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WELCOME

WELCOME. Bladder Cancer. Presented by: Ms. Krantee More. INTRODUCTION. GENERAL OBJECTIVE: To gain in depth knowledge regarding CANCER OF URINARY BLADDER. SPECIFIC OBJECTIVES:. SPECIFIC OBJECTIVES: After completing the seminar students will be able to:

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WELCOME

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  1. WELCOME

  2. Bladder Cancer Presented by: Ms. Krantee More.

  3. INTRODUCTION • GENERAL OBJECTIVE: • To gain in depth knowledge regarding CANCER OF URINARY BLADDER.

  4. 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

  5. DEFINATION • Bladder cancer is a cancerous tumor in the bladder -- the organ that holds urine

  6. Epidemiology of Bladder CA • 4th most common CA in men, 9th 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)

  7. 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)

  8. 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. ANATOMY AND PHYSIOLOGY

  10. Pathophysiology

  11. 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

  12. Continue… • Lower extremity edema from iliac vessel compression, • Physical: occasionally an abdominal or pelvic mass may be palpable.

  13. 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)

  14. 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

  15. 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

  16. Treatment: Medical(Ta, T1, CIS): non muscle invasive • 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

  17. 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

  18. 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

  19. 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.

  20. 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.

  21. 2. Radiation therapy: External beam radiation therapy has been shown to be inferior to radical cystectomy.

  22. 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.

  23. 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.

  24. Research evidence: • A research carried out by “Yursh Xia 4th 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.”

  25. SUMMARY

  26. CONCLUSION

  27. References

  28. Harrison’s Internal Medicine • Cecil Textbook of Medicine • Cancer: Principles & Practice of Oncology • National Cancer Institute website • American Cancer Society website

  29. THANK YOU

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