By :

Aan Nuraeni
Eka Afrima Sari
Faculty of Nursing Universitas Padjadjaran
2017
Urinary Tract Cancers include:
Urinary bladder
Kidney and renal pelvis
Ureter
Prostate

TOBACCO use continues to be a leading

cause of all Urinary Tract Cancers.
 These tumors may metastasize early to
the LUNGS, BONE, LIVER, BRAIN, and
CONTRALETERAL KIDNEY.
Clinical Manifestations

Early symptoms : no specific characteristic

Many renal tumors produce NO SYMPTOMS
and are discovered on a routine physical
examination as a PALPABLE ABDOMINAL
MASS.
The Classic Triad of Sign and Symptoms (hanya
terjadi pada 10% pasien): gross hematuria,
flank pain and palpable mass advanced
disease
Clinical Manifestation-cont
The usual sign that first calls attention to the
tumor is PAINLESS HEMATURIA, which may be
either intermittent and microscopic or continuous
and gross
Tekanan karena kompresi ureter, ekstensi tumor
ke area perirenal atau hemorrhage kedalam
kidney tissue DULL PAIN in the back
Clot atau sel tumor melewati ureter Nyeri
Kolik
Generalized symptoms : weight loss, weakness,
and anemia
Diagnosis studies

Primary examination : IVP with nephrotomography,

IV Urography, cystoscopic examination, renal
angiograms.
Ultrasound (USG) : differentiate between a tumor
and cyst
Other common studies : angiography, percutaneuos
needle aspiration, CT, and magnetic resonance
imaging (MRI).
Radionuclide isotope scanning is used to detect
metastases
 Test-test tersebut melelahkan bagi
pasien: efek sistemik dari sel tumor, bagi
lansia, dan pasien yang cemas karena
diagnosis dan hasil pemeriksaan.

Tugas perawat:
Bantu persiapan pasien baik secara fisik
dan psikologis untuk prosedur dan
monitor tanda dan gejala dehidrasi dan
kelelahan.
Medical Management
Goal: to eradicate the tumor before metastasis occurs

