Bladder and Kidney Cancer Flashcards Preview

Nursing > Bladder and Kidney Cancer > Flashcards

Flashcards in Bladder and Kidney Cancer Deck (34):
1

Bladder cancer (urothelial cancer)

• Malignant cancers of the urothelium
• Multifocal
• Highly invasive
• Most urothelial cancers occur in the bladder

2

Bladder cancer: risk factors

• Cigarette smoking
• Exposure to dyes/toxins
• Phenacetin containing analgesics
• Radiation therapy
• Cyclophosphamide (Cytoxan)
• Chronic recurrent stones• Chronic lower urinary infections
• Indwelling catheters

3

Bladder cancer S/S:

▫ Hematuria
▫ Dysuria
▫ Frequency
▫ Urgency

4

BC: DX

1. Urinalysis: gross or microscopic hematuria.
2. Bladder wash specimen and bladder biopsy.
3. IV urogram, CT, MRI.

5

BC: surgical management

• Cystectomy
- Radical surgery plus intravesical chemotherapy
• Transurethral resection or fulguration

6

Cystectomy : partial

▫ Resection of the portion of the bladder wall containing the tumor
along with a portion of normal tissue

7

Complete cystectomy

▫ Involves the removal of:
 Bladder, prostate, and seminal vesicles
 Bladder, uterus, cervix, urethra, and the ovaries

8

Transurethral resection or fulguration

▫ Used for the diagnosis and treatment of superficial lesions
▫ Used to control bleeding
▫ Tumor mass is excised
▫ The remaining portion of the tumor are cauterized

9

Ileal conduit

▫ Ureters are surgically placed in the ileum, Urine is collected in a
pouch
▫ Continent reservoirs or “neobladders” are being used

10

Uterosigmodoistomy

• Diverts urine to the large intestine, so no stoma is required
• Client excretes urine with bowel movements

11

Neobladder

internal reservoir created from part of the small intestine ; because it is connected to the urethra , the patient can learn to void normally.

12

BC: Nonsurgical management

• Radiation Therapy
• Chemotherapy
• Intravesical Therapy:
- Prophylactic immunotherapy with instillation of bacille Calmette Guerin (BCG)

13

Radiation therapy (local)

• Used with cystectomy
• May be used as the primary therapy
• Can be combined with systemic chemotherapy
Typical side effects:
▫ Inflammation of the rectum
▫ Incontinence
▫ Skin irritation

14

Chemotherapy (systemic)

1. Chemotherapy drugs:
▫ Cisplatin (Platinol)
▫ Vinblastin (Velban)
▫ Doxorubicin (Adriamycin)
▫ Methotrexate
2. Successful in prolonging life
3. Rarely results in a cure

15

Chemotherapy side effects

▫ Alopecia
▫ Anemia
▫ Thrombocytopenia (low platelet count )
▫ Mucositis
▫ Bruising/Excessive bleeding
▫ Neutropenia ( low count of WBC)

16

Immunotherapy

• Biological therapy
▫ Treatment is used to enhance the immune system’s ability to fight
disease

17

Bacille Calmette-Guérin (BCG)

▫ Used to prevent tumor recurrence of superficial cancers
▫ Stimulates the immune system rather than acting directly on
cancer cells in the bladder

18

BCG (local)

• Can be delivered directly into the bladder
• Usually initiated at weekly intervals
• Patient’s position can be changed every 15 minutes
• Sometimes used with interferon

19

BCG : side effects

▫ Inflammation of the bladder
▫ Inflammation of the prostate
▫ Flu-like symptoms
▫ Irritative voiding symptoms and hemorrhagic cystitis

20

BC: nursing diagnosis

• Altered pattern of urinary elimination
• Risk for altered skin integrity
• Risk for infection
• Body image disturbance
• Anxiety, anticipatory grieving
• Pain
• Ineffective breathing pattern
• Knowledge deficit

21

Nursing responsibilities

• Increase fluid intake
• Smoking Cessation Information
• Assess patient for secondary (UTI)
• Routine urologic follow-up
• Address fears and concerns
• Client education

22

Community- based care

• Electrolyte replacement
• Foods to avoid
• Self-care abilities
• Pouch application
• Skin care/Pouch care
• Drainage mechanisms
• Counseling
• United Ostomy Association
• American Cancer Society
• The wound, Ostomy, and Continence Nurses Society

23

Renal cell carcinoma

• Also known as adenocarcinoma of the kidney
• Account for about 28,800 new cases and 11,300 deaths annually
• 5 year survival rate is 60%
• Occurs twice as often in men than in women

24

Kidney cancer: risk factors

• Cigarette smoking
• Obesity
• Exposure to:
Asbestos,
Cadmium, and
Gasoline,
Lead
• HTN/Treatment for HTN

25

Kidney cancer: manifestations

▫ Weight loss
▫ Weakness
▫ Anemias
▫ Gross hematuria
▫ Flank pain
▫ Palpable mass

26

Kidney cancer complications

• Metastasis:
▫ Lungs, liver, and long bones (Common sites)
• Local extension of kidney cancer into the renal vein and vena cava
• Urinary tract obstruction

27

KC: DX

1. Urinalysis: show RBC
2. IV urogram: detect renal masses
3. CT with contrast or MRI: outline mass
4. Biopsy of the tumor

28

KC: Nonsurgical management

• Radiofrequency ablation
▫ Minimally invasive
▫ Effectiveness undergoing evaluation
▫ Not widely available
• Radiation Therapy
• Chemotherapy
• Biological response modifiers (BRMs)

29

Biological response modifiers (BRMs)

▫ Interferon (INF) (Most commonly used)
- Interferons have a direct antiproliferative effect on tumor cells.
▫ Tumor necrosis factor (TNF)

30

KC: Surgical management

• Nephrectomy: Kidney removal
• Radical nephrectomy
▫ Removal of the kidney, adrenal gland, surrounding fascia, part of
the ureter, and draining lymph nodes.

31

Nephrectomy : Preoperative care

▫ Instruct the client about surgical routines
▫ Probable site of incision
▫ Presence of dressings, drains or other equipment
▫ Reassure client about pain relief

32

Nephrectomy :Operative procedure

▫ Positioning
▫ Trunk area flexed to increase exposure to the kidney area
▫ Removal of the 11th or 12thrib
▫ Nephrectomy
▫ Radiation therapy

33

Nephrectomy: Postoperative care

▫ Assess for hemorrhage and adrenal insufficiency
▫ Inspect abdomen for distention from bleeding, check linens under
the client
▫ Second kidney: Assess urine output for the first 24 hours after surgery
▫ Drain may be placed near the surgical site to remove residual fluid
▫ Complications: Atelectasis/Pneumonia
• Pain management: Opioid analgesics (hydromorphone and morphine
sulfate)
• Prevention of complications: Antibiotics

34

Ileal reservoir: Kock's pouch

divert urine into surgically created pouch, or pocket that functions as a bladder. The stoma is continent, and the patient removes urine by regular self catheterization. Teach how to use the catheter to drain the pouch.