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The Hong Kong Cancer Support Network provides you with comprehensive, free cancer information and professional assistance, ensuring that every patient and family member does not have to face the challenge alone.
Bladder cancer
Bladder cancer is one of the most common malignancies of the urinary system, predominantly arising from the urothelial (transitional cell) epithelium lining the bladder. Its pathogenesis is strongly associated with environmental, lifestyle, and hereditary factors. The disease primarily affects males over 50 years of age and is frequently asymptomatic in early stages, emphasizing the critical importance of early detection and long-term surveillance for preserving quality of life and reducing recurrence risk.
Major risk factors include:
- Tobacco smoking: The most significant modifiable risk factor; carcinogenic compounds in cigarette smoke (particularly aromatic amines and polycyclic aromatic hydrocarbons) increase risk in a dose-dependent manner (current smokers have 3–7-fold higher risk compared to never-smokers).
- Occupational chemical exposure: Prolonged contact with aromatic amines (e.g., 2-naphthylamine, benzidine), aniline dyes, and certain industrial chemicals (textile, rubber, paint, and leather industries) markedly elevates incidence.
- Chronic bladder irritation/inflammation: Recurrent or persistent urinary tract infections, long-term indwelling catheters, bladder calculi, and schistosomiasis (Schistosoma haematobium, especially in endemic regions) promote urothelial dysplasia and malignant transformation.
- Genetic and familial predisposition: First-degree relatives of bladder cancer patients have approximately 2-fold increased risk; germline mutations in DNA repair genes and hereditary syndromes (e.g., Lynch syndrome) further contribute to susceptibility.
Early screening in high-risk populations, regular health monitoring, and proactive nursing interventions are essential for improving quality of life, minimizing recurrence, and preventing disease-related complications.
Early-stage bladder cancer is frequently overlooked due to subtle or nonspecific symptoms. As the disease progresses, the following manifestations may become evident:
- Hematuria: Painless hematuria is the most characteristic and earliest warning sign, presenting as gross hematuria (visible to the naked eye) or microscopic hematuria; it occurs in approximately 80–90% of patients and is the presenting symptom in ~75% of cases.
- Lower urinary tract symptoms (LUTS): Urinary frequency, urgency, dysuria, or sensation of incomplete bladder emptying secondary to tumor irritation of the urothelium or mechanical obstruction by the mass.
- Lower abdominal or pelvic/suprapubic discomfort: Dull, persistent pain or pressure; pain may worsen in advanced stages due to tumor invasion or distension.
- Recurrent urinary tract infections: Persistent or refractory UTIs, often with sterile pyuria, should raise high suspicion for underlying malignancy.
- Advanced-stage manifestations: Unintentional weight loss, fatigue, lower extremity edema (due to lymphatic/venous obstruction or hypoalbuminemia), bone pain, or flank pain suggestive of local extension, regional invasion, or distant metastasis (commonly to lymph nodes, liver, lungs, or bone).
Some patients may also experience chronic fatigue, anorexia, or persistent voiding dysfunction, warranting prompt multidisciplinary evaluation and nursing intervention.
Diagnosis of bladder cancer utilizes a multimodal approach aimed at early detection, accurate histological classification, clinical staging, and development of individualized nursing care plans:
- Imaging studies
- Ultrasonography (transabdominal or transrectal): Initial noninvasive screening tool for detecting bladder masses, evaluating wall thickening, and identifying hydronephrosis suggestive of obstruction.
- Contrast-enhanced computed tomography (CT) urography or magnetic resonance imaging (MRI): Essential for assessing tumor size, depth of invasion (detrusor muscle involvement), extravesical extension, pelvic lymph node status, and upper urinary tract evaluation (CT urography is the preferred modality in most guidelines).
- 18F-FDG PET-CT: Selectively employed in high-risk or muscle-invasive disease for detection of occult distant metastases, nodal disease beyond the pelvis, and restaging in recurrent cases.
- Endoscopic evaluation
- Cystoscopy (flexible or rigid, with white-light and/or enhanced imaging techniques such as blue-light cystoscopy or narrow-band imaging): Gold standard for direct visualization of bladder mucosa, tumor morphology, multifocality, and performance of targeted or mapping biopsies; remains the cornerstone of definitive diagnosis.
