Cancers of the urinary tract include bladder cancer, kidney cancer (renal cell carcinoma), and cancers of the renal pelvis and ureter. Prostate cancer, a genitourinary cancer, is included here because it affects urinary function and shares nursing care.

Bladder cancer

• Most are urothelial carcinoma (formerly transitional cell carcinoma), arising from the lining of the bladder
• Non-muscle-invasive (most at diagnosis — high recurrence rate, needs lifelong surveillance) versus muscle-invasive (higher risk of spread)
• Risk factors: cigarette smoking (the strongest risk factor), occupational exposure to aromatic amines and chemicals (dyes, rubber, leather, paint), older age, male sex, chronic bladder irritation (long-term catheters, stones), prior pelvic radiation, cyclophosphamide, and chronic Schistosoma haematobium infection (squamous cell type, mainly in Africa and the Middle East)

Renal cell carcinoma (RCC)

• Arises from the renal tubules; often found incidentally on imaging
• Risk factors: smoking, obesity, hypertension, long-term dialysis (acquired cystic disease), and inherited syndromes (von Hippel-Lindau)
• May produce hormones (paraneoplastic effects): erythrocytosis, hypercalcemia, hypertension

Prostate cancer

• Adenocarcinoma, usually slow-growing; risk rises with age, family history, and Black ancestry
• Often found by PSA testing; spreads to bone (back pain)

Bladder cancer

• Painless gross hematuria — the classic first sign (may be intermittent — any visible blood in urine needs evaluation)
• Irritative symptoms: frequency, urgency, dysuria (may mimic UTI)
• Late: pelvic or flank pain, leg edema, weight loss

Renal cell carcinoma

• Often no symptoms early; the classic triad of flank pain, hematuria, and a palpable flank mass appears in only a minority and suggests advanced disease
• Fatigue, weight loss, fever, anemia; left varicocele (rare)

Prostate cancer

• Usually silent early; later, urinary obstruction symptoms, hematuria, bone pain, and signs of spinal cord compression (back pain, leg weakness, bowel or bladder dysfunction)

All clients — pain, nutrition, fatigue, coping, body image, sexual function, and support systems.

Bladder cancer

• Urinalysis and urine cytology
• Cystoscopy with biopsy — the key diagnostic test; transurethral resection of bladder tumor (TURBT) both diagnoses and treats non-invasive tumors
• CT urography to evaluate the upper tract

Kidney cancer

• Contrast CT or MRI of abdomen; chest imaging for metastases
• Biopsy in selected cases; creatinine and eGFR before contrast and surgery

Prostate cancer

• PSA and digital rectal exam; multiparametric MRI; prostate biopsy (Gleason grade/Grade Group); bone scan or PSMA PET for staging
• Screening: for men aged 55–69, PSA screening is an individual shared decision after discussion of benefits and harms

Labs during treatment: CBC, creatinine, electrolytes (potassium, magnesium), liver function, calcium.

Bladder cancer

• TURBT for non-muscle-invasive tumors, followed by intravesical therapy for intermediate/high risk:
  • Bacillus Calmette-Guérin (BCG) — a live attenuated bacterium that triggers local immune response. Adverse effects: cystitis symptoms, hematuria, flu-like symptoms; rarely disseminated BCG infection (high fever, sepsis). Not given after traumatic catheterization, with gross hematuria, or active UTI (entry into bloodstream). Handle as biohazard per policy. Contraindicated in immunosuppressed clients; staff who are immunocompromised or pregnant should not prepare it
  • Intravesical chemotherapy (mitomycin, gemcitabine)
• Muscle-invasive disease: neoadjuvant cisplatin-based chemotherapy, then radical cystectomy with urinary diversion; or bladder-sparing chemoradiation
• Advanced disease: chemotherapy, immune checkpoint inhibitors, antibody-drug conjugates (e.g., enfortumab vedotin — boxed warning for serious skin reactions including Stevens-Johnson syndrome/TEN, so report rash or blistering; also hyperglycemia, peripheral neuropathy, eye disorders)

Urinary diversion types

• Ileal conduit — ureters implanted into a segment of ileum brought out as a stoma; urine drains continuously into an external pouch; mucus in urine is normal
• Continent cutaneous reservoir (e.g., Indiana pouch) — internal pouch emptied by self-catheterization through a stoma
• Orthotopic neobladder — pouch connected to the urethra; voids by relaxing the pelvic floor and increasing abdominal pressure; night-time incontinence common early

Kidney cancer

• Partial nephrectomy (preserves kidney function) or radical nephrectomy; ablation for small tumors in poor surgical candidates; active surveillance for very small masses
• Advanced: immune checkpoint inhibitors combined with tyrosine kinase inhibitors (e.g., axitinib, cabozantinib) — hypertension, diarrhea, hand-foot skin reaction, liver toxicity, fatigue, impaired wound healing and bleeding (usually held before surgery)
• RCC responds poorly to traditional chemotherapy and radiation

Prostate cancer

• Active surveillance (low risk); radical prostatectomy (urinary incontinence and erectile dysfunction are key risks); radiation (external beam or brachytherapy)
• Androgen deprivation therapy (ADT) — GnRH agonists (leuprolide; initial testosterone flare can worsen bone pain or obstruction — an antiandrogen such as bicalutamide is often given for the first weeks to block it) or antagonists (degarelix, relugolix). Adverse effects: hot flashes, decreased libido, erectile dysfunction, gynecomastia, fatigue, bone loss (osteoporosis), weight gain, insulin resistance, cardiovascular risk

Key drug safety in genitourinary cancer care

Listed in priority order.

