bladder cancer

Question 1

urothelial cancer

Answer 1

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

Question 2

bladder cancer

Answer 2

Tends to be recurrent
Multiple tumors common
Tumors range from papillomas (premalignant) to invasive carcinomas

Question 3

bladder cancer risk factors

Answer 3

1. Smoking
2. Exposure to chemicals used in rubber, paint/dye, textile, leather, and electric cable industries
3. Parasitic infection

Question 4

bladder cancer clinical manifestations

Answer 4

1. Painless hematuria
   a. Predominant fining
   b. May be intermittent
   c. Gross or microscopic
2. Frequency, urgency, or dysuria
   a. Accompanies infection or obstruction

Question 5

bladder cancer diagnostics

Answer 5

urinalysis
CT Scan
MRI
Ultrasound (less valuable)
Intravenous pyelogram (IVP- check for shellfish/iodine allergy)

Question 6

surgical management for superficial, low grade or papillary tumors (bladder cancer)

Answer 6

Simple excision (TURBT) transurethral resection/removal of bladder tumor
Partial Cystectomy

Question 7

surgical management for invasive bladder cancer

Answer 7

Complete (radical) cystectomy with urinary diversion

Question 8

radical cystectomy

Answer 8

Removes bladder, urethra, uterus, prostate & seminal vesicles/uterus & fallopian tubes & ovaries, lymph node

Question 9

Simple excision (TURBT) transurethral resection/removal of bladder tumor

Answer 9

1. 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

Question 10

partial cystectomy

Answer 10

1. Isolated tumors
2. Up to ½ of bladder can be removed
3. Post-op bladder can expand to increase capacity
4. Painful spasms

Question 11

Ureterostomies

Answer 11

1. Brings ureter(s) to abdomen with stoma(s)

2. UTIs common due to reflux (urine that flows backward)

Question 12

Ileal Conduit (Ureteroileostomy)

Answer 12

1. Use terminal ileum (least absorptive bowel) and connect ureters
2. Easier to construct vs. other methods
   Increased risk of pyelonephritis, calculi & hydronephrosis (fluid buildup in the kidneys due to an obstruction of urine flow)

Question 13

considerations for ileal conduit

Answer 13

1. Must wear an appliance

2. Require meticulous skin care and assessment for leakage

Question 14

kock pouch

Answer 14

Reservoir created from ascending colon & terminal ileum with a valve to prevent reflux;

1. Uses self-cath. postop to drain reservoir
2. Requires longer surgery (8-10 hours)
3. Contraindicated if bowel disease

Question 15

complications of surgical management for bladder cancer

Answer 15

1. Incontinence
2. Leakage at anastomosis site
3. Obstruction of ureters
4. UTIs
5. Erectile Dysfunction

Question 16

bladder cancer post op care

Answer 16

1. Monitor outputs (edema of stoma can occur)
   a. Stool production may not occur for a few days, urine output will be immediate
2. Urine may initially be bloody
3. Mucous in urine is normal discharge from intestinal loop
4. NG for decompression until return of peristalsis
5. Check stoma color (if black or gray-necrosis)
6. Teaching emptying and changing of urostomy appliance

Question 17

bladder cancer radiation

Answer 17

1. In combination with surgery

2. For palliation to prolong life, increase comfort

Question 18

Intravesical Chemo for bladder cancer

Answer 18

(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

Question 19

systemic chemo for bladder cancer

Answer 19

Systemic chemotherapy used for advanced disease to prolong life

Question 20

bladder cancer mets locations

Answer 20

liver
lung
bone