Treatments for Bladder Cancer
Treatments for Bladder Cancer
The list of treatments mentioned in various sources
for Bladder Cancer
includes the following list.
Always seek professional medical advice about any treatment
or change in treatment plans.
Bladder Cancer: Is the Diagnosis Correct?
The first step in getting correct treatment is
to get a correct diagnosis.
Differential diagnosis list for Bladder Cancer may include:
Hidden causes of Bladder Cancer may be incorrectly diagnosed:
- Tobacco smoking
- Occupations at risk are metal industry workers, rubber industry workers, workers in the textile industry, and people who work in printing, auto mechanics have an elevated risk of bladder cancer due to their frequent exposure to hydrocarbons and petroleum-based chemicals. Hairdressers are thought to be at risk as well because of their frequent exposure to permanent hair dyes
- Certain drugs such as cyclophosphamide and phenacetin
- Chronic bladder irritation (infection, bladder stones, catheters, bilharzia) predisposes to squamous cell carcinoma of the bladder
- more causes...»
Bladder Cancer: Marketplace Products, Discounts & Offers
Products, offers and promotion categories available for Bladder Cancer:
Bladder Cancer: Research Doctors & Specialists
- Cancer Specialists:
- Urinary & Bladder Specialists (Urology):
- Kidney Health Specialists (Nephrology):
- more specialists...»
Research all specialists including ratings, affiliations, and sanctions.
Drugs and Medications used to treat Bladder Cancer:
Note:You must always seek professional medical advice about any prescription drug, OTC drug, medication, treatment
or change in treatment plans.
Some of the different medications used in the treatment of Bladder Cancer include:
Unlabeled Drugs and Medications to treat Bladder Cancer:
Unlabelled alternative drug treatments for Bladder Cancer include:
Hospital statistics for Bladder Cancer:
These medical statistics relate to hospitals, hospitalization and Bladder Cancer:
- 0.63% (79,934) of hospital consultant episodes were for malignant neoplasm of bladder in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 96% of hospital consultant episodes for malignant neoplasm of bladder required hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 75% of hospital consultant episodes for malignant neoplasm of bladder were for men in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 25% of hospital consultant episodes for malignant neoplasm of bladder were for women in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 6% of hospital consultant episodes for malignant neoplasm of bladder required emergency hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- more hospital information...»
Hospitals & Medical Clinics: Bladder Cancer
Research quality ratings and patient incidents/safety measures
for hospitals and medical facilities in specialties related to Bladder Cancer:
Hospital & Clinic quality ratings » »
Choosing the Best Treatment Hospital:
More general information, not necessarily in relation to Bladder Cancer,
on hospital and medical facility performance and surgical care quality:
Medical news summaries about treatments for Bladder Cancer:
The following medical news items
are relevant to treatment of Bladder Cancer:
Discussion of treatments for Bladder Cancer:
What You Need To Know About Bladder Cancer: NCI (Excerpt)
The doctor may refer patients to doctors who specialize in
treating cancer, or patients may ask for a referral. Treatment
generally begins within a few weeks after the diagnosis. There
will be time for patients to talk with the doctor about
treatment choices, get a second opinion, and learn more about
bladder cancer. (Source: excerpt from What You Need To Know About Bladder Cancer: NCI)
What You Need To Know About Bladder Cancer: NCI (Excerpt)
People with bladder cancer have many treatment options.
They may have surgery ,
radiation
therapy , chemotherapy ,
or biological
therapy . Some patients get a combination of
therapies.
The doctor is the best person to describe treatment choices
and discuss the expected results of treatment.
A patient may want to talk to the doctor about taking part
in a clinical
trial , a research study of new treatment methods.
Clinical trials are an important option for people with all
stages of bladder cancer. The section on "The
Promise of Cancer Research " has more information about
clinical trials.
Surgery is a common treatment for bladder cancer.
The type of surgery depends largely on the stage and grade of
the tumor. The doctor can explain each type of surgery and
discuss which is most suitable for the patient:
-
Transurethral
resection : The doctor may treat early
(superficial) bladder cancer with transurethral resection
(TUR). During TUR, the doctor inserts a cystoscope into the
bladder through the urethra. The doctor then uses a tool
with a small wire loop on the end to remove the cancer and
to burn away any remaining cancer cells with an electric
current. (This is called fulguration .)
The patient may need to be in the hospital and may need
anesthesia. After TUR, patients may also have chemotherapy
or biological therapy.
-
Radical
cystectomy : For invasive bladder cancer, the
most common type of surgery is radical cystectomy .
The doctor also chooses this type of surgery when
superficial cancer involves a large part of the bladder.
Radical cystectomy is the removal of the entire bladder, the
nearby lymph nodes, part of the urethra, and the nearby
organs that may contain cancer cells. In men, the nearby
organs that are removed are the prostate, seminal
vesicles , and part of the vas
deferens . In women, the uterus, ovaries ,
fallopian
tubes , and part of the vagina are removed.
-
Segmental
cystectomy : In some cases, the doctor may remove
only part of the bladder in a procedure called segmental
cystectomy. The doctor chooses this type of surgery when a
patient has a low-grade cancer that has invaded the bladder
wall in just one area.
