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Dr.

Jayesh Patidar
www.drjayeshpatidar.blogspot.com
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
urine
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Epidemiology of Bladder CA
4
th
most common CA in men, 9
th
in 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)
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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) Incd risk for
squamous & transitional cell CAR
Chronic UTIs, chronic bladder stones, indwelling Foleys
incd risk for squamous cell CAR
Other
Prior h/o bladder CA
Low fluid intake (incd exposure to carcinogens via decd
bladder emptying)
Genetics (eg, Retinoblastoma gene)
Bladder birth defects (eg, persistent urachus) incd risk
for adenocarcinoma.
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ANATOMY AND PHYSIOLOGY
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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 decd
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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Continue
Lower extremity edema from iliac vessel
compression,
Physical: occasionally an abdominal or pelvic
mass may be palpable.
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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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Continue..
Retrograde pyelography in patients in whom
contrast CT scan cant 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
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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
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Treatment: Medical
(Ta, T1, CIS): non muscle invasive
1. Intravesical immunotherapy:
Indications
Adjuvant tx w/ 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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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
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For muscle invasive disease (T2 &
greater)
Neo-adjuvant chemo x 12 wks prior to
cystectomy
Incd 5-yr dz-free survival
MVAC (Methotrexate, Vinblastine,
Doxorubicin, Cisplatin) 3 cycles q 28 days
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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.
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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.
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2. Radiation therapy:
External beam radiation therapy has been
shown to be inferior to radical cystectomy.
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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.
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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.
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Research evidence:
A research carried out by Yursh Xia 4
th
military 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.
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THANK YOU
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