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URINARY TRACT CANCER
By :
Aan Nuraeni
NEOPLASTIC DISORDER OF THE URINARY TRACT
RENAL TUMOR
Symptoms
Early symptoms : no specific characteristic
Generalized symptoms : weight loss, weakness, and anemia
Classic manifestations : gross hematuria, flank pain and palpable mass advanced disease
Diagnosis studies
– Primary examination : IVP with nephrotomography
– Ultrasound (USG) : differentiate between a tumor and cyst
– Other common studies : angiography, percutaneuos needle aspiration, CT, and magnetic resonance imaging (MRI).
– Radionuclide isotope scanning is used to detect metastases
Treatment
– Treatment of choice is radical nephrectomy (Removal of the kidney, adrenal gland, surrounding fascia, part of the ureter, and draining lymph nodes)
– Radiation therapy is used palliatively when there are metastases to bone or lung.
– No effective chemotherapy is available for metastatic renal cell carcinoma
– Biologic therapy a interferon and interleukin-2 are most promising in treatment of metastatic disease.
WILMS’ TUMOR
Definition
Wilms’ Tumor is a common renal tumor of infants and children. 40 % are hereditary, with an autosomal dominant mode of transmission.
Clinical Manifestation
• Abdominal swelling or distension (most common)
• Pain
• Fever
• Hematuria
• Hypertension
Diagnostic Studies
• Ultrasound
• Renal arteriography
Treatment
• These tumors respond well to multymodality therapy, include :
Surgical removal of the involved kidney
Radiation therapy ( it is used postoperatively, and for inoperable tumors, bilateral tumors, and metastase)
Chemotherapy
BLADDER CANCER
Introduction
• The most frequent malignant tumor of the urinary tract is transitional cell carcinoma of bladder.
• The most bladder tumors are papillomatous growths within the bladder.
Risk Factors
• ages ( > 60 y), • men (3 times more risky) • cigarette smoking • exposure to dyes used in
the rubber and cable industries
• chronic abuse of phenacetin-containing analgetics
• women treated with radiation for cervical cancer
• patients receiving cyclophosphamide (cytoxan)
• Reccurent stones (often bladder)
• Chronic lower urinary infections (indwelling catheters for long periods can develop the condition)
Clinical Manifestations
• Gross, painless hematuria (chronic or intermitten) is the most common finding and the first in 85 % to 90 % patients.
• Bladder irritability with dysuria, frequency, and urgency
• The clinical staging of carcinoma of the bladder is determined by the depth of invasion of the bladder wall and surrounding tissue
Diagnostic Studies
• When cancer is suspected, urine specimens for cytology can be obtained to determine the presence of neoplastic or atypical cells.
• Urine test : bladder tumor antigens.
• IVP, Ultrasound, CT, MRI
• Cytoscopy and biopsy
Collaborative therapy
• Surgical Treatment Transurethral resection
with fulguration
Laser Photocoagulation
Open loop resection of fulguration
Segmental cystectomy
Radical cystectomy
• Radiation
• Intravesical Immunotherapy Baccil Calmete-Guerin
(BCG)
• Intravesical Chemotherapy Thiotepa
Mitomycin
Doxorubicin
• Systemic chemotherapy
CANCER OF THE PROSTATE
Introduction
• Cancer of the prostate is the most common cancer in men.
• It is the second leading cause of cancer death in men, after lung cancer.
Etiology & Pathofisiologi
• Prostate cancer is an androgen –dependent adenocarcinoma
• Risk Factors : high fat diets and environmental factors, a family history of prostate cancer is a major factor risk (9%), and hormonal influence.
• A higher incidence exist in men 60 y age or older
Etiology & Pathofisiology…cont..
• The tumor is slow growing and usually begins in the prosterior or lateral portions of the prostate.
• It can spread by 3 route : direct extension; via lymphatics; and via the bloodstream.
• Direct extension is by continuity to the seminal vesicles, uretral mucosa, bladder wall & external sphincter.
• The cancer later spreads through the perineural lymphatic system to the regional lymph nodes.
• The veins from the prostate seem to be mode of spread to the pelvic bones, head of the femur, lower lumbar spine, liver and lungs.
Clinical Manifestations and Complication
• Prostate cancer is asymptomatic in the early stages, eventually the patient may have symptoms similar to those of BPH, including dysuria, hesitancy, frequency, urgency, hematuria, nocturia and retention.
• The prostate feels hard, enlarge, and fixed on rectal examination.
• The enlargement is usually unilateral • Pain in the lumbosacral area which radiates down
to the hips or legs when coupled with urinary symptoms may indicate metastasis
• The tumor can spread to the pelvic lymph nodes, bones, bladder,lungs, and liver.
• Once tumor has spread to distant sites, the major problem becomes the management of pain.
• As the cancer spreads to the bones, pain can become severe, especially in the back and legs because of compression of the spinal cord and osteoblastic lesions.
Diagnostic Studies
Diadaptasi dari : Monahan, F. D., Sands, J. K., Neighbors, M., Marek, J. F., & Green, C. J. (2007). Phipps' Medical Surgical Nursing: Health And Illness Persfective (Eighth ed.). Philadelphia: Mosby Elsevier
Diagnostic Studies..cont
• The normal blood range for PSA is 0 – 2,5 ng/ml
• Men whose PSA is between 1.0 – 2.0 ng/ml should have yearly retesting
• An increase in PSA of more than 0.70 ng/ml/yr, is associated with prostate cancer and a biopsy should be done
• PSA level > 4 ng/ml prostate cancer
Diagnostic Studies..cont
• The PSA test divided into 2 scores : a bound PSA and free PSA
• Low precentage of free PSA tends to indicate cancer prostate
Staging
Diadaptasi dari : Monahan, F. D., Sands, J. K., Neighbors, M., Marek, J. F., & Green, C. J. (2007). Phipps' Medical Surgical Nursing: Health And Illness Persfective (Eighth ed.). Philadelphia: Mosby Elsevier
Collaborative Care
Depends on the stage of the cancer. • Stage A :
– Continue medical follow up, observation, TURP or total prostatectomy
– Radiation therapy
• Stage B : – TURP – Total prostatectomy with
or without lymphadenectomy
– Radiation therapy
• Stage C : – Hormone manipulation (LH
releasing hormone analogues)or orchiectomy
– Radical resection of prostate
– Radiation therapy
• Stage D : – Hormone therapy – Radiation to metastatic
bone areas – chemotherapy
Collaborative care..cont..
Radiation Therapy
• Radiation therapy is commonly used in the management of prostate cancer, especially in men over age 70. as compared with surgery there is a reduce risk of erectile dysfunction.
• Potential side effects of radiation include diarhea, cystitis, and erectile dysfunction
• Radiation therapy may also be combined with the antiandrogen agents such as goserelin (zoladex)
Collaborative care..cont..
Surgical Therapy :
• Suprapubic prostatectomy
• Retropubic prostatectomy
• Perineal prostatectomy
Nursing Diagnoses
• Decisional conflict related to numerous alternative treatment option
• Pain related to surgery, prostatic enlargement, bone metastasis, and bladder spasms
• Altered urinary elimination related to bladder neck sphingther damage
• Sexual disfunction related to effect treatment • Anxiety related to uncertain outcome of disease
process on life and lifestyle and effect of treatment on sexual functioning
Planning
The overall goals are that the patient will :
1. Be an active participant in the treatment plan
2. Have satisfactory pain control
3. Follow the therapeutic plan
4. Accept the effect of the theurapeutic plan on sexual function
5. Find a satisfactory way to manage impact of bladder or bowel function
Nursing implementation