Bladder Cancer

Group 6

Epidemiology

The incidence of bladder cancer is twice as high in white men as in black men. Incidence of bladder cancer increases with age, with the median age at diagnosis being 68 years, and is about 4 times higher in men than in women. Over the past 2 decades, the rate of bladder cancer has been stable in men but has increased in women by 0.2% a year. Bladder cancer is the fourth most common cancer in men in the United States, after prostate, lung, and colorectal cancer, whereas bladder cancer is not even among the top 10 cancers in women. Bladder cancer accounts for nearly 1 in every 20 cancer diagnosed.

Etiology and Risk factors:

Smoking

This is the biggest risk factor for bladder cancer. The longer a person smokes and the more cigarettes they smoke, the greater the risk.

Exposure to chemicals at work

These include chemicals previously used in dye factories and industries that worked with rubber, textiles, printing, gasworks, plastics, paints and chemicals.

Some other jobs have been linked to an increased risk of bladder cancer. Bus and taxi drivers Metal casters, machine setters and operators Leather workers Hairdressers Mechanics Miners Painters

Age
Its unusual for anyone under the age of 40 to get bladder cancer. It becomes more common as people get older

Infection
Repeated (chronic) urinary infections and untreated bladder stones have been linked with a less common type of bladder cancer called squamous cell cancer. People who are paralysed have more bladder infections and also a higher risk of getting this type of bladder cancer.

Gender
Bladder cancer is more common in men than in women.

Diabetes
People who have type 2 diabetes have a 40% increase in their risk of developing bladder cancer.

Bladder stones
Bladder stones are little lumps of calcium that can form in the urinary system. You can get kidney or bladder stones.

Diet and alcohol intake

A healthy diet may lower your risk of bladder cancer. High beta-carotene levels in the diet have been shown in one study to reduce bladder cancer risk in people who smoke. Selenium is a nutrient found in various foods and has also been shown to protect against bladder cancer in some studies.

Family history
If one or more of your immediate relatives have a history of bladder cancer, you may have an increased risk of the disease, although it's rare for bladder cancer to run in families.

Prevention
Don't smoke. Take caution with chemicals. Drink water throughout the day. Choose a variety of fruits and vegetables.

TNM Classifications

T: primary tumour

CIS very early, high grade, cancer cells are detected only in the innermost layer of the bladder lining

Ta the cancer is just in the innermost layer of the bladder lining T1 the cancer has started to grow into the connective tissue beneath the bladder lining

T2 the cancer has grown through the connective tissue into the muscle

T2a the cancer has grown into the superficial muscle T2b the cancer has grown into the deeper muscle

T3 the cancer has grown through the muscle into the fat layer

T3a the cancer in the fat layer can only be seen under a microscope (microscopic invasion) T3b the cancer in the fat layer can be seen on tests, or felt by your doctor during an examination under anaesthetic (macroscopic invasion)

T4 the cancer has spread outside the bladder

T4a the cancer has spread to the prostate, womb (uterus) or vagina T4b the cancer has spread to the wall of the pelvis orabdomen

CIS Ta T1

T2
T3

T4

The N stages of bladder cancer

There are four lymph node stages in bladder cancer. N0 no cancer in any lymph nodes N1: metastasis in a single lymph node 2 cm in greatest dimension N2: metastasis in a single lymph node >2 cm but not >5 cm in greatest dimension, or multiple lymph nodes, none >5 cm in greatest dimension N3: metastasis in a lymph node >5 cm in greatest dimension.

M: distant metastasis
MX: distant metastasis cannot be assessed M0: no distant metastasis M1: distant metastasis.

Histologic Classification
Grade 1: well differentiated - low

grade

Grade 2: moderately differentiated - medium

grade
Grade 3: poorly differentiated - high grade

Clinical Features

Blood in the urine Changes in bladder habits or irritative symptoms Frequency-short intervals Dysuria- burning sensation while passing urine Urgency -inability to hold the urine for any length of time after the initial desire to void Needing to strain (bear down) pain in the Bladder pain Bone pain or tenderness if the cancer spreads to the bone Fatigue

Diagnosing

CT scan MRI Bone scan

urine test Cystoscopy biopsy

Staging

Stage 0 (Papillary Carcinoma and Carcinoma in Situ)

Stage 0a is also called papillary carcinoma, which may look like tiny mushrooms growing from the lining of the bladder.
Stage 0 is is also called carcinoma in situ, which is a flat tumor on the 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 (prostate, seminal vesicles,uterus, or vagina).

Stage IV

cancer has spread from the bladder to the wall of the abdomen or pelvis . Cancer may have spread to one or more lymph nodes or to other parts of the body.

Tx modalities

Multimodality treatment The two primary treatment options for patients with bladder cancer is transurethral resection, systemic chemotherapy , cystectomy.

Prognosis
Many factors can affect a person's prognosis, including: The type and location of the cancer The stage of the disease (the extent to which the cancer has metastasized, or spread) Its grade (how abnormal the cancer cells look, and how quickly the cancer is likely to grow and spread) The person's age, general health, and response to treatment.

Medical Treatment

Transurethral resection Cystectomy

Partial cystectomy- removes only the portion of the bladder Radical cystectomy- remove the entire bladder

Laser photocoagulation Open loop resection Surgery to create a new way for urine to leave your body

Radical Cystectomy

Urostomy

Biological therapy (immunotherapy)

An immune-stimulating bacterium.

Bacille Calmette-Guerin (BCG)

Interferon

A synthetic version of an immune system protein.

Chemotherapy

Radiation therapy

Complications

obstruction of the kidneys. For instance, a partial cystectomy can damage the bladder, but the bladder will still be able to retain urine. After a total cystectomy, however, you will be completely without bladder, so you need another way to store and eliminate urine. Anemia Urethral stricture infertility for women menopause /some sexual dysfunction Men can also experience sexual dysfunction and infertility

Nursing Considerations

Risk for infection related to inadequate defenses, secondary and immune system (the effect of chemotherapy / radiation), malnutrition, invasive procedures.

Wash hands before taking action. Visitors are also encouraged to do the same. Maintain a good personal hygiene Monitor the temperature Examine all the systems to look for signs of infection Avoid / limit invasive procedures and maintain aseptic procedures Collaborative Give antibiotics when indicated.

Risk for Impaired Skin Integrity related to the effects of radiation and chemotherapy, immunologic deficits, decreased nutrient intake and anemia.

Assess the integrity of the skin to see any side effects of cancer therapy, wound healing observed. Instruct patient not to scratch the itch Change the position of the patient on a regular basis Give advise patients to avoid the use of skin creams, oils, powders without medical advice

Other considerations:

To relieve discomfort administer ordered analgesics for pain as necessary. Implement comfort measures and provide distractions that will enable the patient to relax. Monitor the patients intake and output. Question him regularly about changes in his urine elimination pattern to detect changes in his condition. Observe the patients urine for signs of hematuria (reddish tint to gross bloodiness).

Encourage the patient to express feelings and concerns about the extent of the cancer. Instruct the patient and the family about the types of treatment that are being planned for him. Teach the patient and family to recognize and to manage adverse effects of chemotherapy. Stress the importance of notifying the doctor if the patient develops signs and symptoms of urinary tract infection or other sudden changes in his condition.

Postoperatively:

Instuct the pt to drink large amount of fluid Self monitor of urine Encourage to have a sitz bath 2-3 times a day to promote muscle relaxation an reduce risk of urinary retention.

Definition of Terminologies:

Cystoscopy A procedure in which a lighted optical instrument called a cystoscope is inserted through the urethra to look at the bladder. Intravesical situated or occuring in the bladder

Transurethral resection Surgical removal of the prostate gland or bladder lesions by means of an endoscope inserted through the urethra, usually for the relief of prostatic obstruction or for treatment of bladder malignancies Urostomy Surgical construction of an artificial excretory opening from the urinary tract.

THE END