DIVINE WORD COLLEGE OF BANGUED

Rizal St., Zone 6, Bangued, Abra

SCHOOL HEALTH SCIENCES

I. INTRODUCTION

Bladder cancer is a type of cancer that originates in the tissues of the bladder, the organ
responsible for storing urine. Globally, bladder cancer is more common in men than in
women and is most frequently diagnosed in older adults, typically over the age of 55.

Bladder cancer occurs when cells in the bladder start to grow without control. The bladder is a
hollow, balloon-shaped organ in the lower part of the abdomen that stores urine.

The bladder has a muscular wall that allows it to get larger to store urine made by
the kidneys and to shrink to squeeze urine out of the body. There are two kidneys, one on each
side of the backbone, above the waist. The bladder and kidneys work together to remove toxins
and wastes from your body through urine:

 Tiny tubules in the kidneys filter and clean the blood.

 These tubules take out waste products and make urine.

 The urine passes from each kidney through a long tube called a ureter into the bladder.

 The bladder holds the urine until it passes through a tube called the urethra and leaves the
body.

Symptoms

The symptoms of bladder cancer can vary from person to person. The most common symptom is
blood in the urine, called hematuria. It’s often slightly rusty to bright red in color. You may see
blood in your urine at one point, then not see it again for a while. Sometimes there are very small
amounts of blood in the urine that can only be found by having a test done.

Other common symptoms of bladder cancer include

 frequent urination
 DIVINE WORD COLLEGE OF BANGUED
Rizal St., Zone 6, Bangued, Abra
SCHOOL HEALTH SCIENCES

 pain or burning during urination

 feeling as if you need to urinate even if your bladder isn’t full

 urinating often during the night

When the cancer has grown large or spread beyond the bladder to other parts of the body,
symptoms may include

 being unable to urinate

 lower back pain on one side of the body

 pain in the abdomen

 bone pain or tenderness

 unintended weight loss and loss of appetite

 swelling in the feet

 feeling tired

Types

Bladder cancer is categorized based on the type of cells affected. The most common type is
urothelial carcinoma (formerly called transitional cell carcinoma), which accounts for about
90% of cases. This type begins in the urothelial cells lining the bladder. Less common types
include squamous cell carcinoma and adenocarcinoma, which are often associated with
chronic bladder irritation or infection (American Cancer Society, 2021).

Other types of bladder cancer are rare:

 Squamous cell carcinoma is cancer that begins in squamous cells (thin, flat cells lining the
inside of the bladder). This type of cancer may form after long-term irritation or infection
 DIVINE WORD COLLEGE OF BANGUED
Rizal St., Zone 6, Bangued, Abra
SCHOOL HEALTH SCIENCES

with a tropical parasite called schistosomiasis, which is common in Africa and the Middle
East but rare in the United States. When chronic irritation occurs, transitional cells that line
the bladder can gradually change to squamous cells.

 Adenocarcinoma is cancer that begins in glandular cells that are found in the lining of the
bladder. Glandular cells in the bladder make mucus and other substances.

 Small cell carcinoma of the bladder is cancer that begins in neuroendocrine cells (nerve-
like cells that release hormones into the blood in response to a signal from the nervous
system).

There are other ways to describe bladder cancer:

 Non-muscle-invasive bladder cancer is cancer that has not reached the muscle wall of the
bladder. Most bladder cancers are non-muscle-invasive.

 Muscle-invasive bladder cancer is cancer that has spread through the lining of the bladder
and into the muscle wall of the bladder or beyond it.

Risk Factors

Several factors increase the risk of developing bladder cancer:

 including smoking
 exposure to industrial chemicals (such as aromatic amines)
 chronic urinary tract infections
 previous radiation therapy.

Smoking is the most significant risk factor, as carcinogenic chemicals from tobacco can
accumulate in the bladder lining (National Cancer Institute, 2023).
 DIVINE WORD COLLEGE OF BANGUED
Rizal St., Zone 6, Bangued, Abra
SCHOOL HEALTH SCIENCES

Diagnosis

The following tests and procedures are used to diagnose bladder cancer. The results will also
help you and your doctor plan treatment.

Cystoscopy

Cystoscopy is a procedure in which the doctor looks inside the bladder and urethra (the tube that
carries urine out of your body) to check for abnormal areas. A cystoscope is slowly inserted
through the urethra into the bladder to allow the doctor to see inside. A cystoscope is a thin, tube-
like instrument with a light and a lens for viewing. It may also have a tool to remove very small
bladder tumors or tissue samples for biopsy. Cystoscopy helps to diagnose, and sometimes treat,
bladder cancer and other conditions.

Biopsy

A biopsy is usually done during a cystoscopy procedure. Biopsy is a procedure in which a

sample of cells or tissue is removed from the bladder so that a pathologist can view it under a
microscope to check for signs of cancer. It may be possible to remove the entire tumor at the
time of the biopsy.

Computed tomography (CT) urogram or intravenous pyelogram (IVP)

CT urogram is a test that takes a CT scan of the urinary tract using a contrast dye injected into a
vein. IVP is an x-ray imaging test of your urinary tract. After a contrast dye is injected into a
vein, a series of x-ray pictures of the kidneys, ureters, and bladder are taken to find out if cancer
is present in these organs.

Urine tumor marker test

Urinary tumor markers are substances found in the urine that are either made by bladder cancer
cells or that the body makes in response to bladder cancer.
 DIVINE WORD COLLEGE OF BANGUED
Rizal St., Zone 6, Bangued, Abra
SCHOOL HEALTH SCIENCES

Computed tomography (CT) scan

A CT scan uses a computer linked to an x-ray machine to make a series of detailed x-ray pictures
of areas inside the body from different angles. A dye may be injected into a vein or swallowed to
help the organs or tissues show up more clearly.

Magnetic resonance imaging (MRI)

MRI uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas
inside the body, such as the bladder. This procedure is also called nuclear magnetic resonance
imaging. Images may be taken at three different times after the dye is injected, to get the best
picture of abnormal areas in the bladder. This is called triple-phase MRI.

Chest x-ray

A chest x-ray is an x-ray of the organs and bones inside the chest. An x-ray is a type of high-
energy radiation that can go through the body and onto film, making a picture of areas inside the
chest.

Bone scan

A bone scan is a procedure that checks to see if there are rapidly dividing cells, such as cancer
cells, in the bone. A very small amount of radioactive material is injected into a vein and travels
through the bloodstream. The radioactive material collects in the bones with cancer and is
detected by a scanner.

PREVALENCE

Bladder cancer is a significant health concern worldwide, ranking as the 10th most commonly
diagnosed cancer globally. According to the Global Cancer Observatory (GLOBOCAN 2020),
there were approximately 573,000 new cases and 212,000 deaths from bladder cancer in 2020.
The disease is more prevalent in developed countries, with the highest rates reported in Europe
 DIVINE WORD COLLEGE OF BANGUED
Rizal St., Zone 6, Bangued, Abra
SCHOOL HEALTH SCIENCES

and North America. For instance, bladder cancer accounts for about 6% of all new cancer cases
in men in the United States, making it one of the most common cancers in males (World Health
Organization, 2020).

In Asia, the prevalence of bladder cancer varies widely, influenced by lifestyle factors, exposure
to carcinogens, and access to healthcare. Smoking and occupational exposure to industrial
chemicals are significant contributors to bladder cancer in the region. Countries with robust
screening programs, such as Japan and South Korea, report higher detection rates, which may
indicate better cancer surveillance rather than a true increase in incidence (Zhang et al., 2021).

In the Philippines, bladder cancer ranks lower in overall cancer prevalence compared to other
malignancies such as breast, lung, and colorectal cancers. According to the Philippine Cancer
Facts and Estimates (2020), bladder cancer accounts for about 1-2% of all cancer cases in the
country, with an estimated incidence rate of 2.5 cases per 100,000 population. It is more
common in men than women, consistent with global trends, and is often diagnosed in individuals
over the age of 50.

Environmental and occupational factors play a role in the development of bladder cancer in the
Philippines. Prolonged exposure to industrial chemicals, especially in occupations involving dye
and rubber manufacturing, increases risk. Additionally, smoking remains a significant factor,
with tobacco use being a prevalent habit in the country. The limited access to healthcare facilities
and diagnostic tools in rural areas may contribute to under diagnosis and late-stage detection of
bladder cancer, impacting survival rates.
 DIVINE WORD COLLEGE OF BANGUED
Rizal St., Zone 6, Bangued, Abra
SCHOOL HEALTH SCIENCES

II. PATIENT’S PROFILE

Name: Patient ABT

Age: 60 years old

Ward: Orthopedic

Bed #: 4

Sex: Male

Birthdate: April 9, 1964

Birthplace: Bucay, Abra

Address: Laang, Lagangilang, Abra

Civil Status: Married

Nationality: Filipino

Religion: Roman Catholic

Occupation: Farmer

Case Number: 049757

Date of Admission: November 05, 2024

Time of Admission: 11:47 pm

Date of Discharge: November 07, 2024

Time of Discharge: 5:00 pm

 DIVINE WORD COLLEGE OF BANGUED
Rizal St., Zone 6, Bangued, Abra
SCHOOL HEALTH SCIENCES

Chief Complaint: Abdominal pain; No Bowel Movement

Admitting Diagnosis: Urothelial Carcinoma with Bone Metastasis, Acute Renal Failure Obstructive
Uropathy; Bladder Cancer

Principal Diagnosis: Urothelial Carcinoma Stage IV Bladder Cancer with Partial Obstructive Uropathy

Admitting Physician: Dr. T.

A. PAST MEDICAL HISTORY

Patient ABT was diagnosed at the age of 45 of hypertension and on daily anti

hypersensitive medication. Admitted once for severe dehydration due to vomiting.

The patient stated that he consumes 2 packs of cigarette every day for more than 20

years, stopped smoking 5 years after being hospitalized for a smoking-related

condition. Patient ABT also stated that he regularly since the age of 25, averaging

from 2-3 of alcohol per day. At the age of 47 he was hospitalized due to fatigue, he

stated that he had Liver Function tests during that time of hospitalization and revealed

signs of early fibrosis.

B. PRESENT MEDICAL HISTORY

A year ago, Mr. ABT visited the hospital due to persistent blood in his urine for

over two weeks, also reported an increased frequency of urination and mild lower

abdominal discomfort and these symptoms were dismissed as urinary tract

infection. Mr. ABT underwent a cystoscopy, which he stated that it confirmed a

 DIVINE WORD COLLEGE OF BANGUED
Rizal St., Zone 6, Bangued, Abra
SCHOOL HEALTH SCIENCES

presence of a mass in his bladder. Mr. ABT stated that his physician confirmed

the diagnosis of urothelial carcinoma, linking to his long history of long-term

smoking. Mr. ABT was alarmed and sought medical attention, having one week

of abdominal pain with no bowel movement, loss of appetite, hypogastric pain

radiating in the back and persistent abdominal pain, his admitting physician

diagnosed Mr. ABT, with Urothelial Carcinoma with bone metastasis, Acute renal

failure, Obstructive Uropathy; Bladder Cancer.

C. FAMILIAL HISTORY

According to Mr. ABT, his grandfather on his father side died due to cancer. His

father died with chronic liver disease, while his mother died due to hypertension.

Mr. ABT has 3 sons and 2 daughters, each have now their own family and only

the youngest live with them.