Sometimes, when the cancer has spread outside the bladder
and cannot be completely removed, the surgeon removes the
bladder but does not try to get rid of all the cancer. Or, the
surgeon does not remove the bladder but makes another way for
urine to leave the body. The goal of the surgery may be to
relieve urinary blockage or other symptoms caused by the
cancer.
When the entire bladder is removed, the surgeon makes
another way to collect urine. The patient may wear a bag
outside the body, or the surgeon may create a pouch inside the
body with part of the intestine. The sections on "Side
Effects of Treatment " and "Rehabilitation "
have more information about these procedures.
|
These are some questions a patient may want to ask
the doctor about surgery:
-
What kind of operation will it be?
-
How will I feel afterward?
-
What will you do for me if I have pain?
-
How long will I have to stay in the hospital?
-
Will I have any long-term effects?
-
When can I get back to my normal activities?
-
Will I urinate in a normal way?
-
Will the surgery affect my sex life?
-
How often will I need
checkups? |
Radiation therapy (also called radiotherapy) uses
high-energy rays to kill cancer cells. Like surgery, radiation
therapy is local
therapy . It affects cancer cells only in the treated
area.
A small number of patients may have radiation therapy
before surgery to shrink the tumor. Others may have it after
surgery to kill cancer cells that may remain in the area.
Sometimes, patients who cannot have surgery have radiation
therapy instead.
Doctors use two types of radiation therapy to treat bladder
cancer:
-
External
radiation : A large machine outside the body aims
radiation at the tumor area. Most people receiving external
radiation are treated 5 days a week for 5 to 7 weeks as an
outpatient. This schedule helps protect healthy cells and
tissues by spreading out the total dose of radiation.
Treatment may be shorter when external radiation is given
along with radiation implants.
-
Internal
radiation : The doctor places a small container
of a radioactive
substance into the bladder through the urethra or through an
incision
in the abdomen. The patient stays in the hospital for
several days during this treatment. To protect others from
radiation exposure, patients may not be able to have
visitors or may have visitors for only a short period of
time while the implant is in place. Once the implant is
removed, no radioactivity is left in the body.
Some patients with bladder cancer receive both kinds of
radiation therapy.
|
These are some questions a patient may want to ask
the doctor about radiation therapy:
-
Why do I need this therapy?
-
How will the radiation be given?
-
Will I need to stay in the hospital? For how
long?
-
When will the treatments begin? When will they
end?
-
How will I feel during therapy? Are there side
effects?
-
What can I do to take care of myself during
treatment?
-
How will we know if the radiation is working?
-
Will I be able to continue my normal activities
during treatment?
-
How often will I need
checkups? |
Chemotherapy uses drugs to kill cancer cells. The
doctor may use one drug or a combination of drugs.
For patients with superficial bladder cancer, the doctor
may use intravesical
chemotherapy after removing the cancer with TUR. This is local
therapy. The doctor inserts a tube (catheter )
through the urethra and puts liquid drugs in the bladder
through the catheter. The drugs remain in the bladder for
several hours. They mainly affect the cells in the bladder.
Usually, the patient has this treatment once a week for
several weeks. Sometimes, the treatments continue once or
several times a month for up to a year.
If the cancer has deeply invaded the bladder or spread to
lymph nodes or other organs, the doctor may give drugs through
a vein. This treatment is called intravenous
chemotherapy. It is systemic
therapy , meaning that the drugs flow through the
bloodstream to nearly every part of the body. The drugs are
usually given in cycles so that a recovery period follows
every treatment period.
The patient may have chemotherapy alone or combined with
surgery, radiation therapy, or both. Usually chemotherapy is
an outpatient treatment given at the hospital, clinic, or at
the doctor's office. However, depending on which drugs are
given and the patient's general health, the patient may need a
short hospital stay.
Biological therapy (also called immunotherapy) uses
the body's natural ability (immune
system ) to fight cancer. Biological therapy is most
often used after TUR for superficial bladder cancer. This
helps prevent the cancer from coming back.
The doctor may use intravesical biological therapy with
BCG
solution . BCG solution contains live, weakened bacteria .
The bacteria stimulate the immune system to kill cancer cells
in the bladder. The doctor uses a catheter to put the solution
in the bladder. The patient must hold the solution in the
bladder for about 2 hours. BCG treatment is usually done once
a week for 6 weeks.
|
Patients may want to ask these questions about
chemotherapy or biological therapy:
-
Why do I need this treatment?
-
What drug will I get? How will it be given? What
will it do?
-
Will I have side effects? What can I do about
them?
-
How long will I be on this treatment?
-
How often will I need
checkups? |
Side Effects of Cancer Treatment
Because cancer treatment may damage healthy cells and
tissues, unwanted side
effects sometimes occur. These side effects depend on
many factors, including the type and extent of the treatment.
Side effects may not be the same for each person, and they may
even change from one treatment session to the next. Doctors
and nurses will explain the possible side effects of treatment
and how they will help the patient manage them.
The NCI provides helpful booklets about cancer treatments
and coping with side effects, such as Radiation
Therapy and You, Chemotherapy
and You, and Eating
Hints for Cancer Patients. See the "National
Cancer Institute Information Resources " and "National
Cancer Institute Booklets " sections for other sources
of information about side effects.
