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CANCER OF THE
BLADDER
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 Cancer of the bladder is the second most
common urologic malignancy.
 90% of all bladder cancers are transitional
cell carcinomas, which arise from the
epithelial lining if the UT; transitional cell
tumors can also occur in the ureters, renal
pelvis, and urethra.
 The remaining 10% of bladder cancers are
adenocarcinoma, squamous cell
carcinoma, or sarcoma.
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PATHOPHYSIOLOGY AND ETILOGY
 Many bladder tumors are diagnosed when the
lesions are superficial, papillary tumors that are
easily resected.
 One fourth of pts with bladder cancer present
with nonpapillary, muscle invasive disease.
 Bladder tumors tend to be either low grade
superficial tumors / high grade invasive
cancers.
 Metastasis occurs in the bladder wall and
pelvis; para – aortic / supraclavicular nodes; in
liver, lungs, and bone.
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 Although the specific etiology is unknown, it
appears that multiple agents are linked to
the development of cancer of the bladder,
including:
a. Cigarette smoking – the risk of developing
bladder cancer is up to four times higher in
smokers.
b. Prolonged exposure to aromatic amines or
their metabolites – generally dye
manufactured by the chemical industry and
used by other industries.
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c. Exposure to cyclophosphamide (Cytoxan),
radiation therapy to the pelvis, chronic
irritation of the bladder (as in long – term
indwelling catheterization), and excessive
use of the analgesic drug phenacetin, which
has been taken off the market.
 Bladder cancer is the fourth most common
cancer in men; peak incidence occurs four
times more frequently in men.
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CLINICAL MANIFESTATIONS
1. Painless hematuria, either gross /
microscopic – most characteristic sign
2. Dysuria, frequency, urgency - bladder
irritability
3. Pelvic / flank pain – obstruction /
metastases
4. Leg edema – from invasion of pelvic lymph
nodes
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DIAGNOSTIC EVALUATION
 Cystoscopy for visualization of number,
location, and appearance of tumors; for
biopsy
 Urine and bladder washing for cystolgic
study
 Urine flow cytometry – uses a computer –
controlled fluorescence microscope to scan
and image the nucleus of each cell on a slide;
based on the fact that cancer cells contain
abnormally large amounts of DNA
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 IVU – may reveal filling defect indicative of
bladder tumor, also to determine status of
upper tracts.
 To evaluate for metastatic disease:
a. CT scan / MRI – to evaluate extent of
disease and tumor responsiveness
b. Chest X ray – to evaluate for pulmonary
metastases
c. Pelvic lymphadenectomy (during
cystectomy) – most accurate for staging
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MANGEMENT
 Surgery –
Transurethral resection and fulguration –
endoscopic resection for superficial tumors.
Partial cystectomy Radical cystectomy – in men, includes removal
of bladder, prostate and seminal vesicles,
proximal vas deferens, and part of proximal
urethra.
In women, consists of anterior exenteration
with removal of bladder, urethra, uterus,
fallopian tubes, ovaries, and segment of
anterior wall of the vagina.
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 Intravesical (within the bladder)
Chemotherapy
1. Instillation of antineoplastic agent, such as
thiotepa, mitomycin – C, doxorubicin
allows a high concentration of drug to
come in contact with the tumor and
urothelium with minimal systemic toxicity.
2. Instillation of immunotherapeutic agent
BCG stimulates immune response to
prevent recurrence of transitional cell
bladder tumors.
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 Systemic chemotherapy
 Radiation therapy
Complications
Regional metastasis through the pelvis as
well as metastasis to the lung, liver, and
bone.
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Nursing Diagnoses
 Impaired Urinary Elimination related to
hematuria and transurethral surgery
 Acute pain related to irritative voiding
symptoms and catheter – related
discomfort.
 Anxiety related to diagnosis for cancer
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
1.
2.
3.
4.
NURSING INTERVENTIONS
Maintaining Urinary Elimination After
Transurethral Surgery
Maintain patency of indwelling urinary
drainage catheter; manual irrigation is not
recommended due to dangers of bladder
perforation; continuous bladder irrigation
may be used if necessary.
Ensure adequate hydration either orally / IV.
Monitor I&O, including irrigation solution.
Monitor urine output for clearing of
hematuria.
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 Controlling Pain
1. Administer analgesic medication for pelvic
discomfort.
2. Administer anticholinergic medications /
belladona and opium suppositories to
relive bladder spasms.
3. Ensure patency of catheter drainage; do
not irrigate unless specifically ordered.
4. Remove indwelling catheter as soon as
possible after procedure.
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 Relieving Anxiety
1. Allow pt to verbalize fears and concerns.
2. Provide realistic information about diagnostic
studies, surgery, and treatments.
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Pt Education and Health Maintenance
 Advise pt that irritative voiding symptoms
and intermittent hematuria are possible for
several weeks after transurethral resection of
bladder tumors.
 Teach pt importance of vigilant adherence
to follow up schedule: Cystoscopy every 3
months for 1 year, then every six months to 1
year thereafter for the rest of pt’s life (70% of
superficial tumors will recur)
 Review purpose and adverse effects of
intravesical chemotherapy treatments
(usually not given after recurrence)
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