Bladder cancer

Bladder Cancer
Dr. JayeshPatidar
www.drjayeshpatidar.blogspot.com

INTRODUCTION
GENERAL OBJECTIVE:
To gain in depth knowledge regarding CANCER OF URINARY BLADDER.
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SPECIFIC OBJECTIVES:
SPECIFIC OBJECTIVES:
After completing the seminar students will be able to:
Enumerate the etiological factors of urinary bladder cancer (ca. bladder),
Illustrate clinical manifestations.
Describe the management of Ca bladder
To enlist the complications occurring due to same disease
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DEFINATION
Bladder cancer is a cancerous tumor in the bladder --the organ that holds urine9/17/2014
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Epidemiology of Bladder CA
4thmost common CA in men, 9thin women,
Annual New Cases = 68,810 (51,230 in M & 17,580 in F)
M:F = 3:1
Annual Deaths = 14,100 (7,750 in M & 4,150 in F)

Risk Factors for Bladder CA
Age, Gender, Race
Cigarette smoking (2-4x higher relative risk)
Exposures to environmental carcinogens:
Occupational -Polycyclic aromatic hydrocarbons,benzene, exhaust from combustion gases, aryl amines
dry cleaners; manufacturers of preservatives, dye, rubber, & leather; pesticide applicators; painters; truck drivers; hairdressers; printers; machinists
Pelvic radiation therapy
Arsenic (eg. in drinking H2O)
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Risk Factors for Bladder CA
Infections
Schistosoma haematobium (N Africa) Inc’d risk for squamous & transitional cell CAR
Chronic UTIs, chronic bladder stones, indwelling Foleys  inc’d risk for squamous cell CAR
Other
Prior h/o bladder CA
Low fluid intake (inc’d exposure to carcinogens via dec’d bladder emptying)
Genetics (eg, Retinoblastoma gene)
Bladder birth defects (eg, persistent urachus) inc’d risk for adenocarcinoma.
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ANATOMY AND PHYSIOLOGY9/17/20148www.drjayeshpatidar.blogspot.com

Pathophysiology
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Clinical Manifestations of Bladder CA
Hematuria (80-90%) –Generally painless and gross hematuria
However, 20% can have only microscopic hematuria
Other urinary Sxs
Frequency, urgency, nocturia –d/t irritative Sxs or dec’d bladder capacity
Pain (less common & often reflects tumor location)
Lower abdominal pain –Bladder mass
Rectal discomfort & perineal pain –Invasion of prostate or pelvis.
Flank pain -Obstruction of ureters
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Lower extremity edema from iliac vessel compression,
Physical: occasionally an abdominal or pelvic mass may be palpable.

Dx of Bladder CA
Pts w/ hematuria, especially if > 40 yrs
Urinary Cytology-microscopy, culture to rule out infection,
USG-abdomen & pelvis,
CT abdomen & pelvis with preinfusion & post infusion phases,
Cystoscopy, regardless of cytology results (mainstay of dx)
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Retrograde pyelography in patients in whom contrast CT scan can’t be performed because of azotemia or due to severe allergy to IV contrast,
Transurethral resection of all visible tumors to determine histology & depth of invasion
Biopsies of erythematous (& possibly normal) areas to assess for CIS

STAGES
Stage 0 --Non-invasive tumors that are only in the bladder lining
*Stage I --Tumor goes through the bladder lining, but does not reach the muscle layer of the bladder
*Stage II --Tumor goes into the muscle layer of the bladder
*Stage III --Tumor goes past the muscle layer into tissue surrounding the bladder
*Stage IV --Tumor has spread to neighboring lymph nodes or to distant sites (metastatic disease)
Stage V--*Prostate 2)Rectum 3)Ureters 4)Uterus 5)Vagina 6)Bones 7)Liver 8)Lungs

Treatment: Medical(Ta, T1, CIS): non muscle invasive
1.Intravesical immunotherapy:
Indications
Adjuvant txw/ resection to prevent recurrence
Eliminate disease that cannot be controlled by endoscopic resection alone (less common)
Recurrent disease, > 40% involvement of bladder surface, diffuse CIS, T1 dz
Generally not needed for solitary papillary lesions

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Agents
Std agent --BCG
Generally 6 weekly txs then monthly maintenance x 1-3 yrs
Toxicities = Bladder irritability / spasm, hematuria, dysuria, & rarely systemic TB
Other agents –Mitomycin-C, Interferon, Gemcitabine

For muscle invasive disease (T2 & greater)
Neo-adjuvant chemo x 12 wks prior to cystectomy
Inc’d 5-yr dz-free survival
MVAC (Methotrexate, Vinblastine, Doxorubicin, Cisplatin) –3 cycles q 28 days

Surgical Rx: For Ta, T1, CIS (non muscle invasive)
1. Endoscopic treatment:
TURBT-To dignose, to stage, to treat visible tumors.
Electrocautry or LASER fulguration of bladder is sufficient for low grade, small volume tumors.
2. Radical cystectomy:
Patients withunresectable, prostatic urethra involvement & BCG failure are indications for this procedure.

Muscle invasive disease: T2 & greater
1. Radical cystoprostectomy: (men)
Remove the bladder, prostate & pelvic lymph nodes.
After removal of bladder, urinary diversion must be created.
Types:
Continent,
Incontinent.

2. Radiation therapy:
External beam radiation therapy has been shown to be inferior to radical cystectomy.

Complications:
Body image disturbances,
Skin irritation,
Recurrence,
Infertility in women as uterus is removed,
Infertility in men if prostate is removed,
Menopause if ovaries are removed,
Sexual disturbances if vagina has been made shorter,
Metastasis to distant organs.

Nursing Diagnosis:
Dysurea related to disease condition,
Disturbed sleep pattern due to urgency & frequency of micturition,
Acute pain related to disease condition,
Altered nutrition secondary to pain due to disease condition,
Anxiety related to surgery,
Disturbed body image related to surgery.

Research evidence:
A research carried out by “YurshXia 4thmilitary medical university” states that, “Adjuvant Radiotherapy in addition to cystectomy also increases survival rates.”
A research by “Dept of Urology Health Science, Centre West Virginia Morgan Town” says that “Garlic can be used an immunotherapy besides BCG.”

THANK YOU

Bladder cancer

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