male urethral cancer
Introduction
Introduction to male urethral cancer Urethral cancer is a urothelial tumor and is relatively rare in clinical practice. Primary urethral cancer is rare, mainly in women. Most male urethral cancer is more than 40 years old. Female urethral cancer is more common in middle-aged and elderly people. Primary urethral tumors are rare in clinical practice. Malignant tumors include cancer, sarcoma and melanin. Tumors, etc., the incidence of urethral tumors: male is about 19:1, the urethra is the only urinary tract tumor female than the male only, secondary urinary tract cancer is more common than the primary, difficult to treat, poor prognosis. basic knowledge The proportion of sickness: 0.01% Susceptible people: male Mode of infection: non-infectious Complications: hematuria
Cause
Male urinary tract cancer cause
(1) Causes of the disease
It is unclear that chronic urethritis, urethral stricture and repeated urethral dilatation may be the cause. The tissue type of primary urethral cancer varies according to the origin of the squamous cell carcinoma, and the squamous cell carcinoma is the majority, followed by the epithelial cancer. The cancer is rare, the male urethral scapular fossa covers the squamous epithelium, the penis and the ball urethra cover the pseudostratified or columnar epithelium, the posterior urethra covers the transitional epithelium, and the penile urethral tumor 50% to 70% from the bulb. About 50% secondary to the urethral stricture in the distal side, accompanied by mucosal squamous metaplasia, which is the majority of squamous cell carcinoma; adenocarcinoma originates from the urethral gland or Lirttre gland, urethral ball, and membrane tumor often Invasion of the deep structure of the perineum, including the skin of the penis and scrotum, urinary genital warts and prostate; tumors in the scaphoid can invade the penis head rich in blood vessels and lymphatic vessels, anterior urethral tumors usually metastasize to the shallow deep lymph nodes of the inguinal, posterior urethral tumors Transfer to the obturator and the iliac crest, the external lymph nodes, but when the tumor invades the penis or perineal skin, it can be transferred to the inguinal lymph nodