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bladder cancer, its incidence, etiology, clinical manifestations, diagnosis, medical nand nursing management are included in this ppt.
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Nursing care of the patient
with“Bladder cancer”Mrs. Shaina Sharma
R.N, MSc. N
Invasive bladder cancer : spread to
lymph nodes, other organs in
the pelvis or other organs
(liver and lungs)
Begins in the lining of the
bladder & spread through the lining into the muscular
wall of the bladder.
Rapid, uncontrolled
growth of abnormal cells in
the bladder
INCIDENCE
• In India bladder cancer is the fifth most common cancer In men according to Delhi based registry with age adjusted incidence rate of 5.8/100,000
• Incidence is much lower in females 1.5 cases/100,000
• Male to female ratio= 8.6:1
High urinary pH
High cholesterol
intake
Pelvic radiation therapy
Cancers arising from
prostrate, colon & rectum
In the Western world, tobacco use is the single most important cause of bladder cancer, accounting for an estimated 40-70% of all cases.
Smokers' risks of bladder cancer are 2-3 times higher compared to nonsmokers
90% of bladder cancers are transitional cell carcinoma. The other 10% are squamous cell carcinoma, adenocarcinoma, sarcoma, small cell carcinoma,
CLASSIFICATION
STAGES OF BLADDER CANCER
Stage T1-4N1-2M1-2: Cancer spread out of abdomen/pelvic wall to lymph nodes or distant organs like liver, lungs, or bones.
Stage T4: Cancer penetrated into the adjacent structures (prostate, uterus, or vagina). Regional lymph nodes not involved yet.
Stage T3: Cancer penetrated through muscular bladder wall into the surrounding fat.
Stage T2: Cancer penetrated the muscular bladder wall.
Stage T1: Cancer penetrated into the submucosal tissue.
Stage CIS: Flat cancer limited to the innermost lining of the bladder. It is high grade.
Hematuria
Urinary tract infection
• Pain with metastasis
• Any change in voiding/urine
PHYSICAL EXAMINATION
URINALYSIS URINE CYTOLOGY
CYSTOSCOPY
CT SCAN PYELO-
GRAPHY
BIOPSY ULTRASOUND
Stop smoking
Avoid exposure to industrial chemicals
Avoid exposure to arsenic
Eat healthy food
Adequate fluid intake
MANAGEMENT
Depends on:-
Grade of tumor Stage of tumor Multicentricity
SURGICAL MANAGEMENT
Transuretheral resection
Cystectomy
Intra venous
TopicalIntra vesical
Intra-vesical BCG effective in:
Superficial transitional cell
carcinoma
Carcinoma in situ
Decreasing tumor progression
Radiation treatment can be used:
As part of the treatment for early stage bladder cancer, after limited surgery
As the main treatment for people with early stage cancers who can’t have surgery
As part of the treatment for advanced bladder cancers
To help prevent or treat symptoms caused by advanced bladder cancers
•Transurethral resection•Chemotherapy•Radiotherapy
Trimodality therapy
Treating hematuria
Hydrostatic therapy
Instillation of formalin, phenol or silver nitrate
Photodynamic therapy (PDT)
Targeted therapies
Gene therapy
Other modalities of treatment…..
COMPLICATIONS
Regional metastasis
through pelvis
Metastasis to liver, lungs
and bone
NURSING ASSESSMENT
HEMATURIA
IRRITATIVE VOIDING
SYNDROME
RISK FACTORS
WEIGHT LOSS
FATIGUE
SIGNS OF METASTASIS
COPING ABILITY
KNOWLEDGE OF DISEASE
FEELINGS ABOUT
IMPOTENCE
ASSESSMENT CONT……
NURSING DIAGNOSIS
Impaired urinary
elimination related to
hematuria and transuretheral
surgery
Acute pain related to irritative voiding
symptoms and catheter related
discomfort
Anxiety related to diagnosis of
cancer
NURSING CARE/NURSING INTERVENTIONS
Maintaining urinary
elimination after TUS
Controlling pain
Relieving anxiety
PATIENT TEACHING
• Irritative voiding symptoms & Intermittent hematuria after TUR
• Follow up schedule • Yearly cystoscopy
Advise the
patient about:-