Nursing care of the patient

with“Bladder cancer”Mrs. Shaina Sharma

R.N, MSc. N

Invasive bladder cancer : spread to

lymph nodes, other organs in

the pelvis or other organs

(liver and lungs)

Begins in the lining of the

bladder & spread through the lining into the muscular

wall of the bladder.

Rapid, uncontrolled

growth of abnormal cells in

the bladder

INCIDENCE

• In India bladder cancer is the fifth most common cancer In men according to Delhi based registry with age adjusted incidence rate of 5.8/100,000

• Incidence is much lower in females 1.5 cases/100,000

• Male to female ratio= 8.6:1

High urinary pH

High cholesterol

intake

Pelvic radiation therapy

Cancers arising from

prostrate, colon & rectum

In the Western world, tobacco use is the single most important cause of bladder cancer, accounting for an estimated 40-70% of all cases.

Smokers' risks of bladder cancer are 2-3 times higher compared to nonsmokers

90% of bladder cancers are transitional cell carcinoma. The other 10% are squamous cell carcinoma, adenocarcinoma, sarcoma, small cell carcinoma, 

CLASSIFICATION

STAGES OF BLADDER CANCER

Stage T1-4N1-2M1-2: Cancer spread out of abdomen/pelvic wall to lymph nodes or distant organs like liver, lungs, or bones.

Stage T4: Cancer penetrated into the adjacent structures (prostate, uterus, or vagina). Regional lymph nodes not involved yet.

Stage T3: Cancer penetrated through muscular bladder wall into the surrounding fat.

Stage T2: Cancer penetrated the muscular bladder wall.

Stage T1: Cancer penetrated into the submucosal tissue.

Stage CIS: Flat cancer limited to the innermost lining of the bladder. It is high grade.

Hematuria

Urinary tract infection

• Pain with metastasis

• Any change in voiding/urine

PHYSICAL EXAMINATION

URINALYSIS URINE CYTOLOGY

CYSTOSCOPY

CT SCAN PYELO-

GRAPHY

BIOPSY ULTRASOUND

Stop smoking

Avoid exposure to industrial chemicals

Avoid exposure to arsenic

Eat healthy food

Adequate fluid intake

MANAGEMENT

Depends on:-

Grade of tumor Stage of tumor Multicentricity

SURGICAL MANAGEMENT

Transuretheral resection

Cystectomy

Intra venous

TopicalIntra vesical

Intra-vesical BCG effective in:

Superficial transitional cell

carcinoma

Carcinoma in situ

Decreasing tumor progression

Radiation treatment can be used:

As part of the treatment for early stage bladder cancer, after limited surgery

As the main treatment for people with early stage cancers who can’t have surgery

As part of the treatment for advanced bladder cancers

To help prevent or treat symptoms caused by advanced bladder cancers

•Transurethral resection•Chemotherapy•Radiotherapy

Trimodality therapy

Treating hematuria

Hydrostatic therapy

Instillation of formalin, phenol or silver nitrate

Photodynamic therapy (PDT)

Targeted therapies

Gene therapy

Other modalities of treatment…..

COMPLICATIONS

Regional metastasis

through pelvis

Metastasis to liver, lungs

and bone

NURSING ASSESSMENT

HEMATURIA

IRRITATIVE VOIDING

SYNDROME

RISK FACTORS

WEIGHT LOSS

FATIGUE

SIGNS OF METASTASIS

COPING ABILITY

KNOWLEDGE OF DISEASE

FEELINGS ABOUT

IMPOTENCE

ASSESSMENT CONT……

NURSING DIAGNOSIS

Impaired urinary

elimination related to

hematuria and transuretheral

surgery

Acute pain related to irritative voiding

symptoms and catheter related

discomfort

Anxiety related to diagnosis of

cancer

NURSING CARE/NURSING INTERVENTIONS

Maintaining urinary

elimination after TUS

Controlling pain

Relieving anxiety

PATIENT TEACHING

• Irritative voiding symptoms & Intermittent hematuria after TUR

• Follow up schedule • Yearly cystoscopy

Advise the

patient about:-