7. Bladder cancer: bladder is most common site of urinary tract cancer.
   • Risk factors:
     1. Contact with certain dyes.
     2. Cigarette smoking.
     3. Excessive coffee intake.
     4. Prolonged use of analgesics with phenacetin.
     5. Three times more common in men.
   • Annual incidence: 54,500 new cases; 12,100 estimated deaths.
   • Assessment:
     1. 1. Subjective data:
        • a. Frequency, urgency.
        • b. Pain: flank, pelvic; dysuria.
     2. 2. Objective data:
        • Painless hematuria (initially).
        • Diagnostic tests:
          1. Cystoscopy, intravenous pyelogram (IVP) - mass or obstruction.
          2. Bladder biopsy, urine cytology - malignant cells.
        • Lab data: urinalysis - increased RBC (>4.8/μL - men, >4.3/μL - women); erythrocytes (>30 mg/dL)
   • Analysis/nursing diagnosis:
     1. Risk for injury related to surgical intervention.
     2. Altered urinary elimination related to surgery.
   • Nursing care plan/implementation:
     1. Goal: assist patient through treatment protocol.
        • a. Radiation: cobalt, radioisotopes, radon seeds; often before surgery to slow tumor growth.
        • Chemotherapy:
          1. Antitumor antibiotics: doxorubicin hydrochloride (Adriamycin), mitomycin.
          2. Antimetabolites: 5-fluorouracil (5-FU).
          3. Alkylating agents: thiotepa.
          4. Sedatives, antispasmodics.
     2. Goal: prepare patient for surgery - types:
        • Transurethral figuration or excision: used for small tumors with minimal tissue involvement.
        • Segmental resection: up to half the bladder may be resected.
        • Cystectomy with urinary diversion: complete removal of the bladder; performed when disease appears curable.
     3. Goal: assist with acceptance of diagnosis and treatment.
     4. Goal: prevent complication during postoperative period.
        • Transurethral figuration or excision:
          1. Monitor for clots, bleeding, spasms.
          2. Maintain patency of Foley catheter.
        • Urinary diversion with stoma:
          1. Protect skin, ensure proper fit of appliance - because constantly wet with urine.
          2. Prevent infection by increasing acidity of urine and increasing fluid intake.
          3. Health teaching.
             • Self-care of stoma and appliance.
             • Expected and side effects of medications.
             • Importance of follow-up visits for early detection of metastasis.
   • Evaluation/outcome criteria:
     1. Accepts treatment plan.
     2. Uses prescribed measures to decrease side effects of surgery, radiation, chemotherapy.
     3. Plans follow-up visits for further evaluation.
     4. Maintains dignity.
   
   
8. Laryngeal cancer
   • Risk factors:
     1. Eight times more common in men.
     2. Occurs most often after age 60.
     3. Cigarette smoking.
     4. Alcohol.
     5. Chronic laryngitis, vocal abuse.
     6. Family predisposition to cancer.
   • Annual incidence: 10,900 new cases; 4230 estimated deaths.
   • Assessment:
     1. Subjective data:
        • Dysphagia - pain in areas of Adam's apple; radiates to ear.
        • Dyspnea.
     2. Objective data:
        • Persistent hoarseness.
        • Cough and hemoptysis.
        • Enlarged cervical nodes.
        • General debility and weight loss.
        • Foul breath.
        • Diagnosis made by history, laryngoscopy with biopsy and microscopic study of cells.
   • Analysis/nursing diagnosis:
     1. Impaired verbal communication related to removal of larynx.
     2. Body image disturbance related to radical surgery.
     3. Ineffective airway clearance related to increased secretions through tracheostomy.
   • Nursing care plan/implementation: treatment primarily surgical; radiation therapy may also be indicated.