Bladder Cancer

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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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notes.nursium.com: Bladder Cancer
Bladder Cancer
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