Title NCM 114 RLE SEMI FI ✅

NCM 113 RLE Semi Fi BY TONS and MADS d) Bladder tumor antigens, nuclear matrix proteins, adhesion molecules, cytoskeletal proteins, and growth factors 8. Medical Management: Depends on grade of tumor (degree of cellular differentiation), stage of tumor growth ( degree of local invasion and presence or absence of metastasis), and multicentricity (having many centers),age and physical, mental, emotional status 9. Surgical Management a) Transurethral resection or fulguration (cauterization) for simple papillomas (benign epithelial tumors); eradicatetumors through surgical incision or electrical current b) Bladder-sparing surgery, intravesical administration of BCG (attenuated live strain of Mycobacterium bovis, causative agent in TB; to produce local inflammatory) c) The entire lining of urinary tract, or urothelium, is at risk because carcinomatous changes can occur in the mucosa of bladder, renal pelvis, ureter, and urethra. d) Simple cystectomy or radical cystectomy for invasive or multifocal bladder cancer. e) Trimodality therapy—transurethral resection of bladder tumor, radiation, and chemotherapy—in an effort to spare the need for cystectomy. 10. Pharmacologic Therapy a) Chemotherapy w/ combination of methotrexate (Rheumatrex), 5-fluorouracil (5-FU), vinblastine (Velban), doxorubicin (Adriamycin), and cisplatin (Platinol) has been effective in producing partial remission of transitional cell carcinoma of bladder in some patients. b) IV chemotherapy may be accompanied by radiation therapy. T c) Topical chemotherapy is considered when there is a high risk of recurrence, when cancer in situ is present, or when tumor resection has been incomplete; delivers high concentration of medication to tumor to promote tumor destruction. d) Direct infusion of cytotoxic agent through bladder’s arterial blood supply e) BCG - most effective intravesical agent for recurrent bladder cancer, especially superficial transitional cell carcinoma, because it is an immunotherapeutic agent that enhances body’s immune response to cancer; BCG has been shown to decrease risk of tumor progression f) The optimal course of BCG: 6-week course of weekly instillations, followed by a 3-week course at 3 months for tumors that do not respond. g) However adverse effects associated with this prolonged therapy may limit its widespread applicability. At the end of procedure, the patient is encouraged to void and to drink liberal amounts of fluid to flush medication 11. Radiation Therapy a) may be performed preop to reduce microextension of neoplasm and viability of tumor cells, thus reducing chances that the cancer may recur in immediate area or spread through the circulatory or lymphatic systems. b) used in combination with surgery or to control disease in patients with inoperable tumors. c) For more advanced bladder cancer or for patients with intractable hematuria: a large, water-filled balloon placed in bladder produces tumor necrosis by reducing blood supply ofbladder wall (hydrostatic therapy). d) instillation of formalin, phenol, or silver nitrate relieves hematuria and strangury (slow and painful discharge of urine) in some patients. 12. Investigational Therapy a) photodynamic techniques in treating superficial bladder cancer is under investigation. This procedure involves systemic injection of photosensitizing material (hematoporphyrin), which the cancer cell picks up. b) Laser rgenerated light changes hematoporphyrin in cancer cell into toxic agent. This process has received renewed interest with regulatory approval of several photosensitizing medications and light applicators as potential palliative and curative treatments NURSING CARE OF CLIENT WITH DM DM related NCLEX QUESTIONS: IVY 3