1. Post-operative (cystectomy, nephrectomy, prostatectomy)
   • Airway and breathing: flank incision (nephrectomy) is near the diaphragm — pain causes splinting and atelectasis; give analgesia, incentive spirometry, deep breathing; watch for pneumothorax
   • Bleeding and shock — vital signs, dressing and drain output, hemoglobin (the kidney is highly vascular)
   • Urine output at least 0.5 mL/kg/h (about 30 mL/h); after nephrectomy, the remaining kidney must be monitored closely; after diversion, no urine output may mean stent or stoma obstruction — report immediately
   • VTE prophylaxis; early ambulation
2. Stoma assessment (ileal conduit) — stoma should be red or pink and moist; dusky, purple, or black means poor blood supply — report at once; stents from the stoma are normal early
3. Peristomal skin protection — urine must not contact the skin: size the wafer opening to the stoma (only about 1/8 inch (2–3 mm) larger), use skin barrier, change the appliance before it leaks, empty pouch when one-third to one-half full, use a bedside drainage bag at night
4. Chemotherapy safety — hydration and output monitoring with cisplatin; premedicate with antiemetics; neutropenic precautions; safe handling of hazardous drugs and body fluids for 48 hours per policy
5. Pain management — scheduled analgesia, reassess, prevent opioid constipation; bone pain from metastases may need radiation
6. Radiation care — protect treated skin: gentle washing with lukewarm water and mild soap is allowed; pat dry; no heat, ice, or tape on the area; loose soft clothing; sun protection; use only prescribed skin products; for pelvic radiation, watch for radiation cystitis (frequency, dysuria, hematuria) and diarrhea
7. Psychosocial and sexual health — body image with stoma, incontinence, and erectile dysfunction; referral to wound-ostomy-continence nurse, support groups
8. Palliative care — introduced alongside treatment for advanced disease; focus on symptom relief and quality of life for client and family

• Stop smoking — reduces recurrence and new cancers; avoid occupational chemical exposure
• Report any visible blood in urine promptly, even if painless or once only
• Bladder cancer: lifelong cystoscopy surveillance as scheduled (recurrence is common)
• After intravesical BCG (per institutional protocol): hold urine for the prescribed dwell time (often 2 hours); sit to void to avoid splashing; for about 6 hours after, pour household bleach into the toilet and let it stand before flushing; wash hands and genital area after voiding; drink fluids after the dwell; report fever above 38.5°C (101.3°F), chills, or symptoms lasting more than 48 hours
• Urostomy care: continuous urine flow and mucus are normal; drink plenty of fluids; change the appliance when urine output is lowest (early morning); watch for UTI signs (cloudy, foul urine, fever); a peristomal skin rash needs prompt attention
• Continent pouch: catheterize on schedule; irrigate mucus as instructed
• Neobladder: timed voiding every 2–3 hours at first; pelvic floor exercises
• After nephrectomy: protect the remaining kidney — avoid NSAIDs and other nephrotoxins, control BP, stay hydrated, regular kidney function checks
• ADT: weight-bearing exercise, calcium and vitamin D, bone density monitoring; manage hot flashes; cardiovascular risk checks
• After prostatectomy: pelvic floor exercises for incontinence; erectile rehabilitation options
• Seek care for fever during chemotherapy (neutropenia risk)

• Hemorrhage after nephrectomy or TURBT; clot retention
• Stoma necrosis (dark stoma), urine leak (falling urine output, rising drain output, abdominal pain), ureteral stricture, hyperchloremic metabolic acidosis with bowel-segment diversions
• Disseminated BCG infection — high fever, sepsis after instillation
• Cisplatin AKI, hypomagnesemia; febrile neutropenia
• Spinal cord compression from bone metastasis — new back pain with weakness or bladder/bowel change: emergency
• Hypercalcemia of malignancy — confusion, constipation, polyuria
• Immune-related adverse events; opioid-induced respiratory depression

• Painless gross hematuria = bladder cancer until proven otherwise
• Smoking is the leading modifiable risk factor for bladder and kidney cancer; also aromatic amines/dyes
• Diagnosis: cystoscopy with biopsy (bladder); CT (kidney); PSA, MRI, biopsy (prostate)
• Intravesical BCG: live bacteria — sit to void, bleach toilet for about 6 hours, report high fever
• Ileal conduit: continuous urine, mucus is normal, stoma pink and moist; dusky stoma → report
• Keep urine off the skin: correctly sized wafer, empty pouch at one-third to one-half full, night drainage bag
• Cisplatin: nephrotoxicity — hydrate, monitor output, creatinine, magnesium; highly emetogenic
• Opioids: monitor respiratory depression; constipation is most common — start bowel regimen
• Metoclopramide: extrapyramidal effects, tardive dyskinesia
• ADT: hot flashes, decreased libido, erectile dysfunction, osteoporosis
• Radiation skin: gentle washing, no heat, sun protection
• Palliative care goal: symptom control and quality of life