new-bladder-cancer_v.pptx faculty of nursing

Bladder cancer

1. Bladder cancer

2. 1- Anatomy and Physiology of the bladder . 2-Definition of bladder cancer . 3- Causes of bladder cancer. 4- Signs and Symptoms of bladder cancer . 5- Diagnosis of bladder cancer. 6- Risk factors for bladder cancer. 7- Prevention of bladder cancer. 8- Complication of bladder cancer. 9- Management (medical- surgical – nursing ) * Outlines :

3.   Is a types of cancer arising from the epithelial lining ( I .E., The  urothelium ) of the urinary bladder  It is a disease in which abnormal cells multiply without control in the bladder. Known as  transitional cell carcinoma. Definition of bladder cancer:

4. - The bladder is a hollow organ that stores urine. Urine made in the kidneys and flows into the bladder through thin tubes called ureters . Urine leaves the bladder through another tube called the urethra. -The wall of the bladder has several layers. The innermost layer of the bladder is called the urothelium. When the bladder becomes full, it signals its need to empty. The bladder contracts, expelling the urine through another tube called the urethra, in a process called “urinating.” * Anatomy and physiology :

5. Most bladder cancers start in the urothelium Over time, they can grow into or through the other layers of the bladder, and then can spread outside the bladder. As the cancer grows through the layers it becomes more advanced and harder to treat. * C ont :

6. The bladder is lined by a layer of cells. These cells protect the bladder tissue from urine, which can be irritating . Although these lining cells normally produce new cells throughout life , in some people they start to multiply uncontrollably and form a growth, or tumor . “ Growth” and “tumor” are sometimes used to mean cancer or malignancy, although not all tumors are cancerous. * Bladder cancer :

7. There are different types of bladder cancer. The type can affect the type of treatment options as different types need different treatments. *Types of cancer :

8. 1- Transitional cell carcinoma (TCC) Transitional cell carcinoma occurs in the cells that line the inside of the bladder. Transitional cells expand when bladder is full and contract when bladder is empty. The same cells line inside the ureters and urethra, and tumors can form in those places as well . Transitional cell carcinoma is the most common type of bladder cancer in the United States. *Types of cancer cont., :

9. This group has subtypes: Papillary cancers: grow like tiny fingers from the inner bladder lining toward its hollow center. Flat cancers: do not grow toward the center . These tumors are also named based on whether they have grown into the bladder wall: Non-invasive cancers are still in the inner layer of cells (the urothelium) but have not grown into the deeper layers. Invasive cancers have grown into the deeper layers of the bladder. These cancers are more likely to spread and are harder to treat. * Cont :

10. Other cancers that start in the bladder: 2-Squamous cell carcinoma : This type is much less common and is usually invasive. 3-Adenocarcinoma :Adenocarcinoma begins in cells that make up mucus-secreting glands in the bladder. Adenocarcinoma of the bladder is rare in the United States. 4-Small-cell carcinoma : A very small number of bladder cancers are of this type. These cancers often grow quickly. 5-Sarcoma : Sarcomas start in the muscle cells of the bladder. * Cont :

11. It's not always clear what causes bladder cancer. Bladder cancer has been linked to smoking, a parasitic infection, radiation and chemical exposure. Bladder cancer develops when cells in the bladder begin to grow abnormally. Rather than grow and divide in an orderly way, these cells develop mutations that cause them to grow out of control and not die. *Causes:

12. Bladder cancer is unusual in people under 40 years of age. Men are affected four times more often than women. Most importantly, cigarette smokers are two to three times more likely than nonsmokers to develop bladder cancer. Cigarette smoking is a bladder cancer risk factor that can be controlled or modified. 1-Smoking: Smoking is the greatest risk factor for bladder cancer. Smokers get bladder cancer at least 3 times as often as people who don’t smoke. *Risk factors :

13. 2-Workplace chemical exposure: Workers in industries with higher risks of bladder cancer include the makers of rubber, leather, textiles, dyes, and paint products, as well as printing companies. Other workers with a higher risk of bladder cancer include painters, hairdressers, machinists, printers, and truck drivers. Smoking can increase the risk even more among these workers. certain drugs used in chemotherapy (e.g., cyclophosphamide) are also associated with bladder cancer, so people who work with those drugs making, storing, administering or disposing of them may be at higher risk . * Cont:

