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Renal / Genitourinary

Bladder & Kidney Cancer

Urothelial carcinoma High-yield Verified · Sep 2026

Bladder cancer is a malignancy of the bladder lining, over 90% urothelial carcinoma; kidney cancer in adults is mostly renal cell carcinoma, a malignancy of the renal tubule lining.

For the nurse, bladder cancer means three things. Take any blood in the urine seriously. Handle intravesical BCG as a live biohazard and recognize the rare but fatal systemic BCG infection. Teach urostomy care — mucus is normal, blood and a dark stoma are not. Kidney cancer means watching the paraneoplastic labs and protecting the remaining kidney after nephrectomy.

What’s going wrong in the body

The normal physiology, where it fails, and why the body’s compensation backfires.

01 Bladder: carcinogens concentrated in urine

[BLAD] Why smoking hits the bladder. "Tobacco contains harmful chemicals called carcinogens. When you use tobacco, these chemicals get absorbed into the bloodstream," are filtered by the kidneys and collect in the urine. This "exposes your bladder to high levels of these chemicals, which can damage the DNA in the cells lining your bladder" (NCI). Chemicals linked to bladder cancer include "arylamine and aniline dyes, formaldehyde, phenacetin, cyclophosphamide, and arsenic in the drinking water" (StatPearls).

Types. "Urothelial carcinoma is the most frequent type of bladder cancer, constituting over 90% of cases in industrialized nations." Squamous cell carcinoma (about 5%) follows chronic inflammation "from foreign bodies, catheters, human papillomavirus (HPV) infections, cyclophosphamide exposure resulting in hemorrhagic cystitis, or schistosomiasis in travelers or immigrants."

Depth decides treatment. Most tumors stay in the bladder lining (non-muscle-invasive, NMIBC): "NMIBC is the most commonly found type of bladder cancer and accounts for about 75% of the total cases." Others grow into the bladder muscle (MIBC): "MIBC accounts for about 25% of all bladder malignancies." Carcinoma in situ (CIS) is "an aggressive and high-grade but relatively rare (1% to 3%) and superficial form of bladder cancer."

Carcinogens from smoking are filtered into urine and damage the bladder lining, and workplace chemicals add risk; tumor depth decides between bladder-sparing treatment and cystectomy.

02 Intravesical BCG — a live bacterium used as immunotherapy

[BCG] What it is. TICE BCG is "an attenuated, live culture preparation of the Bacillus of Calmette and Guerin (BCG) strain of Mycobacterium bovis." "BCG initially attaches to malignant urothelial cells due to a unique cellular fibronectin protein interaction with the bacteria, after which the BCG becomes internalized. Once inside the tumor cell, the BCG causes an increase in intracellular cytokine production." The full mechanism "is incompletely understood."

Who gets it. After transurethral resection (TURBT) of a non-muscle-invasive tumor, intravesical therapy lowers recurrence: "TURBT surgery releases tumor cells, which can be implanted elsewhere in the bladder," and a single instillation of chemotherapy within 24 hours of resection reduces this. For carcinoma in situ, "Transurethral resection and/or fulguration is of limited value in CIS of the bladder due to the extent of the disease, so BCG is considered first-line therapy." High-risk NMIBC is treated with "a 6-week course of BCG induction (1 dose weekly for 6 weeks)" (StatPearls); the label adds maintenance instillations "at approximately monthly intervals for at least 6 to 12 months."

Why it is dangerous. "BCG is capable of dissemination when administered by the intravesical route, and serious infections, including fatal infections, have been reported." Instilling it into a bleeding bladder "may promote systemic BCG infection," which is why treatment is postponed after resection or gross hematuria. Because it is live, it is handled as a biohazard, and health care workers have been infected through needle sticks.

BCG is instilled after the bladder heals, retained for 2 hours, and triggers a local immune reaction; bladder irritation is expected, while systemic BCG infection is an emergency.

