URINARY TRACT CANCER

By :

Aan Nuraeni

NEOPLASTIC DISORDER OF THE URINARY TRACT

RENAL TUMOR

Symptoms

Early symptoms : no specific characteristic

Generalized symptoms : weight loss, weakness, and anemia

Classic manifestations : gross hematuria, flank pain and palpable mass advanced disease

Diagnosis studies

– Primary examination : IVP with nephrotomography

– Ultrasound (USG) : differentiate between a tumor and cyst

– Other common studies : angiography, percutaneuos needle aspiration, CT, and magnetic resonance imaging (MRI).

– Radionuclide isotope scanning is used to detect metastases

Treatment

– Treatment of choice is radical nephrectomy (Removal of the kidney, adrenal gland, surrounding fascia, part of the ureter, and draining lymph nodes)

– Radiation therapy is used palliatively when there are metastases to bone or lung.

– No effective chemotherapy is available for metastatic renal cell carcinoma

– Biologic therapy a interferon and interleukin-2 are most promising in treatment of metastatic disease.

WILMS’ TUMOR

Definition

Wilms’ Tumor is a common renal tumor of infants and children. 40 % are hereditary, with an autosomal dominant mode of transmission.

Clinical Manifestation

• Abdominal swelling or distension (most common)

• Pain

• Fever

• Hematuria

• Hypertension

Diagnostic Studies

• Ultrasound

• Renal arteriography

Treatment

• These tumors respond well to multymodality therapy, include :

Surgical removal of the involved kidney

Radiation therapy ( it is used postoperatively, and for inoperable tumors, bilateral tumors, and metastase)

Chemotherapy

BLADDER CANCER

Introduction

• The most frequent malignant tumor of the urinary tract is transitional cell carcinoma of bladder.

• The most bladder tumors are papillomatous growths within the bladder.

Risk Factors

• ages ( > 60 y), • men (3 times more risky) • cigarette smoking • exposure to dyes used in

the rubber and cable industries

• chronic abuse of phenacetin-containing analgetics

• women treated with radiation for cervical cancer

• patients receiving cyclophosphamide (cytoxan)

• Reccurent stones (often bladder)

• Chronic lower urinary infections (indwelling catheters for long periods can develop the condition)

Clinical Manifestations

• Gross, painless hematuria (chronic or intermitten) is the most common finding and the first in 85 % to 90 % patients.

• Bladder irritability with dysuria, frequency, and urgency

• The clinical staging of carcinoma of the bladder is determined by the depth of invasion of the bladder wall and surrounding tissue

Diagnostic Studies

• When cancer is suspected, urine specimens for cytology can be obtained to determine the presence of neoplastic or atypical cells.

• Urine test : bladder tumor antigens.

• IVP, Ultrasound, CT, MRI

• Cytoscopy and biopsy

Collaborative therapy

• Surgical Treatment Transurethral resection

with fulguration

Laser Photocoagulation

Open loop resection of fulguration

Segmental cystectomy

Radical cystectomy

• Radiation

• Intravesical Immunotherapy Baccil Calmete-Guerin

(BCG)

• Intravesical Chemotherapy Thiotepa

Mitomycin

Doxorubicin

• Systemic chemotherapy

CANCER OF THE PROSTATE

Introduction

• Cancer of the prostate is the most common cancer in men.

• It is the second leading cause of cancer death in men, after lung cancer.

Etiology & Pathofisiologi

• Prostate cancer is an androgen –dependent adenocarcinoma

• Risk Factors : high fat diets and environmental factors, a family history of prostate cancer is a major factor risk (9%), and hormonal influence.

• A higher incidence exist in men 60 y age or older

Etiology & Pathofisiology…cont..

• The tumor is slow growing and usually begins in the prosterior or lateral portions of the prostate.

• It can spread by 3 route : direct extension; via lymphatics; and via the bloodstream.

• Direct extension is by continuity to the seminal vesicles, uretral mucosa, bladder wall & external sphincter.

• The cancer later spreads through the perineural lymphatic system to the regional lymph nodes.

• The veins from the prostate seem to be mode of spread to the pelvic bones, head of the femur, lower lumbar spine, liver and lungs.

Clinical Manifestations and Complication

• Prostate cancer is asymptomatic in the early stages, eventually the patient may have symptoms similar to those of BPH, including dysuria, hesitancy, frequency, urgency, hematuria, nocturia and retention.

• The prostate feels hard, enlarge, and fixed on rectal examination.

• The enlargement is usually unilateral • Pain in the lumbosacral area which radiates down

to the hips or legs when coupled with urinary symptoms may indicate metastasis

• The tumor can spread to the pelvic lymph nodes, bones, bladder,lungs, and liver.

• Once tumor has spread to distant sites, the major problem becomes the management of pain.

• As the cancer spreads to the bones, pain can become severe, especially in the back and legs because of compression of the spinal cord and osteoblastic lesions.

Diagnostic Studies

Diadaptasi dari : Monahan, F. D., Sands, J. K., Neighbors, M., Marek, J. F., & Green, C. J. (2007). Phipps' Medical Surgical Nursing: Health And Illness Persfective (Eighth ed.). Philadelphia: Mosby Elsevier

Diagnostic Studies..cont

• The normal blood range for PSA is 0 – 2,5 ng/ml

• Men whose PSA is between 1.0 – 2.0 ng/ml should have yearly retesting

• An increase in PSA of more than 0.70 ng/ml/yr, is associated with prostate cancer and a biopsy should be done

• PSA level > 4 ng/ml prostate cancer

Diagnostic Studies..cont

• The PSA test divided into 2 scores : a bound PSA and free PSA

• Low precentage of free PSA tends to indicate cancer prostate

Staging

Diadaptasi dari : Monahan, F. D., Sands, J. K., Neighbors, M., Marek, J. F., & Green, C. J. (2007). Phipps' Medical Surgical Nursing: Health And Illness Persfective (Eighth ed.). Philadelphia: Mosby Elsevier

Collaborative Care

Depends on the stage of the cancer. • Stage A :

– Continue medical follow up, observation, TURP or total prostatectomy

– Radiation therapy

• Stage B : – TURP – Total prostatectomy with

or without lymphadenectomy

– Radiation therapy

• Stage C : – Hormone manipulation (LH

releasing hormone analogues)or orchiectomy

– Radical resection of prostate

– Radiation therapy

• Stage D : – Hormone therapy – Radiation to metastatic

bone areas – chemotherapy

Collaborative care..cont..

Radiation Therapy

• Radiation therapy is commonly used in the management of prostate cancer, especially in men over age 70. as compared with surgery there is a reduce risk of erectile dysfunction.

• Potential side effects of radiation include diarhea, cystitis, and erectile dysfunction

• Radiation therapy may also be combined with the antiandrogen agents such as goserelin (zoladex)

Collaborative care..cont..

Surgical Therapy :

• Suprapubic prostatectomy

• Retropubic prostatectomy

• Perineal prostatectomy

Nursing Diagnoses

• Decisional conflict related to numerous alternative treatment option

• Pain related to surgery, prostatic enlargement, bone metastasis, and bladder spasms

• Altered urinary elimination related to bladder neck sphingther damage

• Sexual disfunction related to effect treatment • Anxiety related to uncertain outcome of disease

process on life and lifestyle and effect of treatment on sexual functioning

Planning

The overall goals are that the patient will :

1. Be an active participant in the treatment plan

2. Have satisfactory pain control

3. Follow the therapeutic plan

4. Accept the effect of the theurapeutic plan on sexual function

5. Find a satisfactory way to manage impact of bladder or bowel function

Nursing implementation