Bladder and Kidney Cancer

Question 1

Bladder cancer (urothelial cancer)

Answer 1

• Malignant cancers of the urothelium
• Multifocal
• Highly invasive
• Most urothelial cancers occur in the bladder

Question 2

Bladder cancer: risk factors

Answer 2

• Cigarette smoking
• Exposure to dyes/toxins
• Phenacetin containing analgesics
• Radiation therapy
• Cyclophosphamide (Cytoxan)
• Chronic recurrent stones• Chronic lower urinary infections
• Indwelling catheters

Question 3

Bladder cancer S/S:

Answer 3

▫ Hematuria
▫ Dysuria
▫ Frequency
▫ Urgency

Question 4

BC: DX

Answer 4

1. Urinalysis: gross or microscopic hematuria.
2. Bladder wash specimen and bladder biopsy.
3. IV urogram, CT, MRI.

Question 5

BC: surgical management

Answer 5

• Cystectomy
- Radical surgery plus intravesical chemotherapy
• Transurethral resection or fulguration

Question 6

Cystectomy : partial

Answer 6

▫ Resection of the portion of the bladder wall containing the tumor
along with a portion of normal tissue

Question 7

Complete cystectomy

Answer 7

▫ Involves the removal of:
 Bladder, prostate, and seminal vesicles
 Bladder, uterus, cervix, urethra, and the ovaries

Question 8

Transurethral resection or fulguration

Answer 8

▫ 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

Question 9

Ileal conduit

Answer 9

▫ Ureters are surgically placed in the ileum, Urine is collected in a
pouch
▫ Continent reservoirs or “neobladders” are being used

Question 10

Uterosigmodoistomy

Answer 10

• Diverts urine to the large intestine, so no stoma is required
• Client excretes urine with bowel movements

Question 11

Neobladder

Answer 11

internal reservoir created from part of the small intestine ; because it is connected to the urethra , the patient can learn to void normally.

Question 12

BC: Nonsurgical management

Answer 12

• Radiation Therapy
• Chemotherapy
• Intravesical Therapy:
- Prophylactic immunotherapy with instillation of bacille Calmette Guerin (BCG)

Question 13

Radiation therapy (local)

Answer 13

• 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

Question 14

Chemotherapy (systemic)

Answer 14

1. Chemotherapy drugs: 
▫ Cisplatin (Platinol) 
▫ Vinblastin (Velban)
▫ Doxorubicin (Adriamycin)
▫ Methotrexate
2. Successful in prolonging life
3. Rarely results in a cure

Question 15

Chemotherapy side effects

Answer 15

▫ Alopecia
▫ Anemia
▫ Thrombocytopenia (low platelet count )
▫ Mucositis
▫ Bruising/Excessive bleeding
▫ Neutropenia ( low count  of WBC)

Question 16

Immunotherapy

Answer 16

• Biological therapy
▫ Treatment is used to enhance the immune system’s ability to fight
disease

Question 17

Bacille Calmette-Guérin (BCG)

Answer 17

▫ Used to prevent tumor recurrence of superficial cancers
▫ Stimulates the immune system rather than acting directly on
cancer cells in the bladder

Question 18

BCG (local)

Answer 18

• 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

Question 19

BCG : side effects

Answer 19

▫ Inflammation of the bladder
▫ Inflammation of the prostate
▫ Flu-like symptoms
▫ Irritative voiding symptoms and hemorrhagic cystitis

Question 20

BC: nursing diagnosis

Answer 20

• 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

Question 21

Nursing responsibilities

Answer 21

• Increase fluid intake
• Smoking Cessation Information
• Assess patient for secondary (UTI)
• Routine urologic follow-up
• Address fears and concerns
• Client education

Question 22

Community- based care

Answer 22

• 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

Question 23

Renal cell carcinoma

Answer 23

• 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

Question 24

Kidney cancer: risk factors

Answer 24

• Cigarette smoking
• Obesity
• Exposure to:
Asbestos, 
Cadmium, and 
Gasoline, 
Lead
• HTN/Treatment for HTN

Question 25

Kidney cancer: manifestations

Answer 25

``` ▫ Weight loss ▫ Weakness ▫ Anemias ▫ Gross hematuria ▫ Flank pain ▫ Palpable mass ```

Question 26

Kidney cancer complications

Answer 26

• Metastasis: ▫ Lungs, liver, and long bones (Common sites) • Local extension of kidney cancer into the renal vein and vena cava • Urinary tract obstruction

Question 27

KC: DX

Answer 27

1. Urinalysis: show RBC 2. IV urogram: detect renal masses 3. CT with contrast or MRI: outline mass 4. Biopsy of the tumor

Question 28

KC: Nonsurgical management

Answer 28

``` • Radiofrequency ablation ▫ Minimally invasive ▫ Effectiveness undergoing evaluation ▫ Not widely available • Radiation Therapy • Chemotherapy • Biological response modifiers (BRMs) ```

Question 29

Biological response modifiers (BRMs)

Answer 29

▫ Interferon (INF) (Most commonly used) - Interferons have a direct antiproliferative effect on tumor cells. ▫ Tumor necrosis factor (TNF)

Question 30

KC: Surgical management

Answer 30

• Nephrectomy: Kidney removal • Radical nephrectomy ▫ Removal of the kidney, adrenal gland, surrounding fascia, part of the ureter, and draining lymph nodes.

Question 31

Nephrectomy : Preoperative care

Answer 31

▫ Instruct the client about surgical routines ▫ Probable site of incision ▫ Presence of dressings, drains or other equipment ▫ Reassure client about pain relief

Question 32

Nephrectomy :Operative procedure

Answer 32

``` ▫ Positioning ▫ Trunk area flexed to increase exposure to the kidney area ▫ Removal of the 11th or 12thrib ▫ Nephrectomy ▫ Radiation therapy ```

Question 33

Nephrectomy: Postoperative care

Answer 33

▫ 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

Question 34

Ileal reservoir: Kock's pouch

Answer 34

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.