- Histopathological examination
- Transurethral resection of bladder tumor (TURBT) biopsy or radical cystectomy specimen analysis: Provides definitive confirmation of urothelial carcinoma (or variant histologies), WHO/ISUP grading, depth of invasion (pT stage: non-muscle-invasive [NMIBC: Ta/Tis/T1] vs. muscle-invasive [MIBC: ≥T2]), lymphovascular invasion, and presence of carcinoma in situ (CIS).
- Tumor biomarkers and molecular testing
- Urine-based tumor markers (e.g., NMP22, BTA stat, UroVysion FISH, Cxbladder, Bladder EpiCheck): Adjunctive noninvasive tools for detection of recurrence in surveillance protocols and triage of hematuria, particularly in low-to-intermediate-risk NMIBC.
- Molecular profiling and genomic classifiers (e.g., FGFR3 mutations, TP53 status, Decipher, GSC, or immune signatures): Increasingly utilized to predict recurrence/progression risk in NMIBC, guide adjuvant therapy decisions in MIBC, identify candidates for neoadjuvant/adjuvant immunotherapy or FGFR-targeted therapy, and inform personalized long-term surveillance and nursing care strategies.
Nursing and supportive care strategies for renal cell carcinoma (RCC) can be categorized into conventional treatment modalities and personalized supportive approaches, aimed at delaying disease progression, preserving quality of life, protecting residual renal function, enhancing immune function, and promoting overall health:
Surgical Management
- Indicated for localized and locally advanced tumors; procedures include partial nephrectomy (nephron-sparing surgery, preferred when technically feasible) or radical nephrectomy, with template-based retroperitoneal lymph node dissection when clinically indicated.
- Postoperative care incorporates structured nutritional support, wound care, pain management, early ambulation, and psychological counseling to facilitate recovery, minimize complications, and restore functional independence and activities of daily living.
Targeted Therapy and Immunotherapy
- First-line systemic therapy for intermediate- to high-risk advanced/metastatic RCC or postoperative recurrence; regimen selection is guided by IMDC/MSKCC risk stratification and molecular/tumor characteristics (e.g., PD-L1 expression).
- Includes tyrosine kinase inhibitors (e.g., sunitinib, pazopanib, cabozantinib, axitinib), anti-VEGF agents, mTOR inhibitors, and immune checkpoint inhibitors (e.g., nivolumab monotherapy, pembrolizumab + axitinib, nivolumab + cabozantinib, or nivolumab + ipilimumab combinations).
- Supportive care emphasizes immune enhancement, proactive toxicity management (hypertension, proteinuria, hand-foot syndrome, immune-related adverse events), and nutritional optimization to maximize treatment tolerance and overall well-being.
Chemotherapy
- Conventional cytotoxic chemotherapy has limited efficacy in clear-cell RCC due to intrinsic chemoresistance; may be considered in selected non-clear-cell histologies with sarcomatoid or rhabdoid differentiation, collecting duct carcinoma, or within clinical trials.
- Supportive measures include intensive nutritional therapy, fluid/electrolyte monitoring, antiemetic prophylaxis, and hematopoietic growth factor support to ameliorate adverse effects and sustain physical function.
Nutritional and Intravenous Supportive Therapy
- High-dose intravenous vitamin C, glutathione, balanced amino acid solutions, and trace element infusions may be administered to improve mitochondrial energy production, reinforce antioxidant defenses, support immune competence, and promote physiological recovery.
- Dietary recommendations: Protein intake tailored to residual glomerular filtration rate (eGFR), generous consumption of antioxidant-rich vegetables and fruits, whole grains; strict restriction of high-fat, ultra-processed foods, and sodium to mitigate cardiovascular risk and preserve renal function.
Individualized Monitoring and Long-term Survivorship Care
- Regular surveillance with contrast-enhanced CT or MRI of chest/abdomen/pelvis, laboratory evaluation (renal function panel, CBC, liver function tests), and emerging molecular biomarkers (e.g., circulating tumor DNA) for early detection of recurrence or progression.
- Development and periodic revision of patient-centered care plans incorporating adaptive nutritional, lifestyle, and psychosocial interventions.
- Specialized nursing protocols for patients with chronic inflammation, immunocompromised states, hereditary RCC syndromes, or high metabolic risk profiles to optimize long-term survivorship, preserve renal function, and enhance overall quality of life.
