NCLEX Review Guide: Bladder Cancer

Understanding Bladder Cancer

• Transitional cell carcinoma (TCC) accounts for 90% of bladder cancers, arising from the urothelial lining of the bladder.
• Most common risk factor is cigarette smoking, followed by occupational exposure to chemicals like benzidine and aniline dyes.
• Chronic bladder irritation from recurrent UTIs, bladder stones, or indwelling catheters increases cancer risk.

Assessment Findings

• Painless hematuria is the most common and earliest symptom, occurring in 85-90% of patients.
• Urinary frequency, urgency, and dysuria may occur as the tumor grows and irritates the bladder wall.
• Advanced disease may present with pelvic pain, flank pain, and lower extremity edema from lymph node involvement.

Diagnostic Workup

• Cystoscopy with biopsy is the gold standard for diagnosis, allowing direct visualization and tissue sampling.
• CT urography or IVP helps evaluate the entire urinary tract and detect metastases.
• Urine cytology may show malignant cells but has limited sensitivity for low-grade tumors.

Surgical Interventions

1. Transurethral resection of bladder tumor (TURBT) - First-line treatment for superficial tumors
2. Radical cystectomy - Complete bladder removal for muscle-invasive cancer
3. Urinary diversion - Ileal conduit, continent reservoir, or neobladder creation

Postoperative Care

• Monitor for hemorrhage, infection, and urinary leakage following surgical procedures.
• Assess stoma viability (pink, moist) and urine output (>30 mL/hr) for patients with urinary diversions.
• Provide comprehensive stoma care education including proper appliance fitting and skin care.