NCLEX Review Guide: Bladder Cancer

Understanding Bladder Cancer

• Transitional cell carcinoma (TCC) accounts for 90% of bladder cancers, originating from the urothelial lining of the bladder.
• Risk factors include smoking (primary risk factor), occupational chemical exposure, chronic bladder irritation, and schistosomiasis.
• Men are affected 3-4 times more frequently than women, with peak incidence occurring in the 6th-7th decades of life.

Signs and Symptoms

• Painless hematuria is the most common presenting symptom, occurring in 85-90% of patients with bladder cancer.
• Urinary frequency, urgency, dysuria, and nocturia may indicate advanced disease or concurrent urinary tract infection.
• Late symptoms include pelvic pain, lower extremity edema, and flank pain indicating metastatic disease.

Surgical Interventions

• Transurethral resection of bladder tumor (TURBT) is performed for superficial tumors and provides tissue for staging.
• Radical cystectomy with urinary diversion is indicated for muscle-invasive disease or recurrent superficial tumors.
• Urinary diversions include ileal conduit, continent urinary reservoirs, and neobladder reconstruction.

Post-Cystectomy Nursing Care

1. Monitor urine output and characteristics from all drainage tubes
2. Assess stoma viability (pink, moist) if ileal conduit present
3. Maintain patency of urinary catheters and drainage systems
4. Monitor for signs of infection, bleeding, or anastomotic leaks

Postoperative Care

• Monitor for complications including hemorrhage, infection, thromboembolism, and anastomotic breakdown.
• Provide stoma care education including proper appliance fitting, skin protection, and recognition of complications.
• Address body image concerns and provide emotional support throughout the adaptation process.