Blood in the urine (hematuria) sometimes is a sign of bladder cancer. Learn about other bladder cancer signs and symptoms and explore

1. PRESENTED BY:
MR. ABHAY RAJPOOT

2.  Urinary tract cancer is the cancer of the
urinary tract system. The bladder cancer is
the most common which accounts for more
than 14,000 deaths in US. Bladder cancer is
where a growth of abnormal tissue known as
a tumour develops in the lining of the bladder
in some cases the tumour spreads into
surrounding muscles.

3.  Bladder cancer is a disease in which the
cells lining the urinary bladder loose the
ability to regulate their growth results in a
mass of cells that form a tumor.

5.  Bladder cancer affects more men than women
and it accounts for more than 14,ooo deaths in
united states.
 Incidence of bladder cancer is about 4 times
higher in men than in women.
 Mostly it develops in people over age 60.
 Bladder cancer is the 7th most common cancer
causing death in men and most common cancer
causing death in women.

6.  Age
 Sex
 Smoking
 Recurrent urinary tract infection
 Exposure to certain chemicals

7.  Non muscle invasive bladder cancer –
this is the most common type of bladder
cancer in which the cancerous cells are
contained inside the lining of the bladder.
 Muscle invasive bladder cancer -
In this the cancerous cells spread beyond
the lining into the surrounding muscles of
the bladder.

8.  It consist of stages according to tumor , node and
metastasis
 TX – The primary tumor cannot be evaluated.
 TO – There is no cancer in the bladder.
 Ta – This refers to non invasive papillary
carcinoma.
 Tis – Carcinoma in situ. Cancer is only found in
cells within the lining of bladder.
 TI – Tumor has spread to the subepithelial
connective tissue but does not involve bladder wall
muscle.

9.  T2 – The tumor has spread to the muscle of
the bladder wall.
 T2a – Tumor has spread to deep muscle of
the bladder.
 T3 –The tumor has grown into the
perivesical tissue as seen through a
microscope.
 T3b – Tumor has grown in the perivesical
tissue macroscopically and is large enough
to be seen.

10.  T4 – Tumor has spread to following structures
abdominal wall, the pelvic wall, a man’s
prostate or seminal vesicle or a women’s uterus
or vagina.
 T4a- The tumor has spread to prostate, uterus
or vagina.
 T4b Tumor has spread to pelvic wall or
abdominal wall.
 NODE – Lymph nodes near where cancer
started within pelvis are called regional lymph
node.

11.  NX – Regional lymph nodes cannot be
evaluated.
 NO- Cancer has not spread to the regional
lymph nodes.
 N1- Cancer has spread to single regional lymph
node in pelvis.
 N2 –The cancer has spread to more than one
regional lymph node in pelvis.
 N3 – Cancer has spread to common iliac lymph
node which are located behind the major
arteries in pelvis above bladder.

12.  METASTASIS – It indicate spread of cancer
to other parts of body.
 MO – Cancer has not spread to other parts
of the body.
 M1 – Cancer has spread to other parts of the
body.

13.  GRADING –
 G1 –Well differentiated or low grade.
 G2 – Poorly differentiated or high grade.

14.  Haematuria
 Pelvic or back pain
 Obstruction in voiding
 Burning sensation
 weakness

15.  Infection
 Infertility
 Menopause ( if ovaries are removed in
surgery)
 Sexual dysfunction

16.  Urine microscopy
 Cystoscopy
 Ultrasound scan
 Computed tomography

17. Medical Management -
 Chemotherapy –chemotherapy can be used
alone or in combination with surgery or
radiotherapy. It can be given in two forms-
 Local chemotherapy – It involves putting
chemotherapy medications directly into the bladder
for several hours at a time.
 General chemotherapy – It involves circulation of
medication throughout the body. This approach is
used if cancer has spread and can’t be reached by
local approach.

18.  CHEMO DRUGS USED IN BLADDER
CANCER –
 Cardoplatin
 5-Fu
 Combination of methotrexate , vinblastine ,
doxorubicin , cisplastin
 RADIOTHERAPY -
 External radiotherapy- radiation given directly
at the cancer cells in the bladder may be prior
to surgery or after surgery to shrink the size of
the tumor.

19.  Internal radiotherapy – This is done by
inserting radiation implants into the bladder.
 BCG THERAPY – Bacillus calmette-guerin
is used to treat bladder cancer because it
stimulates immune responses that can
destroy cancer cells within the bladder.

