1. Kidney cancer Bladder cancer Hanjong Park, PhD, RN

2. Kidney cancer “Kidney cancers arise from the cortex or pelvis (and calyces). Tumors from these areas may be benign or malignant. However, malignant tumors are more common.” 2 (Lewis et al., 2014, P 1084)

3. Kidney cancer: Etiology 신세포암 Renal cell carcinoma( 선암종, adenocarcinoma) Malignant tumor 의 가장 흔한 유형 남 (2 배 ) > 여 50-70 세 발견 Risk factors Most common cause: Smoking! Family history(first degree relatives with renal cell carcinoma) Obesity Hypertension Exposure to asbestos, cadmium, and gasoline. Phenacetine Cystic disease of the kidney associated with ESKD 3 김금순 외 (2012), Lewis et al.(2014)

4. Kidney cancer: Clinical manifestations No characteristic early symptoms Common symptoms: Hematuria, Flank pain, Palpable mass in the flank or abdomen, Weight loss, Fever, Hypertension, anemia Symptoms by compressing, stretching, invading structures near or within the kidney Metastasis(lungs, liver, long bones): 30% of patients at the time of diagnosis 4 Local extension of kidney into renal vein & vena cava 김금순 외 (2012), Lewis et al.(2014)

5. Classification for staging Kidney cancer 5 Stage I Diameter of tumor < 7 cm Confined to the kidney Stage II Diameter > 7cm Still confined to kidney 부신 전이 포함 Stage III The tumor extends beyond the kidney to the surrounding tissue( 신정맥, 하대 정맥에 침범 or 종양혈전 형성 ) & may also have spread to a nearby lymph node( 국소림프선 ) Stage IV Cancer spreads outside the kidney to multiple lymph nodes or to distant parts of the body (bones, brain, liver, lung) 종양혈전 김금순 외 (2012), Lewis et al.(2014)

6. 6 Cohen & McGovern(2005). Retrieved from http://www.aboutcancer.com/r enal_cohen_nejm_rvw.htm

7. Kidney cancer : diagnostic studies CT Scan: commonly used in the diagnosis, can detect small kidney tumors Ultrasound: a solid mass tumor vs cyst Angiography Biopsy MRI Radionuclide isotope scanning( 방사선 핵 동위원소 촬영 ): to detect metastases 7 김금순 외 (2012), Lewis et al.(2014)

8. Kidney cancer: Collaborative care1 Surgical treatment Partial nephrecto my( 근치적 신절제 술 ) for smaller tum ors Radical nephrecto my for larger tumo rs Ablation Cryoablation ( 냉동요법 ) Radiofrequency ablation ( 고주파 열치료 ) Radiation therapy( 방사선치료 ) Palliative care: - inoperable cases & - metastasis to bone/ lungs) 8 김금순 외 (2012), Lewis et al.(2014)

9. Kidney cancer: Collaborative care2 Chemotherapy Metastasis: -5-fluorouracil (5-FU) -Floxuridin (FUDR) -Gemcitabine (Gemzar) Biologic therapy ( 생물학적요법 ) Metastasis: - Interleukin-2 (IL-2) - α-interferon Targeted therapy ( 표적치료 ) Metastasis: -Kinase inhibitor (tumor growth & cancer progre ssion ↓ ) 9 김금순 외 (2012), Lewis et al.(2014)

10. Kidney cancer: Collaborative care3 10 신장적출술 후 간호 : 복부수술 간호와 유사 효과적인 호흡운동 수술전 : 수분섭취량 증가 김금순 외 (2012), Lewis et al.(2014)

11. Kidney cancer: Nursing diagnosis 횡경막 근접 부위 절개와 관련된 기도개방 유지불능 ( 비효율적 호흡양상 ) 신장 제거와 관련된 체액과다수술과 관련된 통증수술 부위와 관련된 피부손상 위험성수술후 예후와 관련된 불안 11 김금순 외 (2012), Lewis et al.(2014)

12. Bladder cancer Transitional cell carcinoma( 이행세 포암종 ) of bladder: most frequent malignant tumor of the urinary tract papillomatous growths within bladder( 방광내 유두종 모양 성장 ) 12 Lewis et al.(2014, p. 1085)

13. Bladder cancer: Etiology Transitional cell carcinoma of bladder( 방광 이행 세포암종 ) 요로계 가장 흔한 악성종양 유형 남 (3 배 ) > 여, 60-70 세 흔히 발병 Risk factors Leading cause: Smoking! Exposure to dyes used in the rubber and other industries Phenacetin-containing analgesics(removed from the market) Women treated with radiation for cervical cancer Cyclophosphamide Diabetes drug: pioglitazone (Actos) Chronic, recurrent renal calculi (bladder) Indwelling catheters for long periods( 장기간의 유치도뇨관 ) 13 김금순 외 (2012), Lewis et al.(2014)

14. Bladder cancer : Clinical manifestations Most common sx: Microscopic or gross, painless hematuria Bladder irritability with dysuria, frequency, urgency 14 김금순 외 (2012), Lewis et al.(2014)

15. Classification for staging Bladder cancer Stage I: invaded inner lining of the blad der, no balder wall invasion Stage II: invaded bladder wall, still conf ined to bladder Stage III: spread through the bladder w all to surrounding tissue(prostate in me n or uterus or vagina in women) Stage IV: spread to ghe phymph nodes and other organs(lungs, bones, liver) 15 Harvard Men’s Health Watch(2015, November 1). Bladder cancer: Men at risk. Retrieved from http://www.health.harvard.edu/mens- health/bladder-cancer-men-at-risk Lewis et al.(2014)

16. Bladder cancer : diagnostic studies CT scan Ultrasound MRI Cystoscopy with biopsy the most reliable test for detec ting bladder tumors Urine tests bladder tumor antigens( 방광종양항원 ), neoplastic cells or atypical, exfoliated cells( 탈락세포 ) 16 History IVP Lewis et al.(2014)

17. Bladder cancer : Collaborative care1 Surgical treatment Transurethral resec tion of the bladder (TURBT, 경요도고 주파절제술 = 전기 소작법 ) for superficial lesion invasion Surgical treatment Cystectomy( 방광적 축술 )- total, partial Radical cystectomy ( 근치적방광적축술 ) Urinary diversion ( 요로전환 ) 17 Surgical treatment Laser photocoagul ation( 레이져 광응 고법 ) for superficial lesion invasion 김금순 외 (2012), Lewis et al.(2014)

18. Bladder cancer: Collaborative care2(post- op) 18 Drinking a large volume of fluid for the first weekMonitoring color and consistency of the urine: pink(1-7days), not bright red/ blood clots dark red or rust-colored flecks in the urine(7-10days)- from tumor healing Administration of opioid analgesics with stool softenersHelping family cope with fears about cancer, surgery, and sexualityEmphasize the importance of regular follow-up careFollow-up cystoscopies 김금순 외 (2012), Lewis et al.(2014)

19. Bladder cancer : Collaborative care3 Intravesical immuno therapy( 방광내요법 ) 1 st choice for carcin oma in situ: Bacille Calmette-Gu é rin(BCG) 2 nd choice: α-interferon Thiotepa(Thioplex) Valrubicin(Valstar) Radiation therapy In combination with cystectomy For patients refusing surgery 19 Chemotherapy: invasive bladder ca Methotrexate Cisplantin (Platinol) Vinblastine (Velban) Doxorubicin (Adriamycin) therapy after the initial induction regimen may be beneficial. Bacille Calmette-Guérin (BCG),. 김금순 외 (2012), Lewis et al.(2014)

20. Bladder cancer: Collaborative care4( 방광내요법 프로토콜 ) 20 6-12 주 동안 1 주 간격으로 시행 항암제를 방광 내로 직접 주입 : 약 2 시간 동안 보유 / 매 15 분마다 자세변경 약물 주입 전 방광을 반드시 비우도록 함 요법 후 대부분 출혈성 방광염, 자극성 배뇨증상 경험 BCG side effects: 독감 증상, 빈뇨, 혈뇨, 전신감염 / 오심, 구토, 탈모 같은 화학요법은 나타나지 않음 수분섭취 권장, 금연, 이차요로감염 증상 관찰 (thiotepa -> WBC,PLT ↓ ) BCG/ α-interferon, Thiotepa(Thioplex), Valrubicin(Valstar) 김금순 외 (2012), Lewis et al.(2014)

21. Bladder cancer : Nursing diagnosis(read 1551-2) 요로전환과 관련된 피부손상 위험성 -karaya 분말 ? 정보 부족과 관련된 지식부족 ( 요냄새 관리 )- 알칼리 ? 아스파라거스 ? 수술과 관련된 통증요로전환과 관련된 지식부족 ( 자가간호 ) 수술후 예후와 관련된 불안 21 김금순 외 (2012), Lewis et al.(2014)

22. References 22 김금순 외 (2012). 성인간호학 II, 7 판. 수문사 Cohen, H. T., & McGovern, F. J. (2005). Renal-Cell Carcinoma. New England Journal of Medicine, 353(23), 2477- 2490. doi: doi:10.1056/NEJMra043172 Lewis, Sharon L.; Dirksen, Shannon Ruff; Heitkemper, Margaret M.; Bucher, Linda (2014). Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier Health Sciences. Kindle Edition.