14. 3-Chronic (on-going) bladder irritation and infections: Urinary infections, kidney stones, bladder stones, and bladder catheters left in for a long time have been linked with bladder cancer, but it is not clear if they actually cause bladder cancer. 4-Personal history of bladder (or other urothelial) cancer: People who have had a cancer in the lining of any part of the urinary tract have a higher chance of getting another tumor. * Cont :

15. 5-Genes and family history: People whose family members have had bladder cancer have a higher risk. People who inherit certain gene syndromes also have a higher risk of bladder cancer. 6-Certain medicines and herbal supplements: Use of the diabetes medicine pioglitazone (Actos) for more than a year has been linked with bladder cancer. Supplements that contain aristolochic acid have also been linked with bladder cancer . * Cont :

16. 1-Blood in urine (hematuria). urine may appear dark yellow, bright red or cola colored. Or urine may appear normal, but blood may be detected in a microscopic examination of the urine. 2-Frequent urination. 3-Painful urination. 4-Back pain . 5-Pelvic pain. 6-Loss of appetite and weight loss. Infection of the urinary tract is a common complication, producing frequency , urgency, and dysuria. * Signs and Symptoms :

17. 1- Cystoscopy : A cystoscope is a thin tube with a light and a lens or tiny video camera on the end. The doctor puts it into the bladder through the urethra. With the cystoscope the doctor can see the inside of the bladder. If there is anything that doesn’t look normal, a small piece of tissue is removed (biopsied) and looked at under a microscope. *Diagnosis :

18. Cystoscope:

19.  Indications : Urinary stones   An enlarged prostate gland Inflammation caused by infection or injury Frequent urinary tract infections Blood in your urine   Loss of bladder control or overactive bladder Unusual cells found in urine sample Cystoscopy:

20. Cystoscopy can also be used to treat some conditions such as: Remove a stone from the bladder. Obtain a urine sample from each of the ureters.   Remove small biopsy or tumors from the lining of the bladder. Insert a small tube into a narrowed ureter which helps the flow of urine if there is a narrowing. * Cont :

21. Risks: May feel pain or discomfort  Dye used for fluorescence cystoscopy may cause damage to skin.  May get an infection Have blood in your urine Have swelling that blocks the flow of urine May have headaches or dizziness loss of appetite * Contd :

22. Before procedure: Informed consent  is a legal document that explains the tests, treatments, or procedures that may needed. An IV line: used to give liquid or medicine Dye:   for fluorescence cystoscopy, the caregiver will put a dye into the bladder.  Preoperative care:   the patient may be asked to empty the bladder.  Anesthesia:  Anesthesia medicine is given promote comfort during the procedure . Monitoring:   heart rate and blood pressure * Cont :

23. During procedure: Groin will be cleaned with soap. Sheets are then put over the cleaned area leaving urethral opening uncovered. The cystoscopy is put into urethra and move into the bladder. Liquid may be put into urethra and bladder to wash out the area.  Caregiver will carefully check the bladder for problems or abnormal growths. * Cont :

24. After procedure: The patient stay there until the be fully awake and feeling returns in hips and legs. Pain medicine:   given pain killers to take away or decrease the pain . Vital signs:   check for blood pressure, heart rate, breathing rate, and temperature. * Cont :

25. 2- Urine tests: Urinalysis: This is a simple test to check for blood and other substances in the urine , which might point toward bladder cancer or other problems. 3- Urine cytology: In this test, urine or cells “washed” from the bladder during cystoscopy are sent to the lab to see if cancer cells (or pre-cancer cells) are present. * Cont :

26. 4- Urine culture: For this test, a sample of urine is sent to the lab to see if germs grow in it, which can show if you have an infection. An infection can sometimes cause symptoms like those of bladder cancer. It may take a few days to get the results of this test . 5-Urine tumor marker tests: These tests look for certain substances released by cancer cells into the urine. Some doctors use these tests (along with cytology), but most think that cystoscopy is still the best way to find bladder cancer. * Cont :

27. Prostate-Specific Antigen (PSA) Test: What is the PSA test? Prostate-specific antigen, or PSA, is a protein produced by cells of the prostate gland. The PSA test measures the level of PSA in a man’s blood. For this test, a blood sample is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per milliliter (ng/mL) of blood. *Tumor markers:

28. 6- Biopsy : When a small piece of body tissue is removed and sent to the lab to see if it contains cancer cells, it is called a biopsy. Bladder biopsy samples are most often taken during cystoscopy. This test can tell if bladder cancer is present and what type of cancer it is. It can also tell other important features of the cancer. Invasiveness: A biopsy can show how deep the cancer has grown into (invaded) the bladder wall. It’s important for the doctor to know if cancer cells have grown into the bladder’s muscle layers. * Cont:

29. Grade: Bladder cancers are given a grade based on how they look under the microscope. Low-grade cancers look more like normal tissue and tend to grow more slowly. A high grade means the cancer looks less like normal tissue and is more likely to spread outside the bladder. These cancers can be harder to treat. * Cont :

30. 7- Intravenous pyelogram (IVP): An IVP allows doctors to look at the upper urinary tract, not just the bladder. It’s used because some people with bladder tumors also develop the same type of tumor in the kidneys (where the urine collects) or in the ureters (which lead the urine from the kidneys to the bladder). This is because the urinary tract has the same cell lining from the kidneys to the urethra. In this test, a special liquid called “contrast solution” is injected into a vein where it travels quickly into the kidneys and the urine. X-rays of the urinary system, taken when the contrast solution is in the body, show images of the kidneys, ureters and bladder. * Cont :

31. 8-Retrograde pyelogram: For this test, a thin, flexible tube called a catheter is put through the urethra and up into the bladder or into a ureter. Then a dye is put through the catheter to show the lining of the bladder, ureters, and kidneys on x-rays. Like IVP, this test can be used to find tumors in the urinary tract. * Cont :

32. 9- Computed tomography (CT) scan: The CT scan is a special kind of x-ray that makes detailed pictures of bladder It can help find tumors in bladder , kidneys, and other organs, as well as show any swollen lymph nodes that might contain cancer. Before any pictures are taken, the patient may be asked to drink a liquid called oral contrast. the patient also need an IV line through which will get a different kind of contrast dye. The dye can cause some redness and warm feeling. Some people are allergic to the contrast. * Cont :

33. CT scan

34. 10- Magnetic resonance imaging (MRI): MRI scans use radio waves and strong magnets instead of x-rays to make detailed pictures. They can be used to look at the urinary system or to look for signs that the cancer has spread outside of the bladder into nearby tissues or lymph nodes. * Cont :

35. 11- Ultrasound : Ultrasound uses sound waves to make pictures of the bladder. It can help show the size of a bladder cancer and whether it has spread beyond the bladder. It can also be used to look at the kidneys. This is an easy test to have. The patient simply lie on a table while a kind of wand is placed on the skin over the part of the body being looked at. * Cont :

36. 12- Chest x-ray: A chest x-ray may be done to look for spread of bladder cancer to the lungs. This test is not needed if a CT scan of the chest has been done. 13- Bone scan: A bone scan can help look for cancer that has spread to bones. For this test, a small amount of a radioactive substance is put into a vein. This substance collects in areas of bone that are damaged. A scanner can spot these places and show them on a picture. * Cont :

37. At this time, there is no sure way to prevent bladder cancer. But there are things can be done that might lower the risk. 1-Don’t smoke : The best way to lower risk is not to smoke. Smoking is believed to cause about half of bladder cancer cases among men and women. 2-Limit workplace chemical exposures : It’s important to follow good safety habits if you work with chemicals that might increase bladder cancer risk. These chemicals are commonly used by the makers of rubber *Prevention:

38. 3-Drink plenty of fluids :Some studies have found that drinking plenty of fluids (mainly water) might lower the risk of bladder cancer. 4-Eat lots of fruits and vegetables Some studies have suggested that a diet high in fruits and vegetables might help protect against bladder cancer, but other studies have not found this. Still, eating such a diet has been shown to have many health benefits, including lowering the risk of several other types of cancer. * Cont :

39. Bladder cancer often recurs. Because of this, bladder cancer survivors often undergo follow-up testing for years after successful treatment. What tests the patient wi ll undergo and how often will depend on the type of bladder cancer and treatment , among other factors. People with aggressive cancers may undergo more frequent screening. Those with less aggressive cancers may undergo screening tests less often. *Complication:

40. Bleeding: Occasionally a transfusion is required during or after cystectomy Blood clots: Patients undergoing cystectomy are at risk for blood clot formation; such clots are referred to as deep vein thromboses (DVT). When these clots form, they can break free and travel in the blood stream, ultimately getting lodged in the lungs; this is known as a pulmonary embolism (PE) and can be a life-threatening complication. * Cont :

41. Infection: All patients are treated with broad-spectrum intravenous antibiotics prior to starting the surgery to decrease the chance of infection from occurring after surgery. Stomal Complications: Ileal conduits and continent diversions can be complicated by hernia, prolapsed, and stenosis which can require additional surgery. * Cont :

