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Background

This type of cancer occurs mainly in older adults, with an average age at diagnosis of 73 years, with 9 out of 10 cases of bladder cancer diagnosed in persons over age 55. The American Cancer Society (ACS)(2012) reported that over 73,000 cases were diagnosed in 2012 and that this diagnosis rate has been relatively stable over the last 20 years. Men are three times as likely to get cancer of the bladder as women (American Foundation for Urologic Disease, 2008) and the incidence increases with age.

Risk Factors

Risk factors include chronic bladder irritation and cigarette smoking, the latter contributing to over half of cases. Male gender and age are also risk factors.

Warning signs

The classic symptom of bladder cancer is painless hematuria (blood in the urine). Older adults may attribute the bleeding to hemorrhoids or other causes and feel that because there is no pain, it must not be serious.

Diagnosis

Assessment begins with a thorough history and physical. Diagnosis may involve several tests including an intravenous pyelogram (IVP), urinalysis, and cystoscopy (in which the physician visualizes the bladder structures through a flexible fiber-optic scope). This is a highly treatable type of cancer when caught early. In fact, the ACS (2012a ) estimates that there were more than 500,000 survivors of this cancer in 2012.

Treatment

Once diagnosed, treatment depends on the invasiveness of the cancer. Treatments for bladder cancer include surgery, radiation therapy, immunotherapy, and chemotherapy (ACS, 2012). Specifically, a transurethral resection (TUR) may involve burning superficial lesions through a scope. Bladder cancer may be slow to spread, and less invasive treatments may continue for years before the cancer becomes invasive or metastatic, if ever. Certainly chemotherapy, radiation, and immune (biological) therapy are other treatment options, depending on the extent of the cancer.

Immune/biological therapy includes Bacillus Calmette-Guérin (BCG) wash, an immune stimulant that triggers the body to inhibit tumor growth. BCG treatment can also be done after TUR to inhibit cancer cells from re-growing. Treatments are administered by a physician directly into the bladder through a catheter for 2 hours once per week for 6 or more weeks (Mayo Clinic, 2012a). The patient may be asked to lay on his/her stomach, back, and or sides throughout the procedure. The patient should drink plenty of fluids after the procedure and be sure to empty the bladder frequently. In addition, because the BCG contains live bacteria, the patient should be taught that any urine passed in the first six 6 hours after treatment needs to be treated with bleach: One cup of undiluted bleach should be placed into the toilet with the urine and allowed to sit for 15 minutes before flushing (Mayo Clinic, 2012a).

If the cancer begins to invade the bladder muscle, then removal of the bladder (cystectomy) is indicated to prevent the cancer from spreading. Additional diagnostic tests will be performed if this is suspected, including CT scan or MRI. Chemotherapy and/or radiation may be used in combination with surgery. When the cancerous bladder is removed, the person will have a urostomy, a stoma from which urine drains into a collection bag on the outside of the body, much like a colostomy does. Bleeding and infection are two major complications after surgery, regardless of type, whether a TUR or cystectomy is performed. Significant education of the patient related to intake/output, ostomy care, appliances, and the like is also indicated.

Adapted from Mauk, K. L., Hanson, P., & Hain, D. (2014). Review of the management of common illnesses, diseases, or health conditions. In K. L.
Mauk’s (Ed.) Gerontological Nursing: Competencies for Care. Sudbury, MA: Jones and Bartlett Publishers. Used with permission.

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IRC’s interview with Chad Jukes. Chad lost his limb while serving in Iraq and now is a prolific mountain climber. Follow his upcoming climb in Ecuador with the Range of Motion Project (ROMP) in July on our social media. Dan Easton, our Social Media Director for IRC, will also be climbing with Chad and the elite ROMP team.

A Ministry of Care
Promoting Health in Your Faith Community

Churches tend to focus—rightly so—on spiritual care for parishioners, but what if your church also had a healthcare ministry? Health-related concerns affect the majority of individuals at some point in their lives. Whether it’s facilitating healthcare clinics, hosting seminars by medical professionals, or helping congregants navigate the complex healthcare system, A Ministry of Care explores a variety of ways for any church to become a place where people can be ministered to in spirit, mind, and body. Advanced practice nurses Cynthia Russell and Kristen Mauk guide you through the steps toward starting and sustaining a health-oriented ministry in your church. Pastors, church board members, or motivated lay members can take advantage of the professional tips and advice shared in this handbook in order to better care for the physical well-being of the members in their church and the community beyond.

Cynthia A. Russell
Dr. Cynthia A. Russell is dean and professor of nursing at Holy Family
University, School of Nursing and Allied Health Professions in Philadelphia,
Pennsylvania. Prepared as a psychiatric mental health clinical nurse
specialist, she is also a certified health and wellness coach. She is the
mother of five children and grandmother to four.

Kristen L. Mauk
Dr. Kristen L. Mauk has nearly forty years of teaching and clinical
experience in rehabilitation and gerontology. She is a professor of nursing
and the graduate program director at Colorado Christian University. Dr.
Mauk is the mother of eight children.