03 Kidney: a silent tumor that makes hormones

[RCC] What it is. "Renal cell carcinoma (RCC) is the most common malignant tumor of the kidney and constitutes over 90 percent of all renal malignancies." Clear cell carcinoma "is the most common type (70-80%) of RCC," and "Current studies implicate the VHL gene in the development of both sporadic and familial type of clear cell-RCC." Cancer of the renal pelvis is different — it behaves like bladder cancer.

Silent until late. RCCs "usually remain asymptomatic until late in the disease, and over 50% of tumors may be detected incidentally." "Only 10 to 15% of patients may present with the so-called “classic triad” of flank pain, hematuria and flank fullness." "A third of the patients with RCC have metastatic disease at presentation," most often to lungs, then bone and liver.

The "great mimic." RCC "can produce a number of substances that lead to hypercalcemia (PTHrP), erythrocytosis (erythropoietin), and Cushing syndrome (ACTH)," plus liver dysfunction without metastasis (Stauffer syndrome). Bone metastases are "often osteolytic and causes pathologic fractures, spinal cord compression, and hypercalcemia." A tumor growing into the renal vein can block the testicular vein and cause a varicocele.

Renal cell carcinoma is often found by chance; when it shows itself, it may be through hormones (hypercalcemia, erythrocytosis) or metastases rather than the rare classic triad.

Causes & risk factors

Modifiable factors are teaching targets — the patient can act on them.

[BLAD] Smoking — "the most important known risk factor for bladder cancer"; "At least 50% of bladder cancers will be found in current or former smokers." Risk falls after quitting — by 40% within 4 years (StatPearls) modifiable [BLAD] Workplace chemicals — arylamine and aniline dyes; paint, rubber, petroleum products, agricultural chemicals; barbers, beauticians, dry cleaners, painters, metalworkers modifiable [BLAD] Other — older age, male sex, family history, pelvic radiation or cyclophosphamide/ifosfamide, arsenic in well water, Schistosoma haematobium, long-term urinary catheters (NCI) [RCC] Smoking — "The strongest risk factor for renal cell carcinoma (RCC) is smoking," including pipes and cigars modifiable [RCC] Obesity, high blood pressure, chronic renal failure, trichloroethylene exposure modifiable [RCC] Long-term misuse of pain medicines, including over-the-counter ones (NCI) modifiable [RCC] Family history; von Hippel-Lindau disease or hereditary papillary renal cancer (NCI)

Signs & symptoms

Each finding tied to the mechanism that produces it — and the triage it calls for.