42. Tissue / Organ Injury: Although uncommon, during any surgery there is risk of injury to surrounding tissue and organs including but not limited to the intestines, rectum, blood vessels, nerves, muscles, bladder, and ureters , which could require further surgery. In addition, injuries to nerves and/or muscles can occur from being immobile on the operating room table for extended periods. Conversion to Open Surgery: Rarely, a surgeon performing a robotic radical cystectomy may require conversion to the standard open operation if difficulty is encountered during the robotic procedure. This could result in a larger standard open incision and possibly a longer recuperation period. * Cont :

43. The main types of treatment for bladder cancer are: Intravesical therapy. Chemotherapy. Radiation therapy. 1-Intravesical therapy for bladder cancer: With intravesical treatment the doctor puts a liquid drug right into the bladder rather than giving it by mouth or putting it into a vein. Drugs given this way mainly affect the cells lining the inside of the bladder, with little to no effect on cells elsewhere. For this reason, intravesical therapy is only used for some early-stage bladder cancers. *Medical management:

44. Bacillus Calmette-Guerin therapy (BCG) : is a type of immunotherapy that is useful for treating early-stage bladder cancer. BCG is a type of germ that is usually harmless. It is given right into the bladder through a thin, flexible tube called a catheter. The body’s immune system cells are drawn to the bladder and attack the cancer. BCG is usually started a few weeks after a transurethral resection of the tumor and is given once a week for 6 weeks. Sometimes BCG is given long-term . * Cont :

45. Interferons : are substances normally made by the body to turn on the immune system. They can also be made in the lab and given as medicine in the intravesical treatment of bladder cancer. Other drugs are often given with the interferon to relieve common side effects such as muscle aches, bone pain, headaches, tiredness, nausea, and vomiting. * Cont :

46. Chemotherapy (chemo) is the use of drugs to kill cancer cells . The drugs can be given in different ways . Often chemo drugs are given into a vein or by mouth. 2-Chemotherapy for bladder cancer:

47. The chemotherapy can be used at different times: Chemo might be used to shrink a large tumor so it is easier to remove during surgery. When used this way it is called neoadjuvant therapy. Chemo can be given after surgery or radiation to try to prevent the growth of stray cancer cells still in the body. This is called adjuvant therapy. It can lower the chance that the cancer will come back later . * Cont :

48. Sometimes chemo is given along with radiation to help the radiation work better . This can increase the side effects of radiation. The drugs may be used alone or combined with other drugs, based on why they’re being used . Doctors give chemo in cycles, with each round of treatment followed by a rest period to give the body time to recover. Each chemo cycle typically lasts for a few weeks. * Cont :

49. Radiation therapy is treatment with high-energy rays (such as x-rays) to kill cancer cells or shrink tumors. The type of radiation most often used to treat bladder cancer uses radiation from outside of the body on the cancer. Radiation can be used: As part of the treatment for early stage bladder cancer, after 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. *Radiation therapy for bladder cancer:

50. Skin changes in areas getting radiation, ranging from redness to blisters and sores. Nausea and vomiting Bladder symptoms, like burning or pain when you urinate, feeling the need to go often, or blood in the urine Diarrhea Tiredness Low blood counts, which can lead to fatigue, easy bruising or bleeding, or increased risk of infection These problems usually go away after treatment ends. Some people can have long-term side effects such as problems holding urine, blood in the urine, or pain when urinating. If you have any side effects, you should talk to your doctor. Often there are ways to help. *Side effects of radiation

51. 1- Transurethral surgery: For many early stage bladder cancers, a transurethral resection (TUR), also known as a transurethral resection of the bladder tumor (TURBT), is the most common treatment. Most people have early-stage cancer when it is first found, so this is usually the first treatment they get. Tumors in the bladder are removed using a slender tube with a lens and a light on the end that is put into the bladder through the urethra. This tube is called a resectoscope . ( under general anesthesia) or ( regional anesthesia) for this. There is no need to cut into the belly. *Surgical management :

52. This treatment usually works well, but bladder cancer still often returns in other parts of the bladder. If this surgery has to be done several times, there is a chance that the bladder can become scarred and not able to hold much urine. This means having to urinate often and the chance of losing control of your urine (incontinence ). * Cont :

