After prostate cancer, bladder cancer is the second most common cancer of the genitourinary system. It accounts for 2% of cancer deaths in the United States and 4% of approximately all cancers. The American Cancer Society predicts that in 2023, there will have been nearly 83,000 new cases of bladder cancer, with over 16,000 deaths.
Most bladder tumors are multifocal because the bladder’s environment allows for the continuous bathing of the mucosa with urine that contains tumor cells and can implant in several locations. It can also obstruct the ureters, bladder neck, prostate, and urethra. Direct extension of tumors can occur to the sigmoid colon, rectum, and other organs depending on the sex of the patient, such as the prostate or vagina and uterus. However, occasionally, it can metastasize to the lungs, bones, and liver.
Bladder cancer is staged based on the presence or absence of invasion and is graded (I to IV) based on the degree of differentiation of the cell, with grade I being the best differentiated and slowest growing. When planning the patient's treatment plan, staging and grading are considered.
The exact causes of bladder cancer are not known. However, common risk factors are cigarette smoking and occupational exposure to aromatic amines such as textile dyes, rubber, hair dyes, and paint pigment.
These cytotoxic chemicals enter the bloodstream, are filtered through the kidneys, and concentrate in the urine. This leads to cellular changes in the endothelial lining of the urinary bladder, causing its cancer.
Other associated factors for bladder cancer are chronic bladder irritation, chronic bladder infections, exposure to cyclophosphamide, vesical calculi, and too much caffeine consumption.
Often, patients having bladder cancer present with the complaint of gross, painless, and intermittent hematuria. On a routine urinalysis, you may discover occult blood. The patient may also complain about dysuria and changes in urinary frequency. If there is an infection, burning and pain with urination are present.
In most cases, the patient does not seek medical help until they have a complaint of urinary hesitancy, a decrease in the caliber of the stream, and flank pain along with other symptoms such as suprapubic pain after voiding, bladder irritability, dribbling, and nocturia.
Usually, the physical examination is normal. Bladder cancer becomes palpable when it has spread to other strictures extensively.
Patients with the higher-stage invasive disease are usually treated with radical curative surgery, but those with lower-stage noninvasive disease can be controlled with more conservative measures.
Conservative management is done for superficial bladder tumors that involve surgical removal by transurethral resection of the bladder tumor (TURBT). This is followed by electrical destruction or fulguration, intravesical administration of chemotherapy or immunotherapy, and frequent follow-up. Tumors can also be destroyed by the neodymium: yttrium-aluminum-garnet (Nd:YAG) laser.
Patients with multiple superficial bladder tumors receive intravesical instillation of chemotherapy and immunotherapy, such as the Bacillus Calmette-Guérin (BCG) vaccine. It is made from a strain of Mycobacterium bovis and helps to prevent a relapse.
When conservative treatment does not help, or it fails to respond to intravesical therapy, the patient has to undergo surgery. Partial or segmental cystectomy may be recommended for patients with diffuse, unresectable tumors.
External beam radiation is also used as an adjuvant in treating bladder cancer. High-dose, short-course therapy consisting of 16 to 20 grays (Gy) can be delivered preoperatively to decrease the size of the tumor and prevent its spread during surgery. For patients opposed to a cystectomy and urinary diversion, radiation therapy can be given with a curative intent. However, unfortunately, 50% of patients with invasive bladder cancer eventually relapse.
Since tumors are likely to continue to spread and metastasize to distant sites, procedures such as radical cystectomy with the creation of a urinary diversion, external radiation therapy, or a combination of preoperative radiation therapy followed by radical cystectomy and urinary diversion are recommended.
Postoperatively, nursing care is essential in comforting the patient, preventing complications that occur from major surgery, and helping promote efficient urine drainage. Monitor the patient’s vitals and check their dressing and drains for any symptoms of infection or hemorrhage. If you notice blood or pus in the wound, consult the healthcare provider promptly.
If the patient had a urostomy, check the color of the stoma and the amount and color of the urine in the collection pouch every four hours. Make sure the urine drains immediately. Some stomal edema is normal during the early postoperative period, but the flow of urine should not be obstructed. Also, encourage the patient to take care of the stoma. Allow them to hold the equipment, observe the amount and characteristics of urine drainage, and empty the urine collection pouch. Make sure to maintain the integrity of the skin around the stoma.
Empty the urinary drainage pouch when it is about one-third full to prevent the weight of the pouch from breaking the skin seal and leaking urine onto the skin. This type of direction and education should be taught to the patient.
The emotional well-being of the patient is also important. Be empathetic to the patient’s feelings and concerns about not being sexually active or the altered sexual functioning after a radical cystectomy. Encourage the patient and their partner to explore alternative methods of sexual expression. You can also refer them to a sex therapist who can help them. If erectile dysfunction occurs because of a radical cystectomy, the patient may be a candidate for a penile prosthesis.
A common risk factor for bladder cancer is cigarette smoking. Compel your patients to stop smoking cigarettes as it is harmful to their lives.
Bladder cancer can spread to other genitourinary systems. Therefore, the treatment should be started promptly. Make sure to clear all the doubts and reservations of the patient undergoing surgery. Physical and psychological concerns should be addressed.
About the Author:
Mariya Rizwan is an experienced pharmacist who has been working as a medical writer for four years. Her passion lies in crafting articles on topics ranging from Pharmacology, General Medicine, Pathology to Pharmacognosy.
Mariya is an independent contributor to CEUfast’s Nursing Blog Program.
Please note that the views, thoughts, and opinions expressed in this blog post are solely of the independent contributor and do not necessarily represent those of CEUfast. This blog post is not medical advice. Always consult with your personal healthcare provider for any health-related questions or concerns.
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