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Nursing 172 > Week 13: Chp 63: Bladder Cancer > Flashcards

Week 13: Chp 63: Bladder Cancer Flashcards

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1
Q

Most important risk factor for Bladder cancer

A

smoking

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2
Q

Risk factors for Bladder Cancer

A

aromatic amine exposure from the rubber and chemical industries, polycyclic aromatic hydrocarbon exposure from the coal and aluminum industries, chronic infection or inflammation from chronic catheter use, or incomplete bladder emptying
-In some third-world countries, schistosomiasis, a parasitic infection, is the leading risk factor

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3
Q

Pathophysiology of Bladder Cancer

A

tumor formation in bladder cancer is attributed to genetic changes in target cells

  • target cells are normal cells of the body that have undergone some alteration, synthesize abnormal proteins, and then undergo malignant changes
  • the process is thought to be caused by the activation of oncogenes (genes that when altered promote the uncontrolled proliferation of cancer cells) that act in one of two ways: by inactivation of tumor suppression genes or by activation of genes that cause cells to grow in a rapid, random manner
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4
Q

What system is used for staging all types of cancer

A

The tumor, nodes, metastasis (TNM) staging system

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5
Q

Bladder Cancers are classified as?

A
  • non-muscle invasive cancer (T1), affecting the inner lining of the bladder (urothelium)
  • muscle invasive cancer (T2-T4), the cancer has extended through the urothelium and into the detrusor muscle
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6
Q

Most common presenting symptoms of bladder cancer

A

painless hematuria

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7
Q

Diagnostic Tests

A
  • urine cytology
  • blood and urine tests (to look for tumor markers)
  • urine cultures (to rue out infection)
  • cystoscopy (this is coupled with a biopsy of any lesions that are discovered during the examination)
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8
Q

What diagnostic test is used to make a definitive diagnosis?

A

cystoscopy

-examination of the bladder with a scope

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9
Q

Imaging Studies

A

-CT
-magnetic resonance imaging (MRI)
-positron emission tomography
-ultrasound
>these may be used to determine whether there is spread of the cancer outside the bladder

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10
Q

Drug therapy for low-grade bladder cancers

A
  • topical therapy or installations of solutions into the bladder, intravesical therapy
  • this can be either intravesical immunotherapy or chemotherapy
  • Intravesical immunotherapy, such as bacille Calmette-Guerin (BCG), is aimed at “jumped starting” the body’s own immune defenses to battle the invasion of cancer
  • Intravesical chemotherapy instills medications given to kill actively growing
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11
Q

Intravesical Immunotherapy; Bacille Calmette-Guerin (BCG)

A

used for low-grade bladder cancers

-aimed at “jump starting” the body’s own immune defenses to battle the invasion of cancer

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12
Q

Intravesical Chemotherapy

A

used for low-grade bladder cancers

-instills medications given to kill actively growing cancer cells

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13
Q

Treatment for later-stage bladder cancer

A

-systemic immunotherapy

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14
Q

Systemic Immunotherapy

A

treatment for later-stage bladder cancer

  • in a healthy individual, “check point” molecules keep the immune system from attacking the body’s normal cells; cancer cells avoid being attacked by the immune system by using these checkpoint molecules
  • systemic immunotherapy targets checkpoint molecules
    ex: atezolizumab (Tecentriq), durvalumab (Imfinzi), avelumab (Bavencio), nivolumab (Opdivo) and pembrolizumab (Keytruda)
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15
Q

Management and Treatment for high-grade metastatic bladder cancer

A
  • precision medicine

- target therapy (individuals with cancers that are likely to recur are candidates)

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16
Q

Target Therapy

A
  • used for high-grade metastatic bladder cancer
  • directed at changes in cells that cause them to become cancer: lapatinib (Tykerb) and erlotinib (Tarceva)
  • this therapy may also target blood vessels that carry nutrition to the cancer cells using antiangiogenesis drugs; ex: bevacizumab (Avastin), Sorafenib (Nexavar), cabozantinib (Cometriq), and pazopanib (Votrient)
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17
Q

Safety Alert for Bacille Calmette-Guerin

A

its a live, weakened bacterium
-to ensure that others are not infected by the bacteria, after voiding following treatment, the patient should pour 2 cups of bleach into the toilet and allow it to sit for 20 minutes before flushing

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18
Q

Surgical Interventions for low-grade bladder cancers consist of?

A

excision or removal of the tumor through fulguration or laser ablation
>fulguration destroys the tumor by using high-frequency electrical current
>laser ablation destroys tissue by irradiating it with a laser beam

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19
Q

Fulguration

A

used for low-grade bladder cancers

-destroys the tumor by using high-frequency electrical current

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20
Q

Laser ablation

A

for low-grade bladder cancers

-destroys tissue by irradiating it with a laser beam

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21
Q

What is done prior to treatment

A

a biopsy is done to determine the depth of the invasion

  • intravesical chemotherapy may be given before surgical excision (neoadjuvant) or after surgical excision (adjuvant)
  • radiation is indicated postoperatively
22
Q

Muscle-invasive bladder cancer treatments

A
  • “bladder preservation” (may be combined with radiation and/or chemotherapy)
  • Chemotherapy
  • radiation is indicated postoperatively in those patients who have solid tumor recurrence after cystectomy
23
Q

“Bladder preservation”

A

-used for muscle-invasive bladder cancer

-

24
Q

Chemotherapy

A

is indicated to downgrade tumors preoperatively or to help eradicate cancer that has spread beyond the bladder either grossly (visible to the eye) or microscopically through the lymphatic system

25
Q

Radiation is indicated postoperatively for which patients?

A

in those patients who have solid tumor recurrence after cystectomy

26
Q

Radical Cystectomy combined with neoadjuvant chemotherapy

A
  • another approach for surgical management of invasive bladder cancer
  • considered to be the definitive approach; offers the best chance of cure or extension of the disease-free state
  • in males its called radical cystoprostatectomy
  • in females its called radial cystectomy or anterior exenteration
27
Q

Radical Cystoprostatectomy

A

radical cystectomy combined with neoadjuvant chemotherapy

  • procedure for males
  • surgical management of invasive bladder cancer
  • removal of bladder, prostate, seminal vesicles, lower ureters, and in some cases the urethra
  • involve pelvic lymph node dissection
  • surgical management for invasive bladder cancer
28
Q

Radical cystectomy or anterior exenteration

A

radical cystectomy combined with neoadjuvant chemotherapy

  • procedure for females
  • removal of the bladder, ovaries, fallopian tubes, anterior wall of the vagina, lower ureters, and often urethra
  • involve pelvic lymph node dissection
  • surgical management for invasive bladder cancer
29
Q

Urinary Tract Reconstruction Options

A
  • Ileal Conduit
  • Orthotopic Neobladder
  • Neobladder with Continent Catheterizable stoma
30
Q

Urinary Tract Reconstruction Options: Ileal Conduit

A

uses a short segment of ileum to provide a viaduct for the exit of urine from the body through a stoma on the abdomen
>Advantages: simplest “tried and true” procedure; fewest complications
>Disadvantages: external pouch, stoma; adhesives may cause skin irritation; lifelong equipment (pouches, drainage bag) required
>Bowel used: 10-15 cm of terminal ileum

31
Q

Urinary Tract Reconstruction Options: Orthotopic Neobladder

A

uses 20 to 30 cm of small intestine to create a bladder that is anatomically in the same position as the native bladder and uses the patient’s external sphincter for continence
>Advantages: no external pouch; most closely resembles “normal” urination
>Disadvantages: may require intermittent catheterization; may require physical therapy for sphincter training; may not achieve continence
>bowel used: 30 cm of ileum

32
Q

Urinary Tract Reconstruction Options: Neobladder with Catheterizable stoma

A

a neobladder with Catheterizable stoma and an internal pouch to collect urine
>Advantages: no external pouch; stoma often placed in umbilicus, not visible
>Disadvantages: stoma may not be continent; strictures at skin level may occur; catheter required to empty the internal pouch at regular intervals; option most fraught with complications

33
Q

The nurse understands that non-muscle cancers affect only:
A. muscle and surrounding fat
B. the urothelium, or inner lining of the bladder
C. structures adjacent to the bladder
D. the lobes of the prostate

A

B. the urothelium, or inner lining of the bladder

34
Q

Disease process complications

A

bleeding from friable tumors in the bladder or pain caused by impingement of other organs by the tumor

35
Q

Treatment related complications

A

lasting side effects from chemotherapy, such as peripheral neuropathy (a result of damage to the nerves outside of the brain and spinal cord (peripheral nerves), often causes weakness, numbness and pain, usually in your hands and feet), or hemorrhagic cystitis from radiation

36
Q

Complications from Surgery

A

bowel obstruction, fistula formation (sores or ulcers), hernia development in the surgical site, and complications/ disadvantages specific to the type of reconstruction of the urinary tract

37
Q

Assessment and Analysis: Clinical manifestations and what they are associated with

A

associated with treatment side effects and the emotional factors associated with the diagnosis

  • fatigue and poor nutritional intake may be associated with chemotherapy
  • antibiotic side effects such as lowered hemoglobin and hematocrit, nausea, and oral thrush
  • decreased appetite and a flat affect associated with depression secondary to poor prognosis and a change in body image
  • painless hematuria, which may be gross (visual to the eye) or microscopic, is the most common presenting symptom of bladder cancer
  • may have irritative voiding symptoms (frequency, urgency, nocturia) which may be due to the presence of a tumor in the bladder
38
Q

Nursing Diagnoses

A
  • knowledge deficit associated with disease, diagnostics, and management options
  • alteration in elimination pattern associated with the effects of treatment on a continuum from irritative symptoms to reconstruction of the urinary tract
39
Q

Nursing Interventions: Assessments

A
  • vital signs

- urinalysis

40
Q

Assessments: Vital Signs

A
  • increased pulse and decreased blood pressure may indicate blood loss postoperatively
  • increased pulse, decreased blood pressure, and increased temperature may indicate infection
41
Q

Assessment: Urinalysis

A

hematuria may be present in bladder cancer

42
Q

Nursing Actions:

A
  • administer medications as ordered; intravesical immunotherapy, intravesical chemotherapy, immunotherapy, targeted therapy
  • continuous bladder irrigation (CBI)
  • accurate intake and output
43
Q

Actions: Administer Intravesical Immunotherapy

A

immunotherapy is used to aid the body’s natural defense against tumor growth

44
Q

Actions: administer Intravesical Chemotherapy

A

chemotherapy is used to destroy the tumor cells

45
Q

Actions: administer Immunotherapy (systemic)

A

systemic immunotherapy targets checkpoint molecules to allow for destruction of cancer cells

46
Q

Actions: Administer Targeted Therapy

A

target drug therapy is directed at changes in cells that cause them to become cancer or target blood vessels that carry nutrition to the cancer cells

47
Q

Actions: Continuous Bladder Irrigation (CBI)

A

CBI may be used after tumor excision or biopsy to clear blood and clots from the bladder and prevent obstruction

48
Q

Actions: Accurate intake and output

A

accurate bladder intake and output recording is essential to determine whether clots have cut off the flow of urine,
-if CBI is in place, true urine output= total fluid output minus amount of irrigant instilled

49
Q

Teaching: bladder cancer, treatment, and outcome

A

a cancer diagnosis is frightening

-increasing a patient’s knowledge helps him or her feel a measure of control and increases compliance

50
Q

Well-managed patient

A

has an effective pain management plan in place, is disease-free or symptom controlled, and is aware of the treatment course and options

  • anxiety is at an acceptable level as self-reported or reported by significant others
  • there is an awareness of ho to access support through peer and professional groups

Nursing 172 (120 decks)

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