Treatment of choice is RADICAL NEPHRECTOMY

(Removal of the kidney (and tumor), adrenal gland,
surrounding fascia, part of the ureter, and draining
lymph nodes)
Radiation therapy, hormonal therapy, or chemotheraphy
may be used along with surgery.
RADIATION therapy is used palliatively when there are
metastases to bone or lung.
No effective CHEMOTHERAPY is available for
metastatic renal cell carcinoma
Biologic therapy an interferon and interleukin-2 are
most promising in treatment of metastatic disease.
Medical Management-cont
For patients with bilateral tumors or cancer of
a functional single kidney, NEPHRON-
SPARING SURGERY (partial nephrectomy)
may be considered.
Nephron-sparing surgery is increasingly being
used to treat patients with solid renal lesions.
Tingkat keberhasilan excellent, morbiditas
dan mortalitas operasi rendah
Nursing Management
After surgery cathethers and drains: to maintain a
patent urinary tract, to remove drainage, and to permit
accurate measurement of urine output.
Surgical incision position of the patient during
surgery, the nature of the surgical procedure pain
and muscle soreness
The patient requires frequent analgesia during the
postoperative period and assistance with turning.
Turning, coughing, use of incentive spirometry, and
deep breathing are encouraged to prevent atelectasis
and other pulmonary complications.
The patient and family require assistance and support
to cope with the diagnosis and uncertainties about the
prognosis.
Definition
Wilms Tumor is a common renal tumor of
infants and children. 40 % are hereditary,
with an autosomal dominant mode of
transmission.
Clinical Manifestation
Abdominal swelling or distension (most
common)
Pain
Fever
Hematuria
Hypertension
Diagnostic Studies
Ultrasound
Renal arteriography
Treatment
These tumors respond well to
multymodality therapy, include :
Surgical removal of the involved kidney
Radiation therapy ( it is used postoperatively,
and for inoperable tumors, bilateral tumors,
and metastase)
Chemotherapy
Introduction
The most frequent malignant tumor of the
urinary tract is transitional cell carcinoma of
bladder.
The most bladder tumors are papillomatous
growths within the bladder.
Risk Factors
ages ( > 60 y), patients receiving
men (3 times more cyclophosphamide
risky) (cytoxan)
cigarette smoking Reccurent stones
exposure to dyes used
(often bladder)
in the rubber and cable Chronic lower urinary
industries infections (indwelling
chronic abuse of
catheters for long
phenacetin-containing periods can develop
analgetics the condition)
women treated with
radiation for cervical
cancer
Clinical Manifestations
Bladder tumors usually arise at the base of the bladder
and involve the ureteral orices and bladder neck.
GROSS, PAINLESS HEMATURIA (chronic or
intermitten) is the most common finding and the first
in 85 % to 90 % patients.
Common complication : Infection of the urinary tract
Bladder irritability with dysuria, frequency, and
urgency
Any alteration in voiding or change in the urine,
however, may indicate cancer of the bladder. Pelvic or
back pain may occur with metastasis.
The clinical staging of carcinoma of the bladder is
determined by the depth of invasion of the bladder
wall and surrounding tissue
Diagnostic Studies
When cancer is suspected, urine
specimens for cytology can be obtained
to determine the presence of neoplastic or
atypical cells.
Urine test : bladder tumor antigens.
IVP, Ultrasound, CT, MRI, excretory
urography
Cystoscopy (the mainstay of diagnosis)
and biopsy
Medical Management
Treatment of bladder cancer depends on the
grade of the tumor (the degree of cellular
differentiation), the stage of tumor growth (the
degree of local invasion and the presence or
absence of metastasis), and the multicentricity
(having many centers) of the tumor.
The patients age and physical, mental, and
emotional status are considered when
determining treatment modalities.
Collaborative therapy
Surgical Treatment Intravesical
Transurethral Immunotherapy
resection with Baccil Calmete-Guerin
fulguration (BCG)
Laser Intravesical
Photocoagulation
Chemotherapy
Open loop resection of
fulguration Thiotepa
Segmental cystectomy Mitomycin
Doxorubicin
Radical cystectomy
Radiation Systemic
chemotherapy
Introduction
Cancer of the prostate is the most
common cancer in men.
It is the second leading cause of cancer
death in men, after lung cancer.
Etiology & Pathofisiologi
Prostate cancer is an androgen
dependent adenocarcinoma
Risk Factors : high fat diets and
environmental factors, a family history of
prostate cancer is a major factor risk
(9%), and hormonal influence.
A higher incidence exist in men 60 y age
or older
Etiology & Pathofisiologycont..
The tumor is slow growing and usually begins in
the prosterior or lateral portions of the prostate.
It can spread by 3 route : direct extension; via
lymphatics; and via the bloodstream.
Direct extension is by continuity to the seminal
vesicles, uretral mucosa, bladder wall & external
sphincter.
The cancer later spreads through the perineural
lymphatic system to the regional lymph nodes.
The veins from the prostate seem to be mode of
spread to the pelvic bones, head of the femur,
lower lumbar spine, liver and lungs.
Clinical Manifestations
Cancer of the prostate in its early stages
rarely produces symptoms.
If the neoplasm is large enough to
encroach on the bladder neck, signs and
symptoms of urinary obstruction occur:
difculty and frequency of urination,
urinary retention, and decreased size and
force of the urinary stream.
Other symptoms may include blood in the
urine or semen and painful ejaculation.
Clinical Manifestation-cont
Hematuria may result if the cancer invades
the urethra or bladder, or both.
Prostate cancer can metastasize to bone and
lymph nodes.
Symptoms related to metastases include
backache, hip pain, perineal and rectal
discomfort, anemia, weight loss, weakness,
nausea, and oliguria (decreased urine output).
Clinical Manifestations and
Complication
Prostate cancer is asymptomatic in the early
stages, eventually the patient may have
symptoms similar to those of BPH, including
dysuria, hesitancy, frequency, urgency,
hematuria, nocturia and retention.
The prostate feels hard, enlarge, and fixed on
rectal examination.
The enlargement is usually unilateral
Pain in the lumbosacral area which radiates
down to the hips or legs when coupled with
urinary symptoms may indicate metastasis
 The tumor can spread to the pelvic lymph
nodes, bones, bladder,lungs, and liver.
Once tumor has spread to distant sites,
the major problem becomes the
management of pain.
As the cancer spreads to the bones, pain
can become severe, especially in the back
and legs because of compression of the
spinal cord and osteoblastic lesions.
Diagnostic Studies