53. When bladder cancer is invasive (the cancer has spread beyond the layer of cells where it started and deeper into the bladder wall), all or part of the bladder may need to be removed. This operation is called a cystectomy. When only the tumor and part of the bladder is removed, it is called a partial cystectomy. Nearby lymph nodes are also removed. This surgery allows the person to keep part of their bladder, but it will be smaller so they might have to go more often. The cancer might also come back in a different part of the bladder. 2- Cystectomy:

54. Surgery to remove the whole bladder is called a radical cystectomy. Nearby lymph nodes are also taken out. In men, the prostate is removed as well. In women, the womb (uterus), ovaries, fallopian tubes, and a small part of the vagina are often removed. These procedures are usually done through a cut (incision) in the belly (abdomen) to get to the bladder. * Cont :

55. If the whole bladder is removed, the patient will need another way to store and remove urine. There are several ways to do this. Incontinent diversion Continent diversion Neobladder Reconstructive surgery after cystectomy:

56. 1-Assessment: 1-assess signs and symptoms: A frequent urge to urinate Pain when you urinate Low back pain Blood in urine 2- changes in urination 3- the color change, the frequency and amount of urine. 4-assess signs of infection: fever ; 5- Assess skin and IV site and vein for erythema, edema, tenderness *Nursing management :

57. 1- Risk for Altered Oral Mucous Membranes related to Side effect of some chemotherapeutic agents (e.g., antimetabolites) and radiation Dehydration, malnutrition, NPO restrictions for more than 24 hr 2-  Risk for injury  related to radiation therapy and chemotherapy. 3- Knowledge Deficit  related to diagnostic tests, surgery and urinary diversion. Impaired Urinary Elimination  ( dysuria ) related to the tumor. *Nursing diagnosis:

58. 4- Risk for Infection related to Inadequate secondary defenses and immuno suppression, e.g., bone marrow suppression (dose-limiting side effect of both chemotherapy and radiation).Malnutrition, chronic disease process Invasive procedures   5-Situational Low Self-Esteem related to Biophysical: disfiguring surgery, chemotherapy or radiotherapy side effects, e.g., loss of hair, nausea/vomiting, weight loss, anorexia, sterility, overwhelming fatigue, uncontrolled pain Psychosocial: threat of death; fear and anxiety * Cont :

59. 6-Impaired Skin Integrity related to chemotherapy And radiotherapy. 7-Risk for Constipation/Diarrhea related to Irritation of the GI mucosa from either chemotherapy or radiation therapy. 8-Risk for Altered Sexuality Patterns related to altered body function/ structure, illness, and medical treatment. 9- Acute Pain related to Disease process and Side effects of various cancer therapy agents. * Cont :

60. 10- Disturbed body image related to urinary diversio1 11-Anticipatory Grieving related to Anticipated loss of physiological well-being (e.g., loss of body part; change in body function); change in lifestyle Perceived potential death of patient. * Cont :

61. Encourage verbalization of thoughts or concerns and accept expressions of sadness, anger, rejection.  Expect initial shock and disbelief following diagnosis of cancer and traumatizing procedures (disfiguring surgery, colostomy, amputation). Be aware of debilitating depression. Ask patient direct questions about state of mind. Evaluate and be aware of painful effects of particular therapies (surgery, radiation, chemotherapy, biotherapy). Administer analgesics as indicated. Nursing interventions:

62. Encourage use of stress management skills or complementary therapies (relaxation techniques, music) Provide cuotaneous stimulation (heat or cold, massage) Monitor daily food intake Assess skin and mucous membranes for pallor, delayed wound healing Encourage patient to eat high-calorie, nutrient-rich diet, with adequate fluid intake. Encourage use of supplements and frequent or smaller meals  * Cont :

63. Monitor I&O and specific gravity; Monitor vital signs. Evaluate peripheral pulses, capillary refill. Assess skin turgor and moisture of mucous membranes Encourage increased fluid intake to 3000 mL per day . Emphasize personal hygiene. Promote good hand washing procedures by staff and visitors.  Obtain cultures as indicated. Administer antibiotics as indicated. Use of mouthwash made from warm saline * Cont :

64. Identify and express feelings appropriately. Continue normal life activities, Verbalize understanding of body changes, acceptance of self in situation. Begin to develop coping mechanisms to deal effectively with problems. Demonstrate stable weight & free of signs of malnutrition.  Stimulate appetite/increase dietary intake. Adequate fluid balance as evidenced by stable vital signs, moist mucous membranes, good skin turgor, prompt capillary refill, and individually adequate urinary output. Evaluation: