Question

Describe the palliative management of advanced urinary bladder malignancy.

Hint:

Palliative management in advanced urinary bladder malignancy focuses on symptom control, emotional support, and maintaining quality of life, with a focus on pain management and urinary symptom relief.

Answer 1

Palliative management of advanced urinary bladder malignancy focuses on improving quality of life, managing symptoms, and providing comfort to patients with metastatic or locally advanced disease who are not candidates for curative treatment.
Step 1: Symptom Control:
1. Pain Management: Pain relief is a critical component of palliative care for advanced bladder cancer. This can be achieved with opioid analgesics (e.g., morphine) for severe pain or NSAIDs for mild pain.
2. Hematuria Management: Hematuria is a common symptom in advanced bladder cancer. Intravesical therapies like bladder irrigation, or systemic chemotherapy, can help control bleeding. In some cases, blood clot removal or cystostomy may be necessary.
3. Urinary Obstruction: For patients with urinary retention or hydronephrosis, catheterization, stent placement, or nephrostomy tubes may be used to relieve obstruction and improve renal function.
4. Incontinence Management: For patients with incontinence, absorbent pads, urinary catheters, or surgical diversion may be considered to improve comfort and hygiene.
Step 2: Chemotherapy and Targeted Therapy:
Although chemotherapy is not curative in advanced bladder cancer, it can be used for palliation to shrink tumors, relieve symptoms, and slow disease progression. Common agents used in palliative chemotherapy include cisplatin and gemcitabine.
1. Immunotherapy: Immune checkpoint inhibitors like pembrolizumab and nivolumab may be used in patients with advanced bladder cancer who have failed chemotherapy. These drugs help stimulate the immune system to target and destroy cancer cells.
2. Radiation Therapy: Radiation therapy can be used palliatively to relieve pain from bone metastases, treat obstructive symptoms, or shrink tumors causing obstruction or bleeding.
3. Targeted Therapy: Targeted therapies such as FGFR inhibitors may be used in specific cases based on the genetic profile of the tumor.
Step 3: Psychosocial Support:
Palliative care also involves addressing the emotional, psychological, and spiritual needs of the patient. Support from social workers, psychologists, and palliative care teams is essential for patients and their families to cope with the emotional and mental strain of advanced cancer.