Diadaptasi dari : Monahan, F. D., Sands, J. K., Neighbors, M., Marek, J. F., & Green, C. J. (2007). Phipps' Medical
Surgical Nursing: Health And Illness Persfective (Eighth ed.). Philadelphia: Mosby Elsevier
Diagnostic Studies..cont
The normal blood range for PSA is 0 2,5
ng/ml
Men whose PSA is between 1.0 2.0
ng/ml should have yearly retesting
An increase in PSA of more than 0.70
ng/ml/yr, is associated with prostate
cancer and a biopsy should be done
PSA level > 4 ng/ml prostate cancer
Diagnostic Studies..cont
The PSA test divided into 2 scores : a
bound PSA and free PSA
Low precentage of free PSA tends to
indicate cancer prostate
Sexual Complications
Men with prostate cancer commonly
experience sexual dysfunction before the
diagnosis is made.
With nerve-sparing radical prostatectomy,
the chance of recovering erections is better
for men who are younger and in whom both
neurovascular bundles are spared.
Hormonal therapy also affects the central
nervous system mechanisms that mediate
sexual desire and arousability.
Staging :
http://www.cancer.org/cancer/prostatecanc
er/detailedguide/prostate-cancer-staging

Diadaptasi dari : Monahan, F. D., Sands, J. K.,

Neighbors, M., Marek, J. F., & Green, C. J.
(2007). Phipps' Medical Surgical Nursing:
Health And Illness Persfective (Eighth ed.).
Philadelphia: Mosby Elsevier
Collaborative Care
Depends on the stage of
the cancer.
Stage A :
Continue medical follow
up, observation, TURP or
total prostatectomy
Radiation therapy
Stage B :
TURP
Total prostatectomy with
or without
lymphadenectomy
Radiation therapy
Stage C :
Hormone manipulation
(LH releasing hormone
analogues, Androgen
Deprivation Therapy)or
orchiectomy
Radical resection of
prostate
Radiation therapy
Stage D :
Hormone therapy
Radiation to metastatic
bone areas
Chemotherapy
Collaborative care..cont..
Radiation Therapy
Radiation therapy is commonly used in the
management of prostate cancer, especially in
men over age 70. as compared with surgery
there is a reduce risk of erectile dysfunction.
Potential side effects of radiation include
diarhea, cystitis, and erectile dysfunction
Radiation therapy may also be combined
with the antiandrogen agents such as
goserelin (zoladex)
Collaborative care..cont..
Surgical Therapy :
Suprapubic prostatectomy
Retropubic prostatectomy
Perineal prostatectomy
Nursing Diagnoses
Decisional conflict related to numerous
alternative treatment option
Pain related to surgery, prostatic
enlargement, bone metastasis, and bladder
spasms
Altered urinary elimination related to
bladder neck sphingther damage
Anxiety related to uncertain outcome of
disease process on life and lifestyle and effect
of treatment on sexual functioning
Nursing Diagnosis-cont
Anxiety related to concern and lack of
knowledge about the diagnosis, treatment
plan, and prognosis
Urinary retention related to urethral
obstruction secondary to prostatic
enlargement or tumor and loss of bladder
tone due to prolonged distention/retention
Decient knowledge related to the diagnosis
of: cancer, urinary difculties, and treatment
modalities
Nursing Diagnosis-cont
Imbalanced nutrition: less than body
requirements related to decreased oral
intake because of anorexia, nausea, and
vomiting caused by cancer or its treatment
Sexual dysfunction related to effects of
therapy: chemotherapy, hormonal therapy,
radiation therapy, surgery
Impaired physical mobility and activity
intolerance related to tissue hypoxia,
malnutrition, and exhaustion and to spinal
cord or nerve compression from metastases
Collaborative Problems
Hemorrhage, infection, bladder neck
obstruction
Planning
The overall goals are that the patient will :
1. Be an active participant in the treatment
plan
2. Have satisfactory pain control
3. Follow the therapeutic plan
4. Accept the effect of the theurapeutic plan
on sexual function
5. Find a satisfactory way to manage impact
of bladder or bowel function
Nursing implementation