D. ECONOMIC STATUS

The patient is financially supported by his second daughter who is an OFW. The

house expenditure was allotted to the following: food, electric bill and

medication.
 DIVINE WORD COLLEGE OF BANGUED
Rizal St., Zone 6, Bangued, Abra
SCHOOL HEALTH SCIENCES

V. PHYSICAL ASSESSMENT

The physical examination is conducted systematically following a head-to-toe approach known

as the cephalocaudal assessment. This process involves the techniques of inspection, palpation,

percussion, and auscultation, utilizing tools such as a penlight, thermometer, and stethoscope,

along with the healthcare provider’s senses. During the procedure, student nurses prioritize

recognizing and respecting the client’s feelings, ensuring comfort, and adhering to appropriate

safety measures.

General survey

Patient ABT wore clothes suited to the weather, loose clothing and shorts. Weight loss noted.

Despite illness, the patient’s hygiene remains satisfactory. He was lying on bed. Patient has an

intact IV infusion set inserted at the left metacarpal vein with D5LRS 1L x 8°, infusing well.

Patient was also on blood transfusion, O positive.

Vital Signs:
 DIVINE WORD COLLEGE OF BANGUED
Rizal St., Zone 6, Bangued, Abra
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BP: 110/80 mmHg

PR: 90 bpm

SpO2: 98%

RR: 20 cpm

Temp: 36.6°C

Mental Status:

1. Level of Consciousness

Mr. ABT was conscious and coherent.

2. Mood and Affect

The patient was cooperative and responsive.

3. Thought, Process, Content and Perception

The patient was able to express his thoughts and feelings, and can follow direct instructions.

4. Cognitive Abilities

Mr. ABT was able to concentrate and has no problem memory related issues.

Integumentary System:

 Skin is warm and dry to the touch.

 Jaundice appearance
 DIVINE WORD COLLEGE OF BANGUED
Rizal St., Zone 6, Bangued, Abra
SCHOOL HEALTH SCIENCES

 Visible clubbing of nails

Head and Face:

 The head appears norm cephalic and symmetrical, with no abnormalities noted.

 Scalp and hair are normal, with no lesions or tenderness upon palpation.

 Head movements are smooth and without discomfort.

Eyes:

 Bilateral pupils are equal, round, and reactive to light.

 Appropriate visual tracking and fixation noted.

 Eyelids and periorbital skin appear normal without abnormalities.

Ears

• Ears are bilaterally symmetrical in correlation to the level of the outer canthus of

the eyes.

• No discharges and tenderness noted upon inspection and palpation

Nose:

 No signs of nasal congestion or structural abnormalities.

 Nasal mucosa is moist with no visible lesions.

 DIVINE WORD COLLEGE OF BANGUED
Rizal St., Zone 6, Bangued, Abra
SCHOOL HEALTH SCIENCES

Mouth and Lips:

 Pallor oral mucosa

 Cracks on the lips observed

 Poor dentition

Neck and Throat

• Neck is symmetric, with the head centered and without bulging masses.

• Neck has an equal muscle size (sternocleidomastoid and trapezius muscles).

• There is no distention of the jugular vein neither palpable lymph nodes nor enlargement.

• The trachea in central placement in the midline of the neck.

Thorax, Lungs and Heart

• Normal chest configuration, full respiratory excursion and symmetric chest expansion.

• Bilateral symmetry of vocal fremitus is presently normal.

• Scapula are symmetrical and spine is vertically aligned.

• Shoulders and scapulae are at equal horizontal positions.

• Spine is straight when observed from behind

 DIVINE WORD COLLEGE OF BANGUED
Rizal St., Zone 6, Bangued, Abra
SCHOOL HEALTH SCIENCES

Breast:

 Symmetric breast tissue with no palpable masses or tenderness.

 Skin appears normal without redness, swelling, or lesions.

Abdomen:

 Tenderness in the hypogastric region

ENLARGE