[BLAD] Painless hematuria — visible or found on a test; may come and go early Hold & notify
Why: "The most common symptom is blood in the urine, called hematuria." "You may see blood in your urine at one point, then not see it again for a while" (NCI). "Over a third of patients with gross hematuria … will ultimately be diagnosed with bladder cancer" (StatPearls).
[BLAD] Frequency, urgency, burning; "UTI" symptoms that do not respond to antibiotics Hold & notify
Why: StatPearls: "urinary tract infection symptoms unrelated to infections and unresponsive to antibiotics, or irritative bladder symptoms may be early symptoms of urothelial bladder cancer."
[BLAD] Advanced: unable to urinate, one-sided low back pain, bone pain, weight loss, leg swelling late
Why: Local spread and metastasis (NCI advanced-symptom list).
[RCC] Usually none — found incidentally; sometimes blood in the urine, a lump in the abdomen, or side pain that does not go away
Why: The "classic triad" occurs in only 10 to 15%; fatigue, weight loss, fever, night sweats, hypertension and anemia also occur.
[RCC] Hypercalcemia; erythrocytosis; abnormal liver tests Hold & notify
Why: Paraneoplastic hormones (PTHrP, erythropoietin) or bone metastasis; "laboratory studies in the evaluation of RCC should include exploration for the paraneoplastic syndromes."
[RCC] Excruciating band-like back pain, especially with new weakness or numbness late Hold & notify
Why: Vertebral collapse and spinal cord compression from osteolytic metastasis (StatPearls). See Oncologic Emergencies for cord-compression care.
[BCG] Burning with the first void; frequency, urgency, mild hematuria, malaise for 1–3 days after instillation Expected
Why: Bladder irritability from the induced inflammation, "reported in approximately 60% of patients." Symptoms "typically begin 4 to 6 hours after instillation and last 24 to 72 hours" (label).
[BCG] Fever of 103 °F or higher, flu-like fever lasting more than 72 hours, or any persistent fever or acute febrile illness after BCG Report immediately
Why: Possible systemic BCG infection: "Febrile episodes with flu-like symptoms lasting more than 72 hours, fever ≥103°F" suggest it, and "Deaths have been reported as a result of systemic BCG infection and sepsis." BCG is stopped and the patient "immediately evaluated and treated for systemic infection" (label).
[BCG] Joint pain, cough, rash, severe urinary symptoms; prostatitis, epididymitis or orchitis lasting more than 2 to 3 days Hold & notify
Why: Label: "the physician should be notified" for severe urinary side effects, joint pain, cough or skin rash; local genitourinary inflammation lasting more than 2 to 3 days suggests active infection.
[BCG] High fever, rigors, confusion, low blood pressure or breathing trouble — even long after BCG Report immediately
Why: Systemic BCG infection (BCG-osis): "Deaths have been reported as a result of systemic BCG infection and sepsis." StatPearls: it can present with "mental status changes, chills, high-grade fevers … respiratory failure, hypotension" and "may occur years after the last BCG instillation."
[CONDUIT] Mucus in the urostomy urine Expected
Why: "Some mucous in the urine is normal with a urostomy." NIDDK stoma care likewise begins with "Gently wipe away mucus"
[CONDUIT] Blood in urostomy urine; changes or irritation of the stoma or the skin around it Hold & notify
Why: "Blood is not a normal or expected finding and should be reported to the health care provider." NIDDK: "Inspect the stoma and surrounding skin and contact your health care professional if you notice any skin changes or irritation." Stomal ischemia is a named surgical complication.
[CONDUIT] A darkened stoma color Report immediately
Why: A healthy stoma is moist, above skin level and pink to red. Ostomy follow-up guidance (intestinal stomas; an ileal-conduit stoma is itself ileum) tells patients to report a darkened stoma immediately because it indicates ischemia (an ischemic stoma may look purplish, nonperfused or progressively necrotic), and necrosis at or below the fascia requires immediate surgical revision.

Diagnostics

Test In this disorder Normal
[BLAD] Urinalysis NCI: patients are asked "to give a urine sample as a first step." Hematuria also has other causes — urinary tract infections, kidney or bladder stones, or other kidney problems "could be the cause, not cancer." Blood — sometimes only microscopic —
[BLAD] Cystoscopy, cytology, imaging, transurethral resection with biopsy StatPearls: "Modalities used in diagnosing bladder cancer include imaging (eg, ultrasound, computed tomography, and magnetic resonance imaging), cystoscopy, cytology, transurethral resection, and biopsy." "A CT urogram is the gold-standard imaging modality for the upper urinary tract." Urine cytology sensitivity is "only 44% with a high specificity of 96%," so a negative cytology does not rule cancer out. Tumor seen, sampled and staged by depth —
[RCC] CT abdomen and pelvis; chest imaging "Imaging remains the mainstay in RCC for diagnosis, screening, follow-up, and treatment monitoring." NCI: "A biopsy may not be needed if the imaging test results provide enough information to make a diagnosis." Renal mass; staging for lung and other metastases —
[RCC] Urinalysis, renal function, electrolytes, calcium, CBC, liver tests Renal function "in order to help make decisions on the use of contrast for radiologic tests"; calcium, blood counts and liver tests screen for hypercalcemia, erythrocytosis and Stauffer syndrome. Look for kidney impairment and paraneoplastic changes —
[CONDUIT] Electrolytes, blood gases, vitamin B12 "Ammonia and chloride from the urine can be absorbed, causing hyperchloraemic metabolic acidosis" — in up to 15%. B12 "Levels should be checked at follow-up appointments every 6-12 months" (StatPearls). Watch for hyperchloremic metabolic acidosis and low B12 —
Stage and survival (SEER, 5-year relative) About half of bladder cancers are found in situ. Bladder cancer is most often diagnosed at ages 65–74. Bladder 79.1% overall (in situ 98.0% · localized 73.0% · regional 41.8% · distant 9.6%); kidney and renal pelvis 79.2% (localized 93.6% · regional 77.6% · distant 20.3%) NCI SEER (2016–2022) —

