bladder cancer Flashcards
urothelial cancer
Includes malignant tumors of the urothelium which lines the kidneys, renal pelvis, ureters, bladder and urethra
72% of tumors are in the bladder
27% of tumors are in the kidney
bladder cancer
Tends to be recurrent
Multiple tumors common
Tumors range from papillomas (premalignant) to invasive carcinomas
bladder cancer risk factors
- Smoking
- Exposure to chemicals used in rubber, paint/dye, textile, leather, and electric cable industries
- Parasitic infection
bladder cancer clinical manifestations
- Painless hematuria
a. Predominant fining
b. May be intermittent
c. Gross or microscopic - Frequency, urgency, or dysuria
a. Accompanies infection or obstruction
bladder cancer diagnostics
urinalysis CT Scan MRI Ultrasound (less valuable) Intravenous pyelogram (IVP- check for shellfish/iodine allergy)
surgical management for superficial, low grade or papillary tumors (bladder cancer)
Simple excision (TURBT) transurethral resection/removal of bladder tumor Partial Cystectomy
surgical management for invasive bladder cancer
Complete (radical) cystectomy with urinary diversion
radical cystectomy
Removes bladder, urethra, uterus, prostate & seminal vesicles/uterus & fallopian tubes & ovaries, lymph node
Simple excision (TURBT) transurethral resection/removal of bladder tumor
- Bladder irrigation- solution (NS or Sorbitol) continuously that enters through a 3-way catheter to flush the bladder to prevent an obstruction (allows for patency) until the bleeding subsides
partial cystectomy
- Isolated tumors
- Up to ½ of bladder can be removed
- Post-op bladder can expand to increase capacity
- Painful spasms
Ureterostomies
- Brings ureter(s) to abdomen with stoma(s)
2. UTIs common due to reflux (urine that flows backward)
Ileal Conduit (Ureteroileostomy)
- Use terminal ileum (least absorptive bowel) and connect ureters
- Easier to construct vs. other methods
Increased risk of pyelonephritis, calculi & hydronephrosis (fluid buildup in the kidneys due to an obstruction of urine flow)
considerations for ileal conduit
- Must wear an appliance
2. Require meticulous skin care and assessment for leakage
kock pouch
Reservoir created from ascending colon & terminal ileum with a valve to prevent reflux;
- Uses self-cath. postop to drain reservoir
- Requires longer surgery (8-10 hours)
- Contraindicated if bowel disease
complications of surgical management for bladder cancer
- Incontinence
- Leakage at anastomosis site
- Obstruction of ureters
- UTIs
- Erectile Dysfunction
bladder cancer post op care
- Monitor outputs (edema of stoma can occur)
a. Stool production may not occur for a few days, urine output will be immediate - Urine may initially be bloody
- Mucous in urine is normal discharge from intestinal loop
- NG for decompression until return of peristalsis
- Check stoma color (if black or gray-necrosis)
- Teaching emptying and changing of urostomy appliance
bladder cancer radiation
- In combination with surgery
2. For palliation to prolong life, increase comfort
Intravesical Chemo for bladder cancer
(directly into the bladder) in combination with surgery for early stage tumors (fewer side effects than systemic chemo)
to prevent tumor recurrence of superficial cancers
Instill BCG (tuberculosis vaccine in some countries) for 2 hours; Change patient’s position
Can cause bladder irritability, frequency, urgency, dysuria, hematuria
systemic chemo for bladder cancer
Systemic chemotherapy used for advanced disease to prolong life
bladder cancer mets locations
liver
lung
bone
