Epidemiology:
·
Most
common tumor of the urinary tract
·
Incidence
rate is high in African countries, where schistosomiasis is endemic
·
Male
> female
Etiology/risk
factors:
·
Exposure
to aromatic amines: 2-napthylamine, 4- Aminobiophenyl, benzidine,
chlornaphazine. These chemicals are used in textile, rubber, cable, paint and
printing industry
·
Cigrette
smoking
·
Occupations:
aluminium workers , motor vehicle operators, dry cleaners , chemical workers,
pesticide applicators,miners and cooks.
·
Truck
and bus drivers due to fuel exhaust exposure
·
High
consumption of fried meat and fatexposure to drugs : cyclophosphamide
·
Pelvic
radiation
Parasitic
infection with shistosoma haemotobium
·
Recurrent
UTI
Types:
·
Transitional
cell carcinoma (TCC): papillary ca(most Common), flat ca
·
Squamous
cell ca
·
Adenocarcinoma
·
Sarcoma
Staging:
·
Stage
0 (ca in situ) cancer cells are found in tissue lining the inside of the
bladder
·
Stage
I: cancer has formed and spread to the layer of tissue under the inner lining
of the bladder
·
Stage
II- cancer has spread to either the inner half or outer half of the muscle wall
of the bladder
·
Stage
III- cancer has spread from the bladder to the fatty layer of tissue surrounding
it and may have spread to the reproductive organs
·
Stage IV:
cancer has spread from the bladder to the wall
of the abdomen or pelvis and one
or more lymph nodes or to other parts of body
Signs
and symptoms
·
Microscopic
or gross pain less hematuria(chronic or intermittent) with or without bladder
irritability
·
Bladder
irritability: dysuria,frequency ,urgency
·
Symptoms
of UTI
·
Urinary
hesistancy , decreased in stream force.
·
Flank
pain , due to hydronephrosis
·
In
metastasis: back pain, rectal and supra pubic pain
Diagnosis:
·
History
and physical examination
·
Urine
analysis
·
Urinr
cytological studies
·
IVP
·
Cystoscopy
with biopsy
·
USG
·
CT
Prevention:
·
Smoking
cessation
·
Identification
and screening the hig risk population
·
Urine
cytology as screening
·
Educational
regarding signs and syptoms for the patients undergoing pelvic radiation and
cytotoxic therapy
Management
:
Surgery:
·
Bladder
preservation surgeries: transurethral resection (TUR) with fulguration, TURBT
(transurethral resection of bladder tumor), laser ohotocoagulation, open loop
resection and fulguration
·
Cystectomy:segmental
, partial , total
Radiation
therapy:
·
Used
along with cystectomy
·
Used
as primary therapy when cancer is inoperable or when surgery is refused
·
Used
in combination with chemotherapy
Chemotherapy:
·
Used
preoperatively, before radiation therapy or in metastasis
·
Drugs:
cisplatin, vinblastin, doxorubiucin, methotrexate
Intravesical
therapy :
·
Instilation
of chemotherapeutic or immune stimulating drugs directly into the bladder
through urethral catheter and retained for about 2 ours
·
Weekly
for 6 to 12 weeks
·
Empty
the bladder before the treatment and position to be changed every 15 minutes
for maximum contact in all the areas of bladder
Nursing
Management:
·
Instruct
to drink large volume of fluids post operatively
·
Avoid
intake of alchoholic beverages
·
Educate
to self monitor the urine color
·
Sitz
bath 2-3 times a day to promote muscle
relaxation and to reduce the risk of urinary retention
·
Pain
management
·
Stool
softners
·
Stressing
the need of routine urologic follow up
·
Address
the concerns about sexual activity and baldder functions
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