Complications

Black-box warning — most severe: ■ [BCG] Systemic BCG infection (BCG-osis) Report immediately
"Deaths have been reported as a result of systemic BCG infection and sepsis." "BCG-osis , also known as disseminated BCG, occurs in less than 1% of patients receiving BCG therapy."
Label: "If a patient develops persistent fever or experiences an acute febrile illness consistent with BCG infection, BCG treatment should be discontinued and the patient immediately evaluated and treated for systemic infection," with "2 or more antimycobacterial agents." The label gives two fever cutoffs in different sections — "fever ≥103°F" (Warnings) and, in the adverse-reactions section, fever of ≥38.5 °C (101.3 °F) or epididymitis, prostatitis or orchitis "persisting longer than 2 to 3 days suggest active infection"; both are listed, not merged. It can appear "years after the last BCG instillation."
Warning: [BCG] Live-organism exposure for staff and household Hold & notify
"TICE ® BCG contains live, attenuated mycobacteria. Because of the potential risk for transmission, prepare, handle, and dispose of TICE ® BCG as a biohazard material."
"BCG infections have been reported in health care workers, primarily from exposures resulting from accidental needle sticks or skin lacerations." "Needle stick injuries should be avoided during the handling and mixing of TICE BCG." After treatment, patients void seated and disinfect voided urine with bleach for 6 hours.
Warning: [CONDUIT] Metabolic, infectious and stomal complications of an ileal conduit Hold & notify
Hyperchloremic metabolic acidosis (up to 15%, with osteoporosis risk), vitamin B12 deficiency after some years, frequent UTIs, kidney stones and, in up to 6%, death from end-stage renal failure (StatPearls).
Stoma problems include "parastomal hernia, retraction or stenosis, and bleeding." Urine "can cause excoriation of the skin." "Metabolic complications can be significant; hence, regular follow-up is needed to ensure electrolytes are normal and the patient is not acidotic."
Warning: [RCC] Hypercalcemia and spinal cord compression Hold & notify
Bone metastasis "is often osteolytic and causes pathologic fractures, spinal cord compression, and hypercalcemia." Hypercalcemia may also be paraneoplastic (PTHrP).
"Excruciating, sharp, band-like back pain may be present due to vertebral collapse and spinal cord compression." Emergency management is on the Oncologic Emergencies page.
Caution: [NEPH] Loss of kidney function; systemic-therapy effects Hold & notify
"A person can live with part of one working kidney, but if both kidneys are removed or not working, the person will need dialysis … or a kidney transplant." Partial nephrectomy "may be done to prevent loss of kidney function."
Targeted therapies or surgery may cause "renal function compromise, hypertension, proteinuria, impaired wound healing, gastrointestinal perforation, hemorrhage and thrombosis, reversible leukoencephalopathy, impaired cardiac function and endocrine dysfunction e.g., hypothyroidism."
Caution: [BLAD] Recurrence
"Regular follow-up and monitoring are crucial for those with a history of bladder cancer due to the high recurrence rate."
Patients with NMIBC "should be given a clear schedule for their surveillance cystoscopies and strongly encouraged to stop smoking if they haven't already." TURBT can release tumor cells that implant elsewhere in the bladder; a single intravesical chemotherapy instillation within 24 hours reduces this.

