Urothelial (Bladder) Cancer PDF

Urothelial (Bladder) Cancer Urothelial (Bladder) Cancer - malignant tumors of the urothelium. ○ Urothelium - the lining of transitional cells in the kidney, renal pelvis, ureters, urinary bladder, and urethra. ○ AKA bladder cancer because most of these cancers occur in the bladder. ○ Low grade → les...

Urothelial (Bladder) Cancer Urothelial (Bladder) Cancer - malignant tumors of the urothelium. ○ Urothelium - the lining of transitional cells in the kidney, renal pelvis, ureters, urinary bladder, and urethra. ○ AKA bladder cancer because most of these cancers occur in the bladder. ○ Low grade → less likely to grow, spread and return after treatment ○ Multifocal in bladder-growth pattern - more than one tumor arising from one original tumor. Risk Factors: CEE S F ○ Chemical exposure → hair dyes, rubber, paints, etc. ○ Exposure to gas and diesel fuel ○ Excessive alcohol ○ Smoking ○ FGFR2, FGFR3 genes FGFR2 protein - supports bone growth, particularly during development before birth (embryonic development). Signals certain immature cells in the developing embryo to become bone cells and form the head, hands, feet, and other tissues. FGFR3 gene - provides instructions for making fibroblast growth factor receptor 3 (protein). Part of a family of 4 fibroblast growth factor receptors that share similar structures and functions. Signs and Symptoms ○ Painless hematuria → First symptom (Beets and medication [Rifampin] can cause urine to be red) Primary Prevention: SAR ○ Smoking cessation ○ Alcohol cessation ○ Reducing exposure to chemicals, gas, and diesel fuel. Secondary Prevention ○ Genetic testing ○ Cystoscopy with Biopsy - Definitive test Cystoscopy - procedure to look inside the bladder using a thin camera called a cystoscope. Looks at bladder similar to endoscopy/colonoscopy + biopsy of tumor ○ Female cystoscopy example = https://www.youtube.com/watch?v=7mWw9ryxC_k = https://www.youtube.com/watch?v=tTcU66I4fUU ○ Male cystoscopy example Tertiary Prevention ○ Surgery → Can excise tumor ○ ○ ○ Types: Ileal Conduit - Transurethral resection of bladder for small tumors ○ Involves Cystectomy - Complete bladder removal. ○ Creates Neobladder - Continent reservoir; intestinal graft. Made from large intestines Sewn together to form a pouch Requires functioning urethra. ○ Ureter opening brought to skin. ○ Will have a drain. ○ Irrigate to be sure it’s patent. ○ Patient will not feel bladder fullness. Nursing Care: Concern over extreme weight loss first weeks after surgery Maintain tissue integrity Diet → Don’t want gas producing foods, or can get incontinence How to use pouches, adhesives, emptying (usually q 2-5 hrs.) Emotional, body image, sexual issues, social problems Radiation Therapy Chemotherapy Intravesical Chemotherapy - First treatment Chemo is directly put into the bladder. Bladder instillation of BCG /live virus compound. ○ BCG - Helps to stop or delay bladder cancers growing back or spreading into the deeper layers of the bladder. Contains a weakened bacteria used as a medicine. Used in undeveloped countries to help stop TB (not a true vaccine but will help for a short period of time). Indwells for about 2 hours, then patient urinates and expels live virus Can’t share toilet with others for 24 hours Clothes in contact with urine must be bagged and eliminated After 24 hours toilet must be cleaned with bleach No intercourse for 24 hours Can be painful afterwards for patient Cisplatin - chemotherapy drug Side Effects: High risk of emesis ( > 90%) Nephrotoxicity risk Pre-treatment hydration = 1-2 liters of fluid to maintain urinary output of 100 ml/hr. Monitor: IV site to avoid extravasation. CBC with differential & platelet count For hearing loss For weight loss = 10% decrease in weight → notify HCP may need to adjust dosage.