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Introduction

Bladder cancer is the 4th leading cause of cancer in the USA for men, and the eighth leading cause for both sexes. “This year, an estimated 79,030 adults (60,490 men and 18,540 women) will be diagnosed with bladder cancer in the United States. Among men, bladder cancer is the fourth most common cancer. Men are 4 times more likely than women to be diagnosed with the disease. In addition, incidence rates in white men are double those of black men.” ( Cancer editorial board , 2016 ) Approximately 9 out of 10 people with bladder cancer are over the age of 55. The average age of diagnosis is 75 years of age. The research and statistical data points that although bladder cancer can happen to both women and men it is more prevalent in males. There are over 100,000 new cases and deaths caused by bladder cancer in the USA. For this reason, as, future nurse practitioners it is crucial that we educate and inform ourselves on the new research and data on the risk of bladder cancer for elderly men and how to identify risk factors, signs and symptoms and management of disease.

Bladder cancer can develop in different parts of the urinary system and is not always localized in one part of the bladder. When a patient is diagnosed with bladder cancer the staging has a big factor in the prognosis of the patient. The earlier the detection of bladder cancer the better the prognosis. In most cases bladder cancer is identified early and treated aggressively. Like most cancers, bladder cancer can be treated but may also reoccur after a certain amount of time therefore patients with history of cancer have to be well informed regarding follow up diagnostics. There are different kinds of bladder cancer including urothelial carcinoma and Squamous cell carcinoma. The most common being urothelial cell carcinoma. When understanding bladder cancer, it is important for a advanced practice nurse to understand the pathophysiology, clinical manifestations this diseases may present, diagnostics/ lab work, clinical management of disease including medications and treatments, and most importantly safety and education provided to the patient.

Pathophysiology

The most common type of bladder cancer is urothelial bladder cancer. This form of bladder cancer is more prominent in men. Approximately 72,500 people develop bladder cancer and account for approximately 15,000 deaths in this population in 2013. The pathophysiology of bladder cancer depends on the site of the cancer. In urothelial cancer the cancer develops in the urothelial cells which surround and line the inner aspect of the bladder. Most cancers there is a proliferation of cells that continue to generate over a period and cause tumors and pathogenesis. “Oncogenes of the ras gene family and tumor-suppressor genes including TP53 mutations and

inactivation of retinoblastoma gene (pRb) are implicated in bladder cancer. Loss of heterozygosity at chromosome 9 has been found in all stages of urothelial cell carcinoma.” (pathophysiology book, 2015) Bladder cancer can be further identified by the type of cells including papillary and non-papillary tumors which are much less common than papillary tumors. non -Papillary tumors tend to be more invasive and have poorer diagnosis than papillary tumors and amount for approx. 10-30 % of bladder tumors. Non-papillary tumors are flat and more invasive than papillary tumors which tend to be in situ. Non-papillary tumors and tend to be more aggressive with poorer prognosis.

The factors that have been associated with the development of bladder cancer is history of smoking, working in environments where contact with chemicals such as arsenic in drinking water and exposure to phenacetin. The long term exposure to these chemicals and toxins are what scientist suspect maybe the causative factor in the proliferation of cells in the body leading to cancer and tumors. Statistically men are more prone to bladder cancer than women. There has been a breakthrough in the discovery of reasons why men are more prone to bladder cancer. Scientists have discovered that a protein linked to testosterone synthesis in the body which is more prevalent in men are linked to the development of bladder cancer. “In experiments reported in the journal, mice without the receptor had dramatically lower rates of bladder cancer compared to normal mice with the receptor, and human cancer cells with the receptor were much more aggressive than those without it. Mice develop bladder cancer for many of the same reasons people do, and the molecular signals that control cancer development in mice mirror those in humans.” (Miyimoto, Yang, Chen, Ishiguro, Uemura, Kubota, and Yeh , 2007) There is a definite connection between this protein receptor and the prevalence of bladder cancer in males. Scientists continue to investigate this discovery to find new treatments for this type of cancer.

Another finding was that long-term use of Foley catheter maybe a causing factor of bladder cancer due to the increase of risk of infection, insertion of bacteria and the damage to the bladder that can lead to the development of bladder cancer. This m ay be one of the reasons it is not recommended for patients to have long term use of Foley catheter unless last resort or medically necessary. Chronic aggravation of the urinary system may be one of the causative factors. Past radiation has also been linked to the development of bladder cancer for reasons being the radiation levels can cause cell damage that leads to the development of cancer. It is evident that the cause of bladder cancer and pathophysiology is hormonal and environmental. As FNP this is pertinent information in the education of cancer and risk factors that can be avoided such as smoking and unnecessary long-term use of Foley catheter.

Diagnostics and Laboratories

Once clinical manifestations are present and persistent in patients and all other possibilities have been ruled out it is important to begin to investigate the possibility of cancer.

Description of the Clinical Manifestation and Assessment

Bladder cancer is usually discovered in the early stages due to the clinical manifestations that will present. Some of the clinical manifestations of bladder cancer include hematuria, painful urination and back pain. Other symptoms that may present with bladder cancer is frequent urination and pelvic pain. The symptoms described may sound like a UTI or Cystitis which needs to be ruled out first before an assumption is made. If there is hematuria present a nurse should ask the patient details regarding how long this has been occurring and furthermore describe the urine color and consistency using as much description as possible. Back pain can also develop but depending on the location if its flank pain may be a kidney infection. Upon assessment it is important for the nurse to assess the patient’s urine schedule and pattern, assess the patient’s social history and also career history including work environment in the past and past exposure of radiation. As a FNP it is important to paint a picture of the symptoms and history of the patient. It is also beneficial to ask about family history of cancer.

TOPIC : BLADDER CANCER

GRADING RUBRIC ADVANCED PATHOPHYSIOLOGY GENETIC AND CANCER ASSIGNMENT

100 points total 10% of grade

References

Miyamoto, H., Yang, Z., Chen, Y. T., Ishiguro, H., Uemura, H., Kubota, Y., ... & Yeh, S. (2007). Promotion of bladder cancer development and progression by androgen receptor signals. Journal of the National Cancer Institute, 99(7), 558-568.