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Flashcards in bladder cancer Deck (20):
1

urothelial cancer

Includes malignant tumors of the urothelium which lines the kidneys, renal pelvis, ureters, bladder and urethra
72% of tumors are in the bladder
27% of tumors are in the kidney

2

bladder cancer

Tends to be recurrent
Multiple tumors common
Tumors range from papillomas (premalignant) to invasive carcinomas

3

bladder cancer risk factors

1. Smoking
2. Exposure to chemicals used in rubber, paint/dye, textile, leather, and electric cable industries
3. Parasitic infection

4

bladder cancer clinical manifestations

1. Painless hematuria
a. Predominant fining
b. May be intermittent
c. Gross or microscopic
2. Frequency, urgency, or dysuria
a. Accompanies infection or obstruction

5

bladder cancer diagnostics

urinalysis
CT Scan
MRI
Ultrasound (less valuable)
Intravenous pyelogram (IVP- check for shellfish/iodine allergy)

6

surgical management for superficial, low grade or papillary tumors (bladder cancer)

Simple excision (TURBT) transurethral resection/removal of bladder tumor
Partial Cystectomy

7

surgical management for invasive bladder cancer

Complete (radical) cystectomy with urinary diversion

8

radical cystectomy

Removes bladder, urethra, uterus, prostate & seminal vesicles/uterus & fallopian tubes & ovaries, lymph node

9

Simple excision (TURBT) transurethral resection/removal of bladder tumor

1. Bladder irrigation- solution (NS or Sorbitol) continuously that enters through a 3-way catheter to flush the bladder to prevent an obstruction (allows for patency) until the bleeding subsides

10

partial cystectomy

1. Isolated tumors
2. Up to ½ of bladder can be removed
3. Post-op bladder can expand to increase capacity
4. Painful spasms

11

Ureterostomies

1. Brings ureter(s) to abdomen with stoma(s)
2. UTIs common due to reflux (urine that flows backward)

12

Ileal Conduit (Ureteroileostomy)

1. Use terminal ileum (least absorptive bowel) and connect ureters
2. Easier to construct vs. other methods
Increased risk of pyelonephritis, calculi & hydronephrosis (fluid buildup in the kidneys due to an obstruction of urine flow)

13

considerations for ileal conduit

1. Must wear an appliance
2. Require meticulous skin care and assessment for leakage

14

kock pouch

Reservoir created from ascending colon & terminal ileum with a valve to prevent reflux;
1. Uses self-cath. postop to drain reservoir
2. Requires longer surgery (8-10 hours)
3. Contraindicated if bowel disease

15

complications of surgical management for bladder cancer

1. Incontinence
2. Leakage at anastomosis site
3. Obstruction of ureters
4. UTIs
5. Erectile Dysfunction

16

bladder cancer post op care

1. Monitor outputs (edema of stoma can occur)
a. Stool production may not occur for a few days, urine output will be immediate
2. Urine may initially be bloody
3. Mucous in urine is normal discharge from intestinal loop
4. NG for decompression until return of peristalsis
5. Check stoma color (if black or gray-necrosis)
6. Teaching emptying and changing of urostomy appliance

17

bladder cancer radiation

1. In combination with surgery
2. For palliation to prolong life, increase comfort

18

Intravesical Chemo for bladder cancer

(directly into the bladder) in combination with surgery for early stage tumors (fewer side effects than systemic chemo)
to prevent tumor recurrence of superficial cancers
Instill BCG (tuberculosis vaccine in some countries) for 2 hours; Change patient’s position
Can cause bladder irritability, frequency, urgency, dysuria, hematuria

19

systemic chemo for bladder cancer

Systemic chemotherapy used for advanced disease to prolong life

20

bladder cancer mets locations

liver
lung
bone