will help determining its exact nature. In case of a cancerous polyp, the examination will also indicate the degree of depth and severity of the bladder cancer : superficial or invasive tumors (within the muscles) with low or high risk.

Lenght of the stay

1 day

Surgery follow-up

D+1 for the removal of the urinary catheter

Back to home

Allowed as soon as the urination process is satisfactory

All bladder cancers are discussed during multidisciplinary consultation meetings. This meeting gathers all the specialists involved in the management of bladder cancer (urologist, oncologist, radiologist, radiotherapist, pathologist …).

The treatment

For a superficial tumor :

The urologist may recommend a complementary treatment by instillations at a rate of once a week during 6 to 8 weeks.

What are the instillations ?

These instillations are made to limit the risk of recurrence which is the major risk in case of superficial tumor. The solution injected in the bladder is adapted to the nature of the polyp (Mitomycin C or BCG). In any case a regular cystoscopy watch is recommended.

For a tumor invading the bladder muscle :

The standard treatment is surgery (“cystectomy”).

For men, the procedure involves the removal of the bladder and the prostate.
For women, the uterus, ovaries and anterior vaginal wall are removed in addition to the bladder. In any case a lymph node dissection is performed during the procedure.
A short chemotherapy may sometimes be recommended before the surgery. Once the bladder is removed,
Après avoir retiré la vessie, it is necessary to derive the urine from the kidneys. This derivation is made with a segment of the intestine re-routed to the skin (“Bricker”) or shaped to form a new bladder. The choice of the derivation is adapted to each patient, also according to his preference.
The procedure can be performed by open or laparoscopic way, even with robotic assistance. Laparoscopy involves introducing the instruments through small incisions in the abdominal wall and operating with a camera.

If the surgery appears to be impossible, the treatment requires chemotherapy or radiotherapy.