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Bladder Cancer 
Dr. JayeshPatidar 
www.drjayeshpatidar.blogspot.com
INTRODUCTION 
GENERAL OBJECTIVE: 
To gain in depth knowledge regarding CANCER OF URINARY BLADDER. 
9/17/20142www.drjayeshpatidar.blogspot.com
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 
9/17/2014 
3 
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DEFINATION 
Bladder cancer is a cancerous tumor in the bladder --the organ that holds urine9/17/2014 
4 
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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) 
9/17/20145www.drjayeshpatidar.blogspot.com
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) 
9/17/2014 
6 
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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. 
9/17/2014 
7www.drjayeshpatidar.blogspot.com
ANATOMY AND PHYSIOLOGY9/17/20148www.drjayeshpatidar.blogspot.com
Pathophysiology 
9/17/2014 
9 
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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 
9/17/2014 
10www.drjayeshpatidar.blogspot.com
Continue… 
Lower extremity edema from iliac vessel compression, 
Physical: occasionally an abdominal or pelvic mass may be palpable. 
9/17/201411www.drjayeshpatidar.blogspot.com
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) 
9/17/2014 
12www.drjayeshpatidar.blogspot.com
Continue.. 
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 
9/17/201413www.drjayeshpatidar.blogspot.com
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 
9/17/201414www.drjayeshpatidar.blogspot.com
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 
9/17/201415www.drjayeshpatidar.blogspot.com
Continue.. 
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 
9/17/201416www.drjayeshpatidar.blogspot.com
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 
9/17/201417www.drjayeshpatidar.blogspot.com
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. 
9/17/201418www.drjayeshpatidar.blogspot.com
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. 
9/17/201419www.drjayeshpatidar.blogspot.com
2. Radiation therapy: 
External beam radiation therapy has been shown to be inferior to radical cystectomy. 
9/17/201423www.drjayeshpatidar.blogspot.com
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. 
9/17/201424www.drjayeshpatidar.blogspot.com
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. 
9/17/201425www.drjayeshpatidar.blogspot.com
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.” 
9/17/201426www.drjayeshpatidar.blogspot.com
THANK YOU 
9/17/201427www.drjayeshpatidar.blogspot.com

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Bladder cancer

  • 1. Bladder Cancer Dr. JayeshPatidar www.drjayeshpatidar.blogspot.com
  • 2. INTRODUCTION GENERAL OBJECTIVE: To gain in depth knowledge regarding CANCER OF URINARY BLADDER. 9/17/20142www.drjayeshpatidar.blogspot.com
  • 3. 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 9/17/2014 3 www.drjayeshpatidar.blogspot.com
  • 4. DEFINATION Bladder cancer is a cancerous tumor in the bladder --the organ that holds urine9/17/2014 4 www.drjayeshpatidar.blogspot.com
  • 5. 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) 9/17/20145www.drjayeshpatidar.blogspot.com
  • 6. 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) 9/17/2014 6 www.drjayeshpatidar.blogspot.com
  • 7. 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. 9/17/2014 7www.drjayeshpatidar.blogspot.com
  • 9. Pathophysiology 9/17/2014 9 www.drjayeshpatidar.blogspot.com
  • 10. 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 9/17/2014 10www.drjayeshpatidar.blogspot.com
  • 11. Continue… Lower extremity edema from iliac vessel compression, Physical: occasionally an abdominal or pelvic mass may be palpable. 9/17/201411www.drjayeshpatidar.blogspot.com
  • 12. 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) 9/17/2014 12www.drjayeshpatidar.blogspot.com
  • 13. Continue.. 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 9/17/201413www.drjayeshpatidar.blogspot.com
  • 14. 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 9/17/201414www.drjayeshpatidar.blogspot.com
  • 15. 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 9/17/201415www.drjayeshpatidar.blogspot.com
  • 16. Continue.. 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 9/17/201416www.drjayeshpatidar.blogspot.com
  • 17. 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 9/17/201417www.drjayeshpatidar.blogspot.com
  • 18. 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. 9/17/201418www.drjayeshpatidar.blogspot.com
  • 19. 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. 9/17/201419www.drjayeshpatidar.blogspot.com
  • 20. 2. Radiation therapy: External beam radiation therapy has been shown to be inferior to radical cystectomy. 9/17/201423www.drjayeshpatidar.blogspot.com
  • 21. 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. 9/17/201424www.drjayeshpatidar.blogspot.com
  • 22. 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. 9/17/201425www.drjayeshpatidar.blogspot.com
  • 23. 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.” 9/17/201426www.drjayeshpatidar.blogspot.com