Medications for this condition

Why each class is prescribed here — every card links to its full pharmacology page.

Antineoplastic / Chemotherapy Overview First-line High-alert
Oncology

[BLAD] A single intravesical chemotherapy instillation "immediately after a TURBT (within 24 hours) has been shown to reduce the incidence of urothelial cancer recurrence and progression significantly." For advanced disease, "Enfortumab vedotin and pembrolizumab (EV+P) have replaced cisplatin-based treatments as first-line chemotherapy for advanced or metastatic urothelial (bladder) cancer." [RCC] NCI lists targeted drugs (for example sunitinib, cabozantinib, axitinib, pazopanib, everolimus) and immunotherapy (nivolumab, pembrolizumab, ipilimumab, avelumab) for renal cell cancer. Intravesical BCG is immunotherapy with no class page; its label rules are under nursing care.

Beyond medications

  • [BLAD] Transurethral resection (TURBT) — removes non-muscle-invasive tumors; a single intravesical chemotherapy instillation within 24 hours of resection reduces recurrence, and high-risk NMIBC and CIS go on to "a 6-week course of BCG induction (1 dose weekly for 6 weeks)."
  • [BLAD] Radical cystectomy with urinary diversion — for muscle-invasive cancer or NMIBC "that has failed less radical management such as BCG therapy" (StatPearls); trimodal therapy (maximal TURBT with chemoradiation) "has shown equivalent survival to radical cystectomy in carefully selected patients."
  • [CONDUIT] Ileal conduit — "the most common form of incontinent urinary diversion"; "a passive conduit for urine to drain into an appliance." Before surgery, stoma nurses help patients "prepare themselves mentally for the life-changing event of having a stoma," and the stoma is kept off scars, skin creases and the beltline.
  • [RCC] Nephrectomy — partial (cancer plus surrounding tissue, "to prevent loss of kidney function"), simple (kidney only) or radical (kidney, adrenal gland, surrounding tissue and usually nearby lymph nodes). "Tumors (< 7 cm) confined to one pole of the kidney are treated by partial nephrectomy."
  • [RCC] When surgery is not possible — arterial embolization, cryosurgery or thermal ablation; external beam radiation for symptom relief (NCI).
  • Smoking cessation and chemical-exposure reduction — "Educating patients about reducing risk factors, such as smoking cessation and minimizing exposure to industrial chemicals, can significantly reduce their overall risk."

Nursing considerations

The RN-specific layer — each action paired with the reason it matters.

