Bladder Cancer Nursing Care Plan & Management


  1. Bladder cancer is papillomatous growth in the bladder urothelium that undergo malignant changes and that may infiltrate the bladder wall.
  2. Predisposing factors include cigarette smoking, exposure to industrial chemicals and exposure to radiation.
  3. Common signs of metastasis include the liver, bones and lungs
  4. As the tumor progresses can extend to the rectum, vagina and retro- peritoneal structures.
  • Painless hematuria
  • Dysuria
  • Gross hematuria
  • Obstruction of urine flow
  • Development of fistula ( urine from the vagina, fecal material in the urine)
Diagnostic Evaluation

Biopsies of the tumor and adjacent mucosa are definitive, but the following procedures are also used:

  • Cystoscopy, biopsy of tumor and adjacent mucosa
  • Excretory urography
  • Computed CT Scan
  • Ultrasonography
  • Bimanual examination by anesthesia
  • Cytologic evaluation of fresh urine and saline bladder washings

Molecular assays, bladder tumor antigens, adhesion molecules and others are being studied.

Primary Nursing Diagnosis
  • Risk for altered urinary elimination related to the obstruction of urinary flow
Medical Management
  1. Most bladder cancer are poorly radio sensitive and require high doses of radiation
  2. Radiation therapy is more acceptable for advance disease that cannot be eradicated by surgery.
  3. Palliative radiation maybe used to relieve pain and bowel obstruction and control potential hemorrhage and leg edema cause by venous or lymphatic obstruction.
  4. Intracavitary radiation maybe prescribed which protect adjacent tissues.
  5. External radiation combined with chemotherapy or surgery maybe prescribed because the external radiation alone maybe ineffective.
  6. Complications of radiations:
    1. A bacterial cystitis
    2. Proctitis
    3. Fistula formation
    4. Ileitis or colitis
    5. Bladder ulceration and hemorrhage

1. Intravesical instillation

  • An alkylating chemotherapeutic agent is instilled into the bladder
  • This method provides an concentrated topical treatment with little systemic absorption
  • Chemotherapeutic agents used may include thiotepa, mitomycin (Mutamycin), doxorubicin (Adriamycin), cyclophosphamide (Cytoxan), and bacille Calmette-Guerin.
  • The medication is injected into a urethral catheter and retain for two hours.
  • Following instillation, the clients position is rotated every 15 to 30 minutes, starting in the supine position to avoid lying on full bladder.
  • After 2 hours, the client voids in a sitting position and is instructed to increase fluids to flash the bladder.
  • Treat the urine as biohazard and send to radioisotope laboratory for monitoring.
  • For 6 hours following intravesical therapy, disinfect the toilet with household bleach after the client has voided.

2. Systemic chemotherapy

  • Systemic chemotherapy is used to treat inoperable or late tumors.
  • Agents used may include, cysplatin (Platinol), doxorubicin (Adremycin), cyclophospamide (Cytosan), methotrexate (Folex) and Pyridoxine

3. Complications of chemotherapy

  • Bladder irritation
  • Hemorrhagic cystitis
Surgical Interventions

1. Transurethral resection of the bladder

  • Local resection and fulguration ( destruction of tissue by electrical current through electrodes place in direct contact with the tissue)
  • Perform for early tumor for cure or for inoperable tumors for palliation.

2. Partial Cystectomy

  • Partial cystectomy is the removal of up to half of the bladder
  • The procedure is done for early tumors and for clients who cannot tolerate radical cystectomy.
  • During the initial postoperative period bladder capacity is reduced greatly to about 60 mL; however, as the bladder tissue expand, the capacity increases to 200 -400 mL.
  • Maintenance of a continuous output of urine following surgery is critical to prevent bladder distention and stress on the suture line.
  • A urethral catheter and a suprapubic catheter maybe in place, in the suprapubic catheter maybe left in place for 2 weeks until healing occurs.