Surgery
For a few days after TUR, patients may have some blood in
their urine and difficulty or pain when urinating. Otherwise,
TUR generally causes few problems.
After cystectomy, most patients are uncomfortable during
the first few days. However, medicine can control the pain.
Patients should feel free to discuss pain relief with the
doctor or nurse. Also, it is common to feel tired or weak for
a while. The length of time it takes to recover from an
operation varies for each person.
After segmental cystectomy, patients may not be able to
hold as much urine in their bladder as they used to, and they
may need to urinate more often. In most cases, this problem is
temporary, but some patients may have long-lasting changes in
how much urine they can hold.
If the surgeon removes the bladder, the patient needs a new
way to store and pass urine. In one common method, the surgeon
uses a piece of the person's small
intestine to form a new tube through which urine can
pass. The surgeon attaches one end of the tube to the ureters
and connects the other end to a new opening in the wall of the
abdomen. This opening is called a stoma .
A flat bag fits over the stoma to collect urine, and a special
adhesive holds it in place. The operation to create the stoma
is called a urostomy
or an ostomy .
The section called "Rehabilitation
after Bladder Cancer " has more information about how
patients learn to care for the stoma.
For some patients, the doctor is able to use a part of the
small intestine to make a storage pouch (called a continent
reservoir ) inside the body. Urine collects in the
pouch instead of going into a bag. The surgeon connects the
pouch to the urethra or to a stoma. If the surgeon connects
the pouch to a stoma, the patient uses a catheter to drain the
urine.
Bladder cancer surgery may affect a person's sexual
function. Because the surgeon removes the uterus and ovaries
in a radical cystectomy, women are not able to get pregnant.
Also, menopause
occurs at once. Hot flashes and other symptoms of menopause
caused by surgery may be more severe than those caused by
natural menopause. Many women take hormone replacement therapy
(HRT) to relieve these problems. If the surgeon removes part
of the vagina during a radical cystectomy, sexual intercourse
may be difficult.
In the past, nearly all men were impotent
after radical cystectomy, but improvements in surgery have
made it possible for some men to avoid this problem. Men who
have had their prostate gland and seminal vesicles removed no
longer produce semen ,
so they have dry
orgasms . Men who wish to father children may consider
sperm
banking before surgery or sperm
retrieval later on.
It is natural for a patient to worry about the effects of
bladder cancer surgery on sexuality. Patients may want to talk
with the doctor about possible side effects and how long these
side effects are likely to last. Whatever the outlook, it may
be helpful for patients and their partners to talk about their
feelings and help one another find ways to share intimacy
during and after treatment.
Radiation Therapy
The side effects of radiation therapy depend mainly on the
treatment dose and the part of the body that is treated.
Patients are likely to become very tired during radiation
therapy, especially in the later weeks of treatment. Resting
is important, but doctors usually advise patients to try to
stay as active as they can.
External radiation may permanently darken or "bronze" the
skin in the treated area. Patients commonly lose hair in the
treated area and their skin may become red, dry, tender, and
itchy. These problems are temporary, and the doctor can
suggest ways to relieve them.
Radiation therapy to the abdomen may cause nausea,
vomiting, diarrhea, or urinary discomfort. The doctor can
suggest medicines to ease these problems.
Radiation therapy also may cause a decrease in the number
of white blood cells, cells that help protect the body against
infection. If the blood counts are low, the doctor or nurse
may suggest ways to avoid getting an infection. Also, the
patient may not get more radiation therapy until blood counts
improve. The doctor will check the patient's blood counts
regularly and change the treatment schedule if it is
necessary.
For both men and women, radiation treatment for bladder
cancer can affect sexuality. Women may experience vaginal
dryness, and men may have difficulty with erections.
Although the side effects of radiation therapy can be
distressing, the doctor can usually treat or control them. It
also helps to know that, in most cases, side effects are not
permanent.
Chemotherapy
The side effects of chemotherapy depend mainly on the drugs
and the doses the patient receives as well as how the drugs
are given. In addition, as with other types of treatment, side
effects vary from patient to patient.
Anticancer drugs that are placed in the bladder cause
irritation, with some discomfort or bleeding that lasts for a
few days after treatment. Some drugs may cause a rash when
they come into contact with the skin or genitals.
Systemic chemotherapy affects rapidly dividing cells
throughout the body, including blood cells. Blood cells fight
infection, help the blood to clot, and carry oxygen to all
parts of the body. When anticancer drugs damage blood cells,
patients are more likely to get infections, may bruise or
bleed easily, and may have less energy. Cells in hair roots
and cells that line the digestive tract also divide rapidly.
As a result, patients may lose their hair and may have other
side effects such as poor appetite, nausea and vomiting, or
mouth sores. Usually, these side effects go away gradually
during the recovery periods between treatments or after
treatment is over.
Certain drugs used in the treatment of bladder cancer also
may cause kidney damage. To protect the kidneys, patients need
a lot of fluid. The nurse may give the patient fluids by vein
before and after treatment. Also, the patient may need to
drink a lot of fluids during treatment with these drugs.
Certain anticancer drugs can also cause tingling in the
fingers, ringing in the ears, or hearing loss. These problems
may go away after treatment stops.
Biological Therapy
BCG therapy can irritate the bladder. Patients may feel an
urgent need to urinate, and may need to urinate frequently.
Patients also may have pain, especially when urinating. They
may feel tired. Some patients may have blood in their urine,
nausea, a low-grade fever, or chills.
Nutrition
Patients need to eat well during cancer therapy. They need
enough calories to maintain a good weight and protein to keep
up strength. Good nutrition often helps people with cancer
feel better and have more energy.
But eating well can be difficult. Patients may not feel
like eating if they are uncomfortable or tired. Also, the side
effects of treatment, such as poor appetite, nausea, or
vomiting, can be a problem. Foods may taste different.
The doctor, dietitian, or other health care provider can
suggest ways to maintain a healthy diet. Patients and their
families may want to read the National Cancer Institute
booklet Eating
Hints for Cancer Patients, which contains many useful
ideas and recipes. The "National
Cancer Institute Booklets " section tells how to get this
publication.
Rehabilitation
Rehabilitation is an important part of cancer care. The
health care team makes every effort to help the patient return
to normal activities as soon as possible.
Patients who have a stoma need to learn to care for it.
Enterostomal
therapists or nurses can help. These health care
specialists often visit patients before surgery to discuss
what to expect. They teach patients how to care for themselves
and their stomas after surgery. They talk with patients about
lifestyle issues, including emotional, physical, and sexual
concerns. Often they can provide information about resources
and support groups.
Followup Care
Followup care after treatment for bladder cancer is
important. Bladder cancer can return in the bladder or
elsewhere in the body. Therefore, people who have had bladder
cancer may wish to discuss the chance of recurrence with the
doctor.
If the bladder was not removed, the doctor will perform
cystoscopy and remove any new superficial tumors that are
found. Patients also may have urine tests to check for signs
of cancer. Followup care may also include blood tests, x-rays,
or other tests.
People should not hesitate to discuss followup care with
the doctor. Regular followup ensures that the doctor will
notice changes so that any problems can be treated as soon as
possible. Between checkups, people who have had bladder cancer
should report any health problems as soon as they appear. (Source: excerpt from What You Need To Know About Bladder Cancer: NCI)
Buy Products Related to Treatments for Bladder Cancer
Book Excerpts: Treatment of Bladder Cancer
Treatments of Bladder Cancer: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the treatments of Bladder Cancer.
Dysuria:
Treatment
(In a Page: Signs and Symptoms)
-
Cystitis/prostatitis: Appropriate antibiotics
–Begin with empiric therapy and adjust to sensitivities
–Noninfectious cystitis: Remove offending medications
or allergens if possible
Pyelonephritis: Outpatient antibiotic treatment in patients who tolerate liquids and have no significant co-morbidities; otherwise, admit for IV hydration and antibiotics
Urolithiasis: Hydration, pain control while attempting to pass stones; urology referral if stones will not pass
Atrophic vaginitis: Consider estrogen creams or systemic replacement if other symptoms
BPH: Symptomatic relief with α-blockers, 5α-reductase-inhibitors, or saw palmetto extract
Sexually transmitted diseases
–Treat specific etiology and screen for coexistent STDs (e.g., HIV, hepatitis B)
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Urinary Stream (Decreased):
Treatment
(In a Page: Signs and Symptoms)
-
Initial evaluation for urinary retention, which must be treated immediately with catheterization to prevent additional injury and relieve pain; thereafter, evaluation and treatment of infection and pain is indicated
-
BPH: “Watchful waiting,” α-blockers, 5α-reductase inhibitors, TURP or other transurethral procedures, and/or open prostatectomy
-
Urethral stricture: Dilation, lysis, open surgical repair
-
Chronic urethritis/prostatitis: Long-term antibiotics
-
Prostate cancer may require prostatectomy or no intervention, depending on stage of the cancer and patient issues (e.g., age, co-morbid conditions)
-
Bladder cancer: Transurethral resection, intravesical chemotherapy; radical cystectomy for late disease, external radiation, and/or systemic chemotherapy
-
Neuropathic bladder: Parasympatholytic medications, intermittent or permanent catheterization, or surgical options (section of sacral nerve roots, ureteral diversion, and/or artificial sphincter)
>>
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Dysuria:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
UTI: Empiric antibiotics (e.g., co-trimoxazole) pending culture; adjust antibiotics based on bacterial sensitivities
-
STD
–Simple cervicitis: Treat with IM ceftriaxone and PO azithromycin, metronidazole if Trichomonas present
–For an ill patient with signs of PID, consider hospital admission, give IV cefoxitin and PO doxycycline
-
Candidal vaginitis: Topical antifungal agents or oral fluconazole
- Hypercalciuria/kidney stones
–Increase fluid intake, decrease sodium intake (increases urinary calcium excretion), do not restrict calcium intake
–Treat with thiazide diuretics (decrease urinary calcium excretion) if patient is persistently symptomatic and/or has urinary calculi
- Avoid instrumentation/local irritants (e.g., bubble baths)
>
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Bladder distention:
Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))
If the patient has severe distention, insert an indwelling urinary catheter to help relieve discomfort and prevent bladder rupture. If more than 700 ml is emptied from the bladder, compressed blood vessels dilate and may make the patient feel faint. Typically, the indwelling urinary catheter is clamped for 30 to 60 minutes to permit vessel compensation.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Bladder cancer:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Superficial bladder tumors are removed by transurethral (cystoscopic) resection and fulguration (electrical destruction). This procedure is adequate when the tumor hasn't invaded the muscle.
Intravesicular chemotherapy is also used for superficial tumors (especially those that occur in many sites) and to prevent tumor recurrence. This treatment involves washing the bladder directly with antineoplastic drugs — most commonly, thiotepa, doxorubicin, mitomycin, or Bacillus Calmette-Guérin immunotherapy.
If additional tumors develop, fulguration may have to be repeated every 3 months for years. However, if the tumors penetrate the muscle layer or recur frequently, cystoscopy with fulguration is no longer appropriate.
Tumors too large to be treated through a cystoscope require segmental bladder resection to remove a full-thickness section of the bladder. This procedure is feasible only if the tumor isn't near the bladder neck or ureteral orifices. Bladder instillation of thiotepa, mitomycin-C, or doxorubicin after transurethral resection may also help control such tumors.
For infiltrating bladder tumors, radical cystectomy is the treatment of choice. The week before cystectomy, treatment may include external beam therapy to the bladder. Surgery involves removal of the bladder with perivesical fat, lymph nodes, urethra, the prostate and seminal vesicles (in males), and the uterus and adnexa (in females). The surgeon forms a urinary diversion, usually an ileal conduit. The patient must then wear an external pouch continuously. Other diversions include ureterostomy, nephrostomy, vesicostomy, ileal bladder, ileal loop, and sigmoid conduit.
Males are impotent following radical cystectomy and urethrectomy because these procedures damage the sympathetic and parasympathetic nerves that control erection and ejaculation. At a later date, the patient may desire a penile implant to make sexual intercourse (without ejaculation) possible.
Treatment of patients with advanced bladder cancer includes cystectomy to remove the tumor, radiation therapy, and systemic chemotherapy with such drugs as doxorubicin, methotrexate, vinblastine, and cisplatin. This combination sometimes is successful in arresting bladder cancer. Cisplatin is the most effective single agent.
Investigational treatments include photodynamic therapy and intravesicular administration of interferon-alfa and tumor necrosis factor. Photodynamic therapy involves I.V. injection of a photosensitizing agent such as hematoporphyrin ether, which malignant cells readily absorb. Then a cystoscopic laser device introduces laser energy into the bladder, exposing the malignant cells to laser light, which kills them. Because this treatment also produces photosensitivity in normal cells, the patient must totally avoid sunlight for about 30 days.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Lower urinary tract infection:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Appropriate antimicrobials are the treatment of choice for most initial lower UTIs. A course of antibiotic therapy lasting from 7 to 10 days is standard, but recent studies suggest that a single dose of an antibiotic or an antibiotic regimen of 3 to 5 days length may be sufficient to render the urine sterile. After 3 days of antibiotic therapy, urine culture should show no organisms. If the urine isn’t sterile, bacterial resistance has probably occurred, making the use of a different antimicrobial necessary. Single-dose antibiotic therapy with amoxicillin or co-trimoxazole may be effective in females with acute noncomplicated UTI. A urine culture taken 1 to 2 weeks later indicates whether or not the infection has been eradicated.
Recurrent infections due to infected renal calculi, chronic prostatitis, or structural abnormality may necessitate surgery; prostatitis also requires long-term antibiotic therapy. In patients without these predisposing conditions, long-term, low-dosage antibiotic therapy is the treatment of choice.
PEDIATRIC TIP Fluoroquinolones aren’t used for children because of possible adverse effects on developing cartilage.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Malignant spinal neoplasms:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment of spinal cord tumors generally includes decompression or radiation. Laminectomy is indicated for primary tumors that produce spinal cord or cauda equina compression; it isn't usually indicated for metastatic tumors. If the tumor is slowly progressive or if it's treated before the cord degenerates from compression, symptoms are likely to disappear, and complete restoration of function is possible. In a patient with metastatic carcinoma or lymphoma who suddenly experiences complete transverse myelitis with spinal shock, functional improvement is unlikely, even with treatment, and his outlook is ominous. If the patient has incomplete paraplegia of rapid onset, emergency surgical decompression may save cord function. Steroid therapy with dexamethasone minimizes cord edema and temporarily relieves symptoms until surgery can be performed. Partial removal of intramedullary gliomas, followed by radiation, may alleviate symptoms for a short time. Metastatic extradural tumors can be controlled with radiation, analgesics and, in the case of hormone-mediated tumors (breast and prostate), appropriate hormone therapy. Transcutaneous electrical nerve stimulation (TENS) may control radicular pain from spinal cord tumors and is a useful alternative to opioid analgesics. In TENS, an electrical charge is applied to the skin to stimulate large-diameter nerve fibers and thereby inhibit transmission of pain impulses through small-diameter nerve fibers. Chemotherapy generally hasn't proven effective against most spinal tumors, but may be recommended in some cases.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Malignant brain tumors:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment includes removing a resectable tumor; reducing a nonresectable tumor; relieving cerebral edema, increased ICP, and other symptoms; and preventing further neurologic damage.
The mode of therapy depends on the tumor's histologic type, radiosensitivity, and location and may include surgery, radiation, chemotherapy, or decompression of increased ICP with diuretics, cortico-steroids, or possibly ventriculoatrial or ventriculoperitoneal shunting of CSF.
A glioma usually requires resection by craniotomy, followed by radiation therapy and chemotherapy. The combination of nitrosoureas (carmustine [BCNU], lomustine [CCNU], or procarbazine) and postoperative radiation is more effective than radiation alone.
Surgical resection of low-grade cystic cerebellar astrocytomas brings long-term survival. Treatment of other astrocytomas includes repeated surgery, radiation therapy, and shunting of fluid from obstructed CSF pathways. Some astrocytomas are highly radiosensitive, but others are radioresistant.
Treatment of oligodendrogliomas and ependymomas includes resection and radiation therapy; for medulloblastomas, resection and possibly intrathecal infusion of methotrexate or another antineoplastic drug. Meningiomas require resection, including dura mater and bone (operative mortality may reach 10% because of large tumor size).
For schwannomas, microsurgical technique allows complete resection of the tumor and preservation of facial nerves. Although schwannomas are moderately radioresistant, postoperative radiation therapy is necessary.
Chemotherapy for malignant brain tumors includes the nitrosoureas that help break down the blood-brain barrier and allow other chemotherapeutic drugs to go through as well. Intrathecal and intra-arterial administration of drugs maximizes drug actions.
Palliative measures for gliomas, astrocytomas, oligodendrogliomas, and ependymomas include dexamethasone for cerebral edema; osmotic diuretics, such as urea and mannitol, to reduce brain swelling; analgesics to control pain; and antacids and histamine receptor antagonists for stress ulcers. These tumors and schwannomas may also require anticonvulsants such as phenytoin to reduce seizures.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Primary malignant bone tumors:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Excision of the tumor with a 3"(7.6 cm) margin is the treatment of choice. It may be combined with preoperative chemo-therapy.
In some patients, radical surgery (such as hemipelvectomy or amputation) is necessary; however, surgical resection of the tumor (commonly with preoperative and postoperative chemotherapy) has saved limbs from amputation.
Intensive chemotherapy includes administration of doxorubicin, vincristine, cyclophosphamide, cisplatin, dacarbazine, and etoposide in various combinations. Chemotherapy may be infused intra-arterially into the long bones of the legs.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Bladder distention:
Emergency interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient has severe distention, insert an indwelling urinary catheter to help relieve discomfort and prevent bladder rupture. If more than 700 ml is emptied from the bladder, compressed blood vessels dilate, which may make the patient feel faint. Typically, the indwelling urinary catheter is clamped for 30 to 60 minutes to permit vessel compensation.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Urinary urgency:
Patient counseling
(Professional Guide to Signs & Symptoms (Fifth Edition))
Instruct sexually active patients in safer sex practices. Teach women and girls about proper genital hygiene such as cleaning from front to back to reduce contamination from fecal bacteria. Instruct women to maintain adequate fluid intake to promote frequent urination.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Urinary tract infection, lower:
Treatment
(Handbook of Diseases)
Appropriate antimicrobials are the treatment of choice for most initial lower UTIs. A 7- to 10-day course of antibiotic therapy is standard, but recent studies suggest that a single dose of an antibiotic or a 3- to 5-day antibiotic regimen may be sufficient to render the urine sterile. After 3 days of antibiotic therapy, urine culture should show no organisms.
If the urine isn’t sterile, bacterial resistance has probably occurred, making the use of a different antimicrobial necessary. Single-dose antibiotic therapy with amoxicillin or co-trimoxazole may be effective in women with acute, noncomplicated UTI. A urine culture taken 1 to 2 weeks later indicates whether the infection has been eradicated.
Recurrent infections due to infected renal calculi, chronic prostatitis, or structural abnormality may necessitate surgery; prostatitis also requires long-term antibiotic therapy. In patients without these predisposing conditions, long-term, low-dosage antibiotic therapy is the treatment of choice.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Bladder cancer:
Treatment
(Handbook of Diseases)
Appropriate treatment for bladder cancer varies.
Superficial bladder tumors
Superficial bladder tumors are removed by transurethral (cystoscopic) resection and fulguration (electrical destruction). This procedure is adequate when the tumor hasn’t invaded the muscle.
Intravesicular chemotherapy is used for superficial tumors (especially those that occur in many sites) and to prevent tumor recurrence. This treatment involves washing the bladder directly with an antineoplastic — most commonly, thiotepa, doxorubicin, mitomycin, or bacille Calmette-Guérin (BCG).
If additional tumors develop, fulguration may have to be repeated every 3 months for years. However, if the tumors penetrate the muscle layer or recur frequently, cystoscopy with fulguration is no longer appropriate.
Tumors too large to be treated through a cystoscope require segmental bladder resection to remove a full-thickness section of the bladder. This procedure is feasible only if the tumor isn’t near the bladder neck or ureteral orifices. Bladder instillations of thiotepa after transurethral resection may also help control such tumors.
Under study Immunotherapy may be used to fight cancer. BCG is an immunomodulating agent commonly used in the treatment of superficial bladder cancer following surgery to remove the tumor. Biologic response modifiers — such as interferons, interleukins, colony-stimulating factors, monoclonal antibodies, and vaccines — may also be used to alter the interaction between the body’s immune defenses and the cancer cells. The goal is to boost, direct, or restore the body’s ability to fight the disease.
Infiltrating bladder tumors
Radical cystectomy is the treatment of choice for infiltrating bladder tumors. The week before cystectomy, treatment may include external beam therapy to the bladder. Surgery involves removal of the bladder with perivesical fat, lymph nodes, urethra, the prostate and seminal vesicles (in males), and the uterus and adnexa (in females). The surgeon forms a urinary diversion, usually an ileal conduit. The patient must then continuously wear an external pouch. (See Caring for a urinary stoma.) Other diversions include ureterostomy, nephrostomy, vesicostomy, ileal bladder, ileal loop, and sigmoid conduit.
Males are impotent following radical cystectomy and urethrectomy because these procedures damage the sympathetic and parasympathetic nerves that control erection and ejaculation. At a later date, the patient may desire a penile implant to make sexual intercourse (without ejaculation) possible.
Advanced bladder cancer
For patients with advanced bladder cancer, treatment includes cystectomy to remove the tumor, radiation therapy, and systemic chemotherapy with such drugs as cyclophosphamide, fluorouracil, doxorubicin, and cisplatin. This combination sometimes is successful in arresting bladder cancer.
Cisplatin is the single most effective agent.
Investigational treatments
Such treatments include photodynamic therapy and intravesicular administration of interferon alfa and tumor necrosis factor. Photodynamic therapy involves I.V. injection of a photosensitizing agent such as hematoporphyrin ether, which malignant cells readily ab
sorb. Then a cystoscopic laser device introduces laser energy into the bladder, exposing the malignant cells to laser light, which kills them. Because this treatment also produces photosensitivity in normal cells, the patient must totally avoid sunlight for about 30 days.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Bone tumors, primary malignant:
Treatment
(Handbook of Diseases)
❑ Excision of the tumor along with a 3"(7.6 cm) margin is the treatment of choice. It may be combined with preoperative chemotherapy.
❑ In some patients, radical surgery (such as hemipelvectomy or interscapulothoracic amputation) is necessary. However, surgical resection of the tumor (often with preoperative and postoperative chemotherapy) has saved limbs from amputation.
❑ Intensive chemotherapy includes administration of doxorubicin, ifosfamide, cisplatin, and high doses of methotrexate, alone or in various combinations for osteosarcomas. Additionally, vincristine, etoposide, and dactinomycin may be added if the patient has Ewing’s sarcoma. Chemotherapy may be infused intra-arterially into the long bones of the legs.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Brain tumors, malignant:
Treatment
(Handbook of Diseases)
Remedial approaches include removing a resectable tumor; reducing a nonresectable tumor; relieving cerebral edema, increased ICP, and other signs and symptoms; and preventing further neurologic damage.
The mode of therapy depends on the tumor’s histologic type, radiosensitivity, and location and may include surgery, radiation, chemotherapy, or decompression of increased ICP with a diuretic, corticosteroid or, possibly, ventriculoatrial or ventriculoperitoneal shunting of CSF.
❑ Gliomas. Treatment usually requires resection by craniotomy, followed by radiation therapy and chemotherapy. The combination of nitrosoureas (carmustine [BCNU], lomustine [CCNU], or procarbazine) and postoperative radiation is more effective than radiation alone.
❑ Astrocytomas. Surgical resection of low-grade cystic cerebellar astrocytomas brings long-term survival. Treatment of other astrocytomas includes repeated surgery, radiation therapy, and shunting of fluid from obstructed CSF pathways. Some astrocytomas are highly radiosensitive, but others are radioresistant.
❑ Oligodendrogliomas and ependymomas. Treatment includes resection and radiation therapy.
❑ Medulloblastomas. Treatment involves resection and, possibly, intrathecal infusion of methotrexate or another antineoplastic.
❑ Meningiomas. Treatment requires resection, including dura mater and bone (operative mortality may reach 10% because of large tumor size).
❑ Schwannomas. Microsurgical technique allows complete resection of the tumor and preservation of facial nerves. Although schwannomas are moderately radioresistant, postoperative radiation therapy is necessary.
Chemotherapy for malignant brain tumors includes a nitrosourea to help break down the blood-brain barrier and permit other chemotherapeutic drugs to go through as well. Intrathecal and intra-arterial administration of drugs maximizes drug action.
Palliative measures for gliomas, astrocytomas, oligodendrogliomas, and ependymomas include dexamethasone for cerebral edema and an antacid and a histamine-receptor antagonist for stress ulcers. These tumors and schwannomas may also require an anticonvulsant.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Bladder distention:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Monitor the patient’s vital signs and the extent of bladder distention. Obtain bladder urinary volume with a bladder scanner. Encourage the patient to change positions to alleviate discomfort. Administer medications for pain relief.
Prepare the patient for diagnostic tests, such as endoscopy and radiologic studies, to determine the cause of bladder distention. Withhold fluids and food if surgery is indicated.
Patient teaching
If the patient doesn’t require immediate urinary catheterization, provide privacy and suggest that a normal voiding position be assumed. Teach Valsalva’s maneuver, or gently perform Credé’s maneuver. Use the power of suggestion to stimulate voiding. For example, run water in the sink, pour warm water over his perineum, place his hands in warm water, or play tapes of aquatic sounds.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Bladder distention:
Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If the patient has severe distention, insert an indwelling urinary catheter to help relieve discomfort and prevent bladder rupture. If more than 700 ml is emptied from the bladder, compressed blood vessels dilate and may make the patient feel faint. Typically, the indwelling urinary catheter is clamped for 30 to 60 minutes to permit vessel compensation.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Dysuria:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Encourage the patient to increase his fluid intake to 3.2 qt (3 L))/day, unless contraindicated. Explain the importance of frequent urination. Show the female patient how to perform proper perineal care and tell her to avoid tub baths, especially bubble baths, and vaginal deodorants. Explain the importance of taking the full course of prescribed antibiotics, even if symptoms subside.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Urethral discharge:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Advise the patient with acute prostatitis to discontinue sexual activity until acute symptoms subside. However, encourage the patient with chronic prostatitis to regularly engage in sexual activity because ejaculation may relieve pain.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Urinary hesitancy:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Teach the patient signs and symptoms of UTI to report. Also, teach him how to perform a clean, intermittent self-catheterization.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Urinary urgency:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Instruct sexually active patients in safer sex practices. Advise women and girls about proper genital hygiene — such as cleaning from front to back to reduce contamination from fecal bacteria. Instruct women to maintain adequate fluid intake, allowing frequent daily voiding.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Bladder distention:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Insert a urinary catheter to relieve distention. If a catheter is already in place, irrigate or replace it to improve function.
▪ Monitor the patient's vital signs, intake and output, and the extent of bladder distention.
▪ Encourage the patient to change positions to alleviate discomfort.
▪ Administer an analgesic, as appropriate.
▪ Prepare the patient for diagnostic tests (such as cystoscopy and radiologic studies) to determine the cause of bladder distention.
▪ Prepare the patient for surgery if interventions fail to relieve bladder distention and obstruction prevents catheterization.
▪ Provide privacy for voiding and encourage a normal voiding position.
Patient teaching
▪ Explain the underlying cause and treatment plan.
▪ Teach the patient to use Valsalva's maneuver or Credé's method to empty the bladder.
▪ Explain how to stimulate voiding or perform self-catheterization as appropriate.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Dysuria:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Monitor the patient's vital signs and intake and output.
▪ Administer prescribed drugs.
▪ Prepare the patient for such tests as urinalysis and cystoscopy.
Patient teaching
▪ Explain the importance of increased fluid intake.
▪ Emphasize the importance of frequent urination.
▪ Teach the patient to perform perineal care.
▪ Discourage the use of bubble baths and vaginal deodorants.
▪ Discuss the importance of taking prescribed drugs as instructed.
▪ Explain to the patient his diagnosis and the treatment plan.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Urethral discharge:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ To relieve symptoms, have the patient take hot sitz baths, increase fluid intake, void frequently, and avoid caffeine, tea, and alcohol.
▪ Monitor him for urine retention.
Patient teaching
▪ Advise the patient with acute prostatitis to discontinue sexual activity until acute symptoms subside.
▪ Encourage the patient with chronic prostatitis to regularly engage in sexual activity because ejaculation may relieve pain.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Urinary hesitancy:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Monitor the patient's voiding pattern and intake and output.
▪ Frequently palpate for bladder distention.
▪ Apply local heat to the perineum or the abdomen to enhance muscle relaxation and aid urination.
▪ Prepare the patient for tests, such as cystometrography or cystourethrography.
Patient teaching
▪ Explain the underlying disorder and treatment plan.
▪ Teach the patient how to perform a clean, intermittent self-catheterization.
▪ Discuss the importance of increasing fluid intake and voiding frequently.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Urinary urgency:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Prepare the patient for the diagnostic workup, including a complete urinalysis, culture and sensitivity studies, and possibly neurologic tests.
▪ Increase the patient's fluid intake and monitor intake and output.
▪ Administer an antibiotic and a urinary anesthetic, such as phenazopyridine.
Patient teaching
▪ Explain the underlying disorder and treatment plan.
▪ Instruct the patient in safer sex practices.
▪ Discuss proper genital hygiene.
▪ Explain the need for adequate fluid intake and frequent voidings.
▪ Explain how to perform Kegel exercises.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Prostate cancer is a subject every man should know about -- it's one of the leading causes of cancer death among men. But many don't know...
Prostate cancer is a subject every man should know about -- it's one of the leading causes of cancer death among men. But many don't know...
Prostate cancer is a subject every man should know about -- it's one of the leading causes of cancer death among men. But many don't know...
People with cancer have a lot on their minds, which is why they may have trouble sleeping. But some cancer treatments can also upset sleep patterns....
See full list of 12 related videos
» Next page: Alternative Treatments for Bladder Cancer
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