Assessment
Ask every patient with blood in the urine about smoking and workplace chemical exposure.
Why: Smoking is the leading risk for both cancers; dyes, paint, rubber and petroleum products raise bladder cancer risk.
Before each BCG instillation, check temperature, urinary symptoms, visible blood in the urine, and the date of any recent resection, biopsy or traumatic catheterization; review medicines for steroids or other immunosuppressants.
Why: Label: treatment is postponed for "a concurrent febrile illness, urinary tract infection, or gross hematuria," and "Seven to 14 days should elapse" after biopsy, TUR or traumatic catheterization; BCG "should not be used in immunosuppressed patients."
After BCG, assess for fever, chills, flu-like symptoms, joint pain, cough, rash and how long they last.
Why: Short-lived irritation is expected; flu-like fever beyond 72 hours, fever ≥103°F or any persistent fever suggests systemic BCG infection, which needs immediate evaluation.
[CONDUIT] Inspect the stoma (healthy: moist, above skin level, pink to red; stomal edema can occur in the immediate postoperative period) and peristomal skin daily and urine (mucus expected, blood not); monitor electrolytes and acid–base results as ordered.
Why: Changes or irritation of the stoma or the skin around it are reported (NIDDK); hyperchloremic metabolic acidosis occurs in up to 15%.
[RCC] Track calcium, blood counts, liver tests and renal function; ask about new back pain.
Why: Paraneoplastic hypercalcemia and erythrocytosis, Stauffer syndrome, bone metastasis and loss of renal function are all RCC concerns.
Interventions
Handle BCG as a biohazard: follow facility precautions for preparation, administration and disposal, and avoid needle sticks.
Why: Boxed warning: "prepare, handle, and dispose of TICE ® BCG as a biohazard material"; staff infections have followed needle sticks.
Have the patient avoid fluids for 4 hours and empty the bladder before instillation; after instillation have them retain it for 2 hours, turning side to side, back and abdomen every 15 minutes.
Why: Label instructions that "maximize bladder surface exposure to the agent"; patients who cannot hold it for 2 hours may void sooner.
Hold the BCG and notify the provider if the patient has a fever, UTI, gross hematuria, recent resection or traumatic catheterization, or is immunosuppressed.
Why: "Instillation of TICE BCG with an actively bleeding mucosa may promote systemic BCG infection."
Escalate at once for fever ≥103°F, flu-like fever beyond 72 hours, any persistent fever, or rigors, confusion, hypotension or respiratory distress after BCG — even long after the last dose.
Why: The label directs that BCG be "discontinued and the patient immediately evaluated and treated for systemic infection"; deaths from BCG sepsis have occurred.
[CONDUIT] Fit the barrier 2 mm larger than the stoma; change it for leaking, odor, excessive skin exposure, itching or burning; use barrier products for urine-excoriated skin.
Why: Open RN urostomy care; urine "can cause excoriation of the skin."
[CONDUIT] Report a darkened stoma immediately (ischemia); report blood in the urine, changes or irritation of the stoma or surrounding skin, or UTI signs such as fever or cloudy, strong-smelling urine.
Why: Blood "is not a normal or expected finding"; urostomy patients are at risk for UTIs.
Patient and family teaching
Report any blood in the urine promptly, even once and without pain.
Why: Painless hematuria may be an early sign of bladder cancer; StatPearls stresses "noticing blood in the urine and seeking prompt medical attention."
After BCG, for 6 hours: sit to void, add an equal volume of household bleach to the urine and wait 15 minutes before flushing, and drink extra fluids.
Why: Label: "Patients should void while seated in order to avoid splashing of urine. For the 6 hours after treatment, urine voided should be disinfected for 15 minutes with an equal volume of household bleach before flushing."
Expect burning with the first void and bladder irritation for 1–3 days; call for joint pain, cough, rash or severe urinary symptoms; get immediate care for a fever of 103 °F or higher, flu-like fever lasting more than 3 days, any persistent fever, or shaking chills, confusion or trouble breathing.
Why: The label lists what to report to the physician and directs that a patient with persistent fever be "immediately evaluated and treated for systemic infection"; "Deaths have been reported as a result of systemic BCG infection and sepsis."
[CONDUIT] Empty the pouch every 2 to 4 hours or when one-third full, use a night drainage bag, and watch for UTI signs.
Why: "A urostomy patient has no voluntary control of urine"; UTIs are a common complication.
Keep up regular follow-up: surveillance cystoscopy after bladder cancer, and electrolyte and B12 checks with an ileal conduit.
Why: Recurrence is common; acidosis and B12 deficiency develop over years.
Quit smoking; limit workplace chemical exposure; avoid long-term misuse of pain medicines.
Why: Smoking is the top risk for both cancers, and bladder risk falls after quitting; long-term pain-medicine misuse is an RCC risk factor (NCI).

How a real nurse thinks

The clinical-judgment loop, worked for a typical presentation — reasoning, not reference.

  1. 1
    Recognize cues

    Fever 38.9 °C, tachycardia, chills and body aches on the day of a planned BCG dose. Last week's 2 days of burning and frequency fit the expected irritative reaction.

