Cancer Of The Bladder And Kidney

Cancer of the bladder • • •

Cancer of the urinary bladder is seen more frequently in people aged 5070 years and affects men more often that women. Tumors usually arise at the base of the bladder neck and involve the ureteral orifices, and bladder neck. More common in whites than Asians or African Americans

Types 1. Transitional cell carcinoma 2. adenocarcinoma 3. Small cell Carcinoma 4. Squamous cell carcinoma 5. Rhabdomyosarcoma- occur in Children

There are two forms of bladder cancer: 1. superficial – which tends to recur 2. Invasive Cause 1. Cigarette smoking. Risk factor 1. Smoking 2. Chronic schistosomiasis (parasitic infection that irritates the bladder) 3. Occupational Carcinogens in rubber, paint, plastics, metal, and autoimmotive exhaust 4. history of pelvic irradiation 5. Cyclophosphamide exposure 6. High fat diet 7. Chronic low fluid intake 8. Slight increase risk with prostate CA.

Staging The following stages are used to classify the location, size, and spread of the cancer, according to the TNM (tumor, lymph node, and metastasis) staging system:

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Stage 0: Cancer cells are found only on the inner lining of the bladder.

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Stage I: Cancer cells have proliferated to the layer beyond the inner lining of the urinary bladder but not to the muscles of the urinary bladder.

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Stage II: Cancer cells have proliferated to the muscles in the bladder wall but not to the fatty tissue that surrounds the urinary bladder.

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Stage III: Cancer cells have proliferated to the fatty tissue surrounding the urinary bladder and to the prostate gland, vagina, or uterus, but not to the lymph nodes or other organs.

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Stage IV: Cancer cells have proliferated to the lymph nodes, pelvic or abdominal wall, and/or other organs.

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Recurrent: Cancer has recurred in the urinary bladder or in another nearby organ after having been treated

Pathophysiology  70-80% is superficial (in lamina propria or mucosa) Usually highly differenciated with long survival  Initial event seems to be activation on oncogene on chromosome 9  20% of tumors are invasive (deeper than lamina propia) at presentation: Tend to be high grade with worse prognosis. Clinical Manifectation 1. Hematuria-gross or microscopic, usually painless 2. Urinary symptom- frequency, urgency and dysuria 3. Any alteration of voiding or change in the urine is indicative 4. Pelvic or back pain may occur with metastasis

Assessment and Diagnostic Methods Biopsies of tumor and adjacent mucosa are definitive, but the following procedures are also used: 1. Cystoscopy, biopsy of tumor and adjacent mucosa 2. Excretory urography 3. Computed Tomography (CT) scan

4. Ultrasonography 5. Bimanual examination under anesthesia 6. Cytologic examination of fresh urine and saline bladder washings 7. Molecular assays, bladder tumor antigens, adhesions molecules and others are being studied Medical Mangement Surgical Management 1. Transurethral resection (TUR) or fulguration for simple papillomas with intravesical bacilli Calmette-Guerin (BCG) is the treatment of choice 2. Monitoring of benign papillomas with cytology and cystoscopy periodically for the rest of patient’s life 3. Simple cystectomy or radicak cystectomy for invasive or multifocal bladder cancer

Pharmacology Therapy 1. Chemotherapy with a combination of Methotrexate, 5-fluoroucil (5-FU), vinblastine, doxotubucin (Adriamycin) and cisplatin ( (M-VAC) and new agents gemitabine and taxanes, possibly by topical chemotherapy applied directly to the bladder wall. 2. Intraversal BCG (effective with superficial transpositional cell carcinoma) 3. Cytotoxic agent infusions through the arterial supply of the involved organ 4. 4. Formalin, phenol, or silver nitrate instillations to achieve relief of hematuria and strangury (slow and painful discharge of urine) in some patients. Radiation Therapy 1. Radiation of tumor preoperatively to reduce micro extension and viability 2. Radiation therapy in combination with surgery to control inoperable tumors 3. Hydrostatic therapy: for advanced bladder cancer or patients with intractable hematuria (after radiation therapy) 4. Hematuria Therapy: for advanced bladder cancer or patients with intractable hematuria (after radiation therapy)

Bladder cancer

Cancer of the Kidneys (Renal Tumors) •

The most common type of Renal tumor (85 %) is renal cell or renal adenocarcinoma

Risk factors 1. Gender (female) 2. Tobacco use 3. Occupational exposure to industrial chemicals 4. Obesity and dialysis 5. Misusing certain pain medicines, including over-the-counter pain medicines, for a long time. 6. Having certain genetic conditions, such as von Hippel-Lindau disease or hereditary papillary renal cell carcinoma. Pathophysiology These tumors may metastasize early to the lungs, bones, liver, brain, and contralateral kidney. One third of patients have metastatic disease at the time of diagnosis. Clinical Manifestations • • • • • •

Blood in the urine. A lump in the abdomen. A pain in the side that doesn't go away. Loss of appetite. Weight loss for no known reason. Anemia. Diagnostic procedures 1. Intravenous urography 2. Cystoscopic examination 3. Nephrotomograms, renal angiograms 4. Ultrasonography 5. Computed tomography (CT) scan

Medical Management The goal of management is to eradicate the tumor before metastasis occurs •

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Radical nephrectomy is preffered treatment, including removal of the kidneys, adrenal gland, and surrounding fats, and lymph nodes; partial nephrectomy may be used for some patients Radiation therapy, hormonal therapy, or chemotherapy may be used with surgery Immunotherapy may be helpful Nephron-sparing surgery for solid renal lesions Renal artery embolization may be used in metastasis to occlude the blod supply to the tumor and kill the tumor cells. Post infarction syndrome of flank and abdominal pain, elevated temperature and gastrointestinal complaints is treated with parenteral analgesics, antiemetics, restricted oral intake, and intravenous fluids Biologic therapy includes interleukin-2, lymphokine-activated killer cells, or possibly interferon.

Nursing Management • Assist patient physiology and psychologically in preparation for extensive diagnostic and therapeutic procedures. Monitor carefully for signs of dehydration and exhaustion • After surgery, give frequent analgesia for pain and muscle soreness • Provide assistance with turning: encourage patient to turn, cough, and take deep breaths t prevent atelectasis and other pulmonary complications • Support patient and family in coping with diagnosis and uncertainties about outcome and prognosis. • Teach patient to inspect and care for the incision and perform other general postoperative care • Inform the patient of limitations on activities, lifting and driving • Teach the patient about correct use of pain medications • Provide instructions about follow-up care and need to notify physician about the fever, breathing difficulty, wound drainage, blood in the urine, pain, or swelling of the legs

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Instruct the patient and family in need for follow-up care to detect sins of metastases, evaluate all subsequent symptoms with possible metastases in mind Emphasize that a yearly physical examination and chest radiograph throughout life is required for patients who have had surgery for renal carcinoma