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Bladder Cancer

Presented by: Ms. Krantee More.

INTRODUCTION

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GENERAL OBJECTIVE:

 To gain in depth knowledge regarding CANCER OF URINARY BLADDER .

SPECIFIC OBJECTIVES:

 SPECIFIC OBJECTIVES: After completing the seminar students will be able to:  Enumerate the etiological factors of urinary bladder cancer (ca. bladder),  Illustrate clinical manifestations.

 Describe the management of Ca bladder  To enlist the complications occurring due to same disease

DEFINATION

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Bladder cancer is a cancerous tumor in the bladder -- the organ that holds urine

Epidemiology of Bladder CA

 4 th most common CA in men, 9 th in women,  Annual New Cases = 68,810 (51,230 in M & 17,580 in F)  M:F = 3:1  Annual Deaths = 14,100 (7,750 in M & 4,150 in F)

Risk Factors for Bladder CA

 Age, Gender, Race  Cigarette smoking (2-4x higher relative risk)  Exposures to environmental carcinogens:   Occupational - Polycyclic aromatic hydrocarbons,benzene, exhaust from combustion gases, aryl amines dry cleaners; manufacturers of preservatives, dye, rubber, & leather; pesticide applicators; painters; truck drivers; hairdressers; printers; machinists  Pelvic radiation therapy  Arsenic (eg. in drinking H2O)

Risk Factors for Bladder CA

 Infections  Schistosoma haematobium (N Africa)  squamous & transitional cell CAR  Inc’d risk for Chronic UTIs, chronic bladder stones, indwelling Foleys  inc’d risk for squamous cell CAR  Other     Prior h/o bladder CA Low fluid intake (inc’d exposure to carcinogens via dec’d bladder emptying) Genetics (eg, Retinoblastoma gene) Bladder birth defects (eg, persistent urachus)  for adenocarcinoma.

inc’d risk

ANATOMY AND PHYSIOLOGY

Pathophysiology

Clinical Manifestations of Bladder CA

 Hematuria (80-90%) – Generally painless and gross hematuria  However, 20% can have only microscopic hematuria  Other urinary Sxs  Frequency, urgency, nocturia – d/t irritative Sxs or dec’d bladder capacity  Pain (less common & often reflects tumor location)   Lower abdominal pain – Bladder mass Rectal discomfort & perineal pain – Invasion of prostate or pelvis.  Flank pain - Obstruction of ureters

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 Lower extremity edema from iliac vessel compression,  Physical: occasionally an abdominal or pelvic mass may be palpable.

Dx of Bladder CA

 Pts w/ hematuria, especially if > 40 yrs  Urinary Cytology- microscopy, culture to rule out infection,  USG- abdomen & pelvis,  CT abdomen & pelvis with preinfusion & post infusion phases,  Cystoscopy, regardless of cytology results (mainstay of dx)

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 Retrograde pyelography in patients in whom contrast CT scan can’t be performed because of azotemia or due to severe allergy to IV contrast,  Transurethral resection of all visible tumors to determine histology & depth of invasion  Biopsies of erythematous (& possibly normal) areas to assess for CIS

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STAGES

Stage 0 -- Non-invasive tumors that are only in the bladder lining

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*Stage I -- Tumor goes through the bladder lining, but does not reach the muscle layer of the bladder

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*Stage II -- Tumor goes into the muscle layer of the bladder

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*Stage III -- Tumor goes past the muscle layer into tissue surrounding the bladder

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*Stage IV -- Tumor has spread to neighboring lymph nodes or to distant sites (metastatic disease)

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Stage V--*Prostate 2)Rectum 3)Ureters 4)Uterus 5)Vagina 6)Bones 7)Liver 8)Lungs

Treatment: Medical

(Ta, T1, CIS): non muscle invasive

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Intravesical immunotherapy:

 Indications Adjuvant tx w/ resection to prevent recurrence  Eliminate disease that cannot be controlled by endoscopic resection alone (less common)  Recurrent disease, > 40% involvement of bladder surface, diffuse CIS, T1 dz  Generally not needed for solitary papillary lesions

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 Agents  Std agent -- BCG   Generally 6 weekly txs then monthly maintenance x 1-3 yrs Toxicities = Bladder irritability / spasm, hematuria, dysuria, & rarely systemic TB  Other agents – Mitomycin-C, Interferon, Gemcitabine

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For muscle invasive disease (T2 & greater)

Neo-adjuvant chemo x 12 wks prior to cystectomy  Inc’d 5-yr dz-free survival  MVAC (Methotrexate, Vinblastine, Doxorubicin, Cisplatin) – 3 cycles q 28 days

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Surgical Rx: For Ta, T1, CIS (non muscle invasive)

1. Endoscopic treatment:   TURBT- To dignose, to stage, to treat visible tumors.

Electrocautry or LASER fulguration of bladder is sufficient for low grade, small volume tumors .

2. Radical cystectomy: Patients withunresectable, prostatic urethra involvement & BCG failure are indications for this procedure.

Muscle invasive disease: T2 & greater

1. Radical cystoprostectomy: (men)  Remove the bladder, prostate & pelvic lymph nodes.

  After removal of bladder, urinary diversion must be created.

Types: Continent, Incontinent.

2. Radiation therapy: External beam radiation therapy has been shown to be inferior to radical cystectomy.

Complications:

 Body image disturbances,  Skin irritation,  Recurrence,  Infertility in women as uterus is removed,  Infertility in men if prostate is removed,  Menopause if ovaries are removed,  Sexual disturbances if vagina has been made shorter,  Metastasis to distant organs.

Nursing Diagnosis:

 Dysurea related to disease condition,  Disturbed sleep pattern due to urgency & frequency of micturition,  Acute pain related to disease condition,  Altered nutrition secondary to pain due to disease condition,  Anxiety related to surgery,  Disturbed body image related to surgery.

Research evidence:

 A research carried out by “ Yursh Xia 4 th military medical university ” states that, “Adjuvant Radiotherapy in addition to cystectomy also increases survival rates .”  A research by “ Dept of Urology Health Science, Centre West Virginia Morgan Town ” says that “Garlic can be used an immunotherapy besides BCG.”

SUMMARY

CONCLUSION

References

 Harrison’s Internal Medicine  Cecil Textbook of Medicine  Cancer: Principles & Practice of Oncology  National Cancer Institute website  American Cancer Society website

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THANK YOU