  2. 2
    Analyze cues

    The label says treatment "should be postponed until resolution of a concurrent febrile illness." A fever with flu-like symptoms after BCG may also be an early sign of systemic BCG infection.

  3. 3
    Prioritize

    Do not instill BCG, and get the fever evaluated now; watch for the signs of sepsis.

  4. 4
    Generate solutions

    Hold the instillation, notify the urologist, recheck vital signs, and ask how long the flu-like symptoms have lasted and about joint pain, cough or rash.

  5. 5
    Take action

    SBAR: 72-year-old on weekly intravesical BCG (dose 3 due today); T 38.9 °C, HR 108, chills and myalgia since last evening. BCG held. Concern for febrile illness vs early systemic BCG infection — requesting evaluation now.

  6. 6
    Evaluate

    Reassess temperature, blood pressure and mental status; escalate at once for rigors, confusion, hypotension or breathing difficulty. The next dose waits until the fever has resolved and the provider approves.

Scenario — you’re the nurse

Work each question before revealing the answer. Rationales explain the wrong options too.

Urology clinic · day of the 3rd weekly BCG instillation, 0900

A 72-year-old man with high-risk non-muscle-invasive bladder cancer, a former smoker and retired painter, had a TURBT 5 weeks ago and is receiving a 6-week course of intravesical BCG. After last week's dose he had burning on urination and frequency for about 2 days, then felt well.

Today — T 38.9 °C; HR 108; BP 118/70; RR 20
History — chills and aching since yesterday evening; says he feels like he has the flu
Urine — clear yellow; no visible blood
Medicines — no steroids or immunosuppressants
Plan on the schedule — BCG instillation #3 at 0930
Q1 Multiple choice
The patient has a temperature of 38.9 °C on the morning of his scheduled BCG instillation. What should the nurse do first?
  1. A. Give acetaminophen and proceed with the instillation
  2. B. Hold the instillation and notify the provider
  3. C. Give the BCG but shorten the retention time to 1 hour
  4. D. Increase oral fluids and instill as scheduled
Reveal answer & rationale
Answer: B
Label: "Treatment should be postponed until resolution of a concurrent febrile illness," and fever after BCG may signal systemic infection (B). Masking the fever and proceeding (A), shortening retention (C) or pushing fluids (D) all expose a febrile patient to live BCG.
Q2 Select all that apply
Which instructions should the nurse give after an intravesical BCG instillation? Select all that apply.
  1. A. Sit down to urinate for the next 6 hours
  2. B. Add an equal volume of household bleach to voided urine and wait 15 minutes before flushing, for 6 hours
  3. C. Drink extra fluids after the dose is voided
  4. D. Expect burning with the first void
  5. E. Avoid all fluids for the rest of the day
  6. F. Get immediate care for a fever of 103 °F or higher or flu-like fever lasting more than 3 days
Reveal answer & rationale
Answer: A, B, C, D, F
Label: void "while seated in order to avoid splashing of urine" (A); for 6 hours, voided urine is "disinfected for 15 minutes with an equal volume of household bleach before flushing" (B); increase fluid intake after treatment (C); "Patients may experience burning with the first void" (D); flu-like fever lasting more than 72 hours or fever ≥103°F suggests systemic BCG infection, which needs immediate evaluation (F). Fluids are withheld only for the 4 hours before treatment (E).
Q3 Multiple choice
Which finding in a patient with an ileal conduit is expected?
  1. A. Mucus in the urine in the pouch
  2. B. Blood in the urine in the pouch
  3. C. Fever with cloudy, strong-smelling urine
  4. D. Red, irritated skin around the stoma
Reveal answer & rationale
Answer: A
"Some mucous in the urine is normal with a urostomy" (A). "Blood is not a normal or expected finding and should be reported" (B). Fever with cloudy or strong-smelling urine suggests a urinary tract infection that needs prompt care (C), and skin changes or irritation around the stoma (D) are reasons to contact the health care professional (NIDDK).
Q4 Multiple choice
A patient with renal cell carcinoma has a calcium level above normal and new band-like back pain. What does the nurse suspect?
  1. A. The classic triad of renal cell carcinoma
  2. B. Bone metastasis with possible spinal cord compression, or paraneoplastic hypercalcemia
  3. C. An expected effect of nephrectomy
  4. D. Dehydration from low fluid intake
Reveal answer & rationale
Answer: B
RCC bone metastasis "is often osteolytic and causes pathologic fractures, spinal cord compression, and hypercalcemia," and band-like back pain may reflect vertebral collapse; RCC also makes PTHrP (B). The classic triad (A) is flank pain, hematuria and flank fullness, present in only 10 to 15%. Neither finding is an expected post-nephrectomy effect (C). Dehydration (D) does not explain band-like back pain.
Q5 Multiple choice
Which statement about kidney cancer is accurate?
  1. A. Most patients present with flank pain, hematuria and a flank mass
  2. B. Over half of renal cell carcinomas are found incidentally on imaging
  3. C. Kidney cancer is not linked to smoking
  4. D. A person cannot live with only one working kidney
Reveal answer & rationale
Answer: B
RCCs usually stay silent and "over 50% of tumors may be detected incidentally" (B). Only 10 to 15% present with the classic triad (A). Smoking is "The strongest risk factor for renal cell carcinoma" (C). NCI: "A person can live with part of one working kidney" (D).

