Bladder cancer is the seventh most common cancer in the UK, with around 10400 new diagnoses each year and causing 5100 deaths1 (CRUK 2011). It is the most frequently occurring cancer of the urinary system.
Bladder cancer is more common in men (fourth most common) than women (thirteenth most common).
About 80% of bladder tumors are confined to the bladder mucosa and called superficial tumours. About 20% are muscle-invading tumours.
Bladder tumours may be single or multiple and can occur anywhere in the urothelium but are usually found on the posterior and lateral wall of the bladder especially near the ureteric orifices. They may also be found in the renal pelvis, ureters and urethra.
The most common symptom of bladder cancer in approx. 85-90% is painless and intermittent haematuria. Investigation is always necessary, as other causes may be to blame. Other symptoms of bladder cancer include, frequent micturition, dysuria, urgency of micturition.
Pain, particularly in the suprapubic region, perineum or sacrum is associated with advanced disease. Loin pain may be an indication of ureteric obstruction.
Patients who present with haematuria undergo a number of investigations, which may include all or some of the following:
Staging of the tumour is essential for appropriate treatment.
Picture supplied by KYOWA.
An accurate assessment of the tumour including depth of penetration into the bladder, involvement of lymph nodes, and spread to other organs are done using the internationally agreed TNM system.
The pathological grading of tumours, which is based on the degree of anaplasia, is also assessed using the WHO 1973 classification.
The stage of the tumour is an important prognostic factor. Superficial tumours have the best prognosis with 90-95% of patients alive, 5yrs from diagnosis5. Patients with muscle invasive tumour have a poorer prognosis.
Bladder cancer spreads by direct invasion through the bladder wall into adjacent organs. Spread can also occur via the lymphatic system with the pelvic and para-aortic nodes involved leading to circulatory involvement giving rise to metastases in the lungs, liver and bones.
Intravesical chemotherapy is administered to patients diagnosed with superficial carcinoma of the bladder. The principle behind the treatment is to expose the bladder mucosa to a chemotheraputic agent; thus killing as many malignant cells as possible, but minimising damage to the normal mucosa. It will also reduce the risk of recurrence.
The safe administration of cytotoxic drugs.
1.3 Patient/client group
Patients with a diagnosis of bladder cancer under the direct care of a Consultant Urologist.
1.4 Exceptions/ contraindications
This policy does not cover the administration of chemotherapy by any other routes.
Bladder chemotherapy should only be administered in designated areas: Urology Centre, Downton Ward, Britford Ward, and Main & Day Surgery Theatres only.
When chemotherapy should be administered
Bladder chemotherapy of Mitomycin stat dose should be administerd by an appropriately trained doctor after TURBT in main theatre or DSU.
Courses of bladder chemotherapy should only be administered by Urology Nurse Specialists in the designated clinic.
This policy covers the administration of Mitomycin C chemotherapy and BCG Immunotherapy.
Mitomycin C is administered within 24 hours of bladder tumour resection as a single dose then, if indicated by Histology once a week for a further 5 weeks. The patient will then have follow up cystoscopies, if further bladder chemotherapy is required the patient will be referred back to the service.
BCG Immunotherapy commences 2 weeks post surgery to prevent any systemic involvement. BCG is administered once a week for 6 weeks. The patient will then have a Cystoscopy approximately 3 months following treatment. The BCG is then administered at 3, 6, 12,18,24,30 and 36 months months as a maintenance if indicated
Consultant Urologist or a Specialist Nurse with Prescribing Qualification should prescribe the first dose of bladder chemotherapy on preprinted bladder treatment chart (See Operational Policy for Chemotherapy within Oncology/Haematology).
Written consent must be sought from the patient before bladder chemotherapy can be administered.
Consent form 3 is to be used where the procedure does not involve any impairment of consciousness.(See Policy for Consent to Examination or Treatment).
Transportation and Storage
An authorised member of the nursing team collects the bladder chemotherapy from the pharmacy department. Each chemotherapy drug is labeled with specific information on its storage until it is administered. Drugs that require refrigeration must be stored in a separate cytotoxic drug fridge that is lockable.