Bladder and Kidney Cancer Flashcards
Bladder cancer (urothelial cancer)
- Malignant cancers of the urothelium
- Multifocal
- Highly invasive
- Most urothelial cancers occur in the bladder
Bladder cancer: risk factors
- Cigarette smoking
- Exposure to dyes/toxins
- Phenacetin containing analgesics
- Radiation therapy
- Cyclophosphamide (Cytoxan)
- Chronic recurrent stones• Chronic lower urinary infections
- Indwelling catheters
Bladder cancer S/S:
▫ Hematuria
▫ Dysuria
▫ Frequency
▫ Urgency
BC: DX
- Urinalysis: gross or microscopic hematuria.
- Bladder wash specimen and bladder biopsy.
- IV urogram, CT, MRI.
BC: surgical management
• Cystectomy
- Radical surgery plus intravesical chemotherapy
• Transurethral resection or fulguration
Cystectomy : partial
▫ Resection of the portion of the bladder wall containing the tumor
along with a portion of normal tissue
Complete cystectomy
▫ Involves the removal of:
Bladder, prostate, and seminal vesicles
Bladder, uterus, cervix, urethra, and the ovaries
Transurethral resection or fulguration
▫ Used for the diagnosis and treatment of superficial lesions
▫ Used to control bleeding
▫ Tumor mass is excised
▫ The remaining portion of the tumor are cauterized
Ileal conduit
▫ Ureters are surgically placed in the ileum, Urine is collected in a
pouch
▫ Continent reservoirs or “neobladders” are being used
Uterosigmodoistomy
- Diverts urine to the large intestine, so no stoma is required
- Client excretes urine with bowel movements
Neobladder
internal reservoir created from part of the small intestine ; because it is connected to the urethra , the patient can learn to void normally.
BC: Nonsurgical management
• Radiation Therapy
• Chemotherapy
• Intravesical Therapy:
- Prophylactic immunotherapy with instillation of bacille Calmette Guerin (BCG)
Radiation therapy (local)
• Used with cystectomy • May be used as the primary therapy • Can be combined with systemic chemotherapy Typical side effects: ▫ Inflammation of the rectum ▫ Incontinence ▫ Skin irritation
Chemotherapy (systemic)
1. Chemotherapy drugs: ▫ Cisplatin (Platinol) ▫ Vinblastin (Velban) ▫ Doxorubicin (Adriamycin) ▫ Methotrexate 2. Successful in prolonging life 3. Rarely results in a cure
Chemotherapy side effects
▫ Alopecia ▫ Anemia ▫ Thrombocytopenia (low platelet count ) ▫ Mucositis ▫ Bruising/Excessive bleeding ▫ Neutropenia ( low count of WBC)
Immunotherapy
• Biological therapy
▫ Treatment is used to enhance the immune system’s ability to fight
disease
Bacille Calmette-Guérin (BCG)
▫ Used to prevent tumor recurrence of superficial cancers
▫ Stimulates the immune system rather than acting directly on
cancer cells in the bladder
BCG (local)
- Can be delivered directly into the bladder
- Usually initiated at weekly intervals
- Patient’s position can be changed every 15 minutes
- Sometimes used with interferon
BCG : side effects
▫ Inflammation of the bladder
▫ Inflammation of the prostate
▫ Flu-like symptoms
▫ Irritative voiding symptoms and hemorrhagic cystitis
BC: nursing diagnosis
- Altered pattern of urinary elimination
- Risk for altered skin integrity
- Risk for infection
- Body image disturbance
- Anxiety, anticipatory grieving
- Pain
- Ineffective breathing pattern
- Knowledge deficit
Nursing responsibilities
- Increase fluid intake
- Smoking Cessation Information
- Assess patient for secondary (UTI)
- Routine urologic follow-up
- Address fears and concerns
- Client education
Community- based care
- Electrolyte replacement
- Foods to avoid
- Self-care abilities
- Pouch application
- Skin care/Pouch care
- Drainage mechanisms
- Counseling
- United Ostomy Association
- American Cancer Society
- The wound, Ostomy, and Continence Nurses Society
Renal cell carcinoma
- Also known as adenocarcinoma of the kidney
- Account for about 28,800 new cases and 11,300 deaths annually
- 5 year survival rate is 60%
- Occurs twice as often in men than in women
Kidney cancer: risk factors
• Cigarette smoking • Obesity • Exposure to: Asbestos, Cadmium, and Gasoline, Lead • HTN/Treatment for HTN
Kidney cancer: manifestations
▫ Weight loss ▫ Weakness ▫ Anemias ▫ Gross hematuria ▫ Flank pain ▫ Palpable mass
Kidney cancer complications
• Metastasis:
▫ Lungs, liver, and long bones (Common sites)
• Local extension of kidney cancer into the renal vein and vena cava
• Urinary tract obstruction
KC: DX
- Urinalysis: show RBC
- IV urogram: detect renal masses
- CT with contrast or MRI: outline mass
- Biopsy of the tumor
KC: Nonsurgical management
• Radiofrequency ablation ▫ Minimally invasive ▫ Effectiveness undergoing evaluation ▫ Not widely available • Radiation Therapy • Chemotherapy • Biological response modifiers (BRMs)
Biological response modifiers (BRMs)
▫ Interferon (INF) (Most commonly used)
- Interferons have a direct antiproliferative effect on tumor cells.
▫ Tumor necrosis factor (TNF)
KC: Surgical management
• Nephrectomy: Kidney removal
• Radical nephrectomy
▫ Removal of the kidney, adrenal gland, surrounding fascia, part of
the ureter, and draining lymph nodes.
Nephrectomy : Preoperative care
▫ Instruct the client about surgical routines
▫ Probable site of incision
▫ Presence of dressings, drains or other equipment
▫ Reassure client about pain relief
Nephrectomy :Operative procedure
▫ Positioning ▫ Trunk area flexed to increase exposure to the kidney area ▫ Removal of the 11th or 12thrib ▫ Nephrectomy ▫ Radiation therapy
Nephrectomy: Postoperative care
▫ Assess for hemorrhage and adrenal insufficiency
▫ Inspect abdomen for distention from bleeding, check linens under
the client
▫ Second kidney: Assess urine output for the first 24 hours after surgery
▫ Drain may be placed near the surgical site to remove residual fluid
▫ Complications: Atelectasis/Pneumonia
• Pain management: Opioid analgesics (hydromorphone and morphine
sulfate)
• Prevention of complications: Antibiotics
Ileal reservoir: Kock’s pouch
divert urine into surgically created pouch, or pocket that functions as a bladder. The stoma is continent, and the patient removes urine by regular self catheterization. Teach how to use the catheter to drain the pouch.