Common questions

What causes bladder & kidney cancer?
Common causes and risk factors include [blad] smoking — "the most important known risk factor for bladder cancer"; "at least 50% of bladder cancers will be found in current or former smokers." risk falls after quitting — by 40% within 4 years (statpearls), [blad] workplace chemicals — arylamine and aniline dyes; paint, rubber, petroleum products, agricultural chemicals; barbers, beauticians, dry cleaners, painters, metalworkers, [blad] other — older age, male sex, family history, pelvic radiation or cyclophosphamide/ifosfamide, arsenic in well water, schistosoma haematobium, long-term urinary catheters (nci), [rcc] smoking — "the strongest risk factor for renal cell carcinoma (rcc) is smoking," including pipes and cigars, [rcc] obesity, high blood pressure, chronic renal failure, trichloroethylene exposure, and others.
Is BCG chemotherapy?
No. BCG is a live, attenuated strain of Mycobacterium bovis used as immunotherapy — it triggers a local immune attack on bladder tumor cells. Because it is live, it is handled as a biohazard and can rarely cause a fatal systemic infection.
Why is painless hematuria taken so seriously?
It is the most common symptom of bladder cancer, and StatPearls reports that "Over a third of patients with gross hematuria and slightly over 10% of those with microscopic hematuria will ultimately be diagnosed with bladder cancer." Bleeding can come and go, so one episode still needs evaluation.
Is mucus in a urostomy pouch a problem?
No — "Some mucous in the urine is normal with a urostomy." Blood is not expected and should be reported, as should changes or irritation of the stoma or the skin around it (NIDDK).
Why is renal cell carcinoma called the "great mimic"?
It releases hormone-like substances — PTHrP (high calcium), erythropoietin (too many red cells), ACTH (Cushing syndrome) — and can disturb liver tests without spreading there, so it can show up as a lab abnormality rather than a kidney symptom.
What is the outlook?
SEER 5-year relative survival is 79.1% for bladder cancer and 79.2% for kidney and renal pelvis cancer — far higher when found early (in situ bladder 98.0%, localized kidney 93.6%) than after distant spread.

Sources

Reviewed by Hae Suk Lee, RN

Educational summary for nursing students. Scenarios are fictional teaching cases. Always verify against current guidelines and your institution's protocols before acting in practice. Not medical advice.

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