Transcript Week 15_Kidney cancer, Bladder cancerx

Kidney cancer
Bladder cancer
Hanjong Park, PhD, RN
Kidney cancer
(Lewis et al., 2014, P 1084)
“Kidney cancers arise from the cortex
or pelvis (and calyces). Tumors from
these areas may be benign or
malignant.
However, malignant tumors are more
common.”
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Kidney cancer: Etiology
신세포암 Renal cell carcinoma(선암종, adenocarcinoma)
• Malignant tumor의 가장 흔한 유형
• 남 (2배) > 여
• 50-70세 발견
Risk factors
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•
•
•
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•
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Most common cause: Smoking!
Family history(first degree relatives with renal cell carcinoma)
Obesity
Hypertension
Exposure to asbestos, cadmium, and gasoline. Phenacetine
Cystic disease of the kidney associated with ESKD
김금순 외(2012), Lewis et al.(2014)
Kidney cancer: Clinical manifestations
No characteristic early symptoms
Common symptoms:
Hematuria, Flank pain, Palpable mass in the flank or abdomen,
Weight loss, Fever, Hypertension, anemia
Symptoms by compressing, stretching, invading structures near or within the kidney
Local extension of kidney into renal vein & vena cava
Metastasis(lungs, liver, long bones): 30% of patients at the time of diagnosis
김금순 외(2012), Lewis et al.(2014)
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Classification for staging Kidney cancer
Stage III
Stage I
• Diameter of tumor < 7 cm
• Confined to the kidney
Stage II
• Diameter > 7cm
• Still confined to kidney
• 부신 전이 포함
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• The tumor extends beyond the kidney
to the surrounding tissue(신정맥, 하대
정맥에 침범 or 종양혈전 형성) &
• may also have spread to a nearby
lymph node(국소림프선)
Stage IV
• Cancer spreads outside the kidney
to multiple lymph nodes or
• to distant parts of the body
(bones, brain, liver, lung)
• 종양혈전
김금순 외(2012), Lewis et al.(2014)
Cohen & McGovern(2005).
Retrieved from
http://www.aboutcancer.com/r
enal_cohen_nejm_rvw.htm
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Kidney cancer : diagnostic studies
• CT Scan: commonly used in the diagnosis,
can detect small kidney tumors
• Ultrasound: a solid mass tumor vs cyst
• Angiography
• Biopsy
• MRI
• Radionuclide isotope scanning(방사선 핵 동위원소 촬영):
to detect metastases
김금순 외(2012), Lewis et al.(2014)
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Kidney cancer: Collaborative care1
Surgical treatment
• Partial nephrecto
my(근치적 신절제
술) for smaller tum
ors
• Radical nephrecto
my for larger tumo
rs
Ablation
• Cryoablation
(냉동요법)
• Radiofrequency
ablation
(고주파 열치료)
Radiation therapy(
방사선치료)
• Palliative care:
- inoperable cases &
- metastasis to bone/
lungs)
김금순 외(2012), Lewis et al.(2014)
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Kidney cancer: Collaborative care2
Chemotherapy
• Metastasis:
- 5-fluorouracil
(5-FU)
- Floxuridin
(FUDR)
- Gemcitabine
(Gemzar)
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Biologic therapy
(생물학적요법)
• Metastasis:
- Interleukin-2
(IL-2)
- α-interferon
Targeted therapy
(표적치료)
• Metastasis:
- Kinase inhibitor
(tumor growth
& cancer progre
ssion↓)
김금순 외(2012), Lewis et al.(2014)
Kidney cancer: Collaborative care3
• 신장적출술 후 간호: 복부수술 간호와 유사
• 효과적인 호흡운동
• 수술전: 수분섭취량 증가
김금순 외(2012), Lewis et al.(2014)
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Kidney cancer: Nursing diagnosis
횡경막 근접 부위 절개와 관련된 기도개방 유지불능(비효율적 호흡양상)
신장 제거와 관련된 체액과다
수술과 관련된 통증
수술 부위와 관련된 피부손상 위험성
수술후 예후와 관련된 불안
김금순 외(2012), Lewis et al.(2014)
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Bladder cancer
Lewis et al.(2014, p. 1085)
• Transitional cell carcinoma(이행세
포암종) of bladder: most frequent
malignant tumor of the urinary
tract
• papillomatous growths within
bladder(방광내 유두종 모양 성장)
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Bladder cancer: Etiology
Transitional cell carcinoma of bladder(방광 이행 세포암종)
• 요로계 가장 흔한 악성종양 유형
• 남 (3배) > 여, 60-70세 흔히 발병
Risk factors
•
•
•
•
•
•
•
•
Leading cause: Smoking!
Exposure to dyes used in the rubber and other industries
Phenacetin-containing analgesics(removed from the market)
Women treated with radiation for cervical cancer
Cyclophosphamide
Diabetes drug: pioglitazone (Actos)
Chronic, recurrent renal calculi (bladder)
Indwelling catheters for long periods(장기간의 유치도뇨관)
김금순 외(2012), Lewis et al.(2014)
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Bladder cancer : Clinical manifestations
Most common sx: Microscopic or gross, painless hematuria
Bladder irritability with dysuria, frequency, urgency
김금순 외(2012), Lewis et al.(2014)
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Classification for staging Bladder cancer
Stage I: invaded inner lining of the blad
der, no balder wall invasion
Stage II: invaded bladder wall, still conf
ined to bladder
Stage III: spread through the bladder w
all to surrounding tissue(prostate in me
n or uterus or vagina in women)
Stage IV: spread to ghe phymph nodes
and other organs(lungs, bones, liver)
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Harvard Men’s Health Watch(2015, November 1). Bladder cancer:
Men at risk. Retrieved from http://www.health.harvard.edu/menshealth/bladder-cancer-men-at-risk
Lewis et al.(2014)
Bladder cancer : diagnostic studies
Urine tests
CT scan
History
• bladder tumor antigens(방광종양항원),
neoplastic cells or atypical,
exfoliated cells(탈락세포)
Ultrasound
IVP
Cystoscopy with biopsy
• the most reliable test for detec
ting bladder tumors
MRI
Lewis et al.(2014)
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Bladder cancer : Collaborative care1
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Surgical treatment
Surgical treatment
Surgical treatment
• Transurethral resec
tion of the bladder
(TURBT, 경요도고
주파절제술=전기
소작법) for
superficial lesion
invasion
• Laser photocoagul
ation(레이져 광응
고법) for
superficial lesion
invasion
• Cystectomy(방광적
축술)- total, partial
• Radical cystectomy
(근치적방광적축술)
• Urinary diversion
(요로전환)
김금순 외(2012), Lewis et al.(2014)
Bladder cancer: Collaborative care2(post- op)
Drinking a large volume of fluid for the first week
Monitoring color and consistency of the urine:
• pink(1-7days), not bright red/ blood clots
• dark red or rust-colored flecks in the urine(7-10days)- from tumor healing
Administration of opioid analgesics with stool softeners
Helping family cope with fears about cancer, surgery, and sexuality
Emphasize the importance of regular follow-up care
Follow-up cystoscopies
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김금순 외(2012), Lewis et al.(2014)
Bladder cancer : Collaborative care3
Intravesical immuno
therapy(방광내요법)
• 1st choice for carcin
oma in situ:
Bacille Calmette-Gu
érin(BCG)
• 2nd choice:
α-interferon
Thiotepa(Thioplex)
Valrubicin(Valstar)
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Chemotherapy:
invasive bladder ca
• Methotrexate
• Cisplantin
• (Platinol)
• Vinblastine
(Velban)
• Doxorubicin
• (Adriamycin)
Radiation therapy
• In combination
with cystectomy
• For patients
refusing surgery
김금순 외(2012), Lewis et al.(2014)
Bladder cancer: Collaborative care4(방광내요법 프로토콜)
BCG/ α-interferon, Thiotepa(Thioplex), Valrubicin(Valstar)
6-12주 동안 1주 간격으로 시행
항암제를 방광 내로 직접 주입: 약 2시간 동안 보유/매 15분마다 자세변경
약물 주입 전 방광을 반드시 비우도록 함
요법 후 대부분 출혈성 방광염, 자극성 배뇨증상 경험
BCG side effects: 독감 증상, 빈뇨, 혈뇨, 전신감염/
오심, 구토, 탈모 같은 화학요법은 나타나지 않음
수분섭취 권장, 금연, 이차요로감염 증상 관찰(thiotepa -> WBC,PLT ↓)
김금순 외(2012), Lewis et al.(2014)
Bladder cancer : Nursing diagnosis(read 1551-2)
요로전환과 관련된 피부손상 위험성-karaya 분말?
정보 부족과 관련된 지식부족(요냄새 관리)- 알칼리? 아스파라거스?
수술과 관련된 통증
요로전환과 관련된 지식부족(자가간호)
수술후 예후와 관련된 불안
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김금순 외(2012), Lewis et al.(2014)
References
• 김금순 외(2012). 성인간호학 II, 7판. 수문사
• Cohen, H. T., & McGovern, F. J. (2005). Renal-Cell Carcinoma. New England Journal of Medicine, 353(23), 24772490. doi: doi:10.1056/NEJMra043172
• Lewis, Sharon L.; Dirksen, Shannon Ruff; Heitkemper, Margaret M.; Bucher, Linda (2014). Medical-Surgical
Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier Health Sciences. Kindle
Edition.
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