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WELCOME
Bladder Cancer
Presented by: Ms. Krantee More.
INTRODUCTION
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GENERAL OBJECTIVE:
To gain in depth knowledge regarding CANCER OF
URINARY BLADDER.
SPECIFIC OBJECTIVES:
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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
DEFINATION
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Bladder cancer is a cancerous tumor
in the bladder -- the organ that holds
urine
Epidemiology of Bladder CA
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4th most common CA in men, 9th in women,
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Annual New Cases = 68,810 (51,230 in M & 17,580 in F)
 M:F = 3:1
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Annual Deaths = 14,100 (7,750 in M & 4,150 in F)
Risk Factors for Bladder CA
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Age, Gender, Race
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Cigarette smoking (2-4x higher relative risk)
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Exposures to environmental carcinogens:
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Occupational - Polycyclic aromatic hydrocarbons,benzene,
exhaust from combustion gases, aryl amines
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dry cleaners; manufacturers of preservatives, dye, rubber, & leather;
pesticide applicators; painters; truck drivers; hairdressers; printers;
machinists
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Pelvic radiation therapy
Arsenic (eg. in drinking H2O)
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Risk Factors for Bladder CA
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Infections
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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
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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.
ANATOMY AND PHYSIOLOGY
Pathophysiology
Clinical Manifestations of Bladder CA
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Hematuria (80-90%) – Generally painless and gross
hematuria
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Other urinary Sxs
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However, 20% can have only microscopic hematuria
Frequency, urgency, nocturia – d/t irritative Sxs or dec’d
bladder capacity
Pain (less common & often reflects tumor location)
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Lower abdominal pain – Bladder mass
Rectal discomfort & perineal pain – Invasion of prostate or
pelvis.
Flank pain - Obstruction of ureters
Continue…
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Lower extremity edema from iliac vessel
compression,
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Physical: occasionally an abdominal or pelvic
mass may be palpable.
Dx of Bladder CA
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Pts w/ hematuria, especially if > 40 yrs
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Urinary Cytology- microscopy, culture to rule out
infection,
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USG- abdomen & pelvis,
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CT abdomen & pelvis with preinfusion & post
infusion phases,
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Cystoscopy, regardless of cytology results
(mainstay of dx)
Continue..
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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,
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Transurethral resection of all visible tumors to
determine histology & depth of invasion
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Biopsies of erythematous (& possibly normal)
areas to assess for CIS
STAGES
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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 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
Continue..
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Agents
 Std agent -- BCG
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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)
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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:
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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:
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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:
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A research carried out by “Yursh Xia 4th
military medical university” states that,
“Adjuvant Radiotherapy in addition to
cystectomy also increases survival rates.”
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A research by “Dept of Urology Health
Science, Centre West Virginia Morgan Town”
says that “Garlic can be used an
immunotherapy besides BCG.”
SUMMARY
CONCLUSION
References
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Harrison’s Internal Medicine
Cecil Textbook of Medicine
Cancer: Principles & Practice of Oncology
National Cancer Institute website
American Cancer Society website
THANK
YOU