20. SURGICAL MANAGEMENT -
 TRANSURETHRAL RESECTION -
 It is a surgical procedure that is used to remove
cancerous tissue from the bladder.
 INCONTINENT URINARY DIVERSION –
 It involves complete removal of bladder and
creation of a urinary diversion is done.
 CONTINENT URINARY DIVERSION -
 It includes kock pouch continent internal ileal
reservior created from a segment of ileum as a r
eserviour of urine the ureters are implanted into
the side of reservior. A special nipple valve is
constructed as passageway through which
catheter is inserted at 4 to 6 hours to drain
urine.

23. ORTHOTOPIC BLADDER SUBSTITUTION -
 It involves the formation of orthotopic
bladder using a section of intestine to make
neobladder and implanting the ureters and
urethra into the neobladder.

25.  NURSING MANAGEMENT -
 PRE-OPERATIVE CARE -
 Consent must be taken prior to surgery .
 Bowel preparation must be done.
 All pre-medication must be done.
 Assess knowledge of proposed surgery and its
long term implications clarrifying
misunderstandings and discussing concerns.
 Prepare the patient psychologically in case of
surgical procedures.

26.  POST OPERATIVE CARE –
 Monitor intake and output carefully and
assess the urine output every hourly.
 Encourage fluid intake.
 Vitals signs must be recorded every hourly.
 Use of all PPE’S and handwashing.
 Ask patient to inform for urine colour
changes.

28.  Risk for injury related to side-effects of
chemotherapy.
 Risk for infection related to leukopenia.
 Imbalanced nutrition less than body
requirement related to disease process and
treatment.
 Risk for ineffective coping related to changes
in body image and potentially terminal
prognosis.

29.  NURSING DIAGNOSIS -
 Risk for injury related to chemotherapy.
 GOAL – To reduce risk for injury.

30. INTERVENTION RATIONALE
 Monitor client for side-effects
of chemotherapy during
administration and reinforce
client education.
 Side-effects such as drug
extravasation and nausea and
vommiting may occur
immediately.
 Monitor client for side-effects
of chemotherapy after
administration such as
leukopenia , diarrhea ,
constipation , hair loss.
 Side-effects may also occur
once drug is administered and
client is at home. Early inter
consentation may minimize
adverse side-effects.
 Provide individualized
education related to
chemotherapy regimen, expected
side-effects administration
schedule, knowledge of each drug
use.
 written and verbal
communication may improve the
client willingness to participation
in treatment and result in better
treatment outcomes.

31.  EVALUATION – Expected outcome
partially met as client is able to rebound
quickly from side-effects of chemotherapy
and resume pre-chemotherapy activities.

32.  NURSING DIAGNOSIS – Risk for infection
related to leukopenia.
 GOAL – To reduce risk for infection.

33. INTERVENTION RATIONALE
 Monitor for infection by
checking vital signs.
 An elevated temperature is
frequently the initial clinical
manifestation.
 Practice good
handwashing and use aseptic
technique when providing
care.
 Handwashing is the most
effective intervention to
decrease risk for infection.
 Monitor respiratory ,
urinary mucosal and skin
system.
 changes in these system are
often a basis for early detection
of infection.
 Administer neupogen as
ordered.
 Neupogen decreases risk for
infection in clients with
increased WBC’S receiving
chemotherapy.

34.  EVALUATION –
 Expected outcome is partially met as client
remain free of infection by seeking treatmebt
promptly.

35.  NURSING DIAGNOSIS – Imbalanced
nutrition less than body requirement related
to disease process and treatment.
 GOAL – To maintain nutritional status of
the patient.

36. INTERVENTION RATIONALE
 To monitor weight
daily.
 To monitor weight
gain or loss.
 Monitor nutritional
intake.
 To maintain
nutritional status of the
patient.
 Arrange for assistance
in attaining and
preparing food.
 Increases intake and
provides appropriate
food.
 Monitor oral cavity.  Pain and taste
alterations may impair
nutritional intake.

37.  EVALUATION – Expected outcome
partially met as clients nutritional status is
maintained by taking measures to prevent
nutritional deficits.

38.  NURSING DIAGNOSIS – Risk for
ineffective coping related to changes in body
image and potentially terminal prognosis.
 GOAL – To improve coping mechanism
and body image.

39. INTERVENTION RATIONALE
 Assess patient’s feeling
about body image and level of
self esteem.
 Provide baseline
assessment for effective
intervention.
 Encourage patient to
verbalize feeling to improve
emotional status.
 Increased dependency and
reduce stress.
 Assist patient in self care
when fatigue, lethargy,
vomitting and dysphagia.
 Physical wellbeing
improves self esteem and
body image.
 Involve professional
counselling to improve
coping mechanism related to
disturbed body image
 Facilitates psychological
support to patient.

40.  EVALUATION – Expected outcome partially
met as evidenced by maintenance of
appropriate body image and coping
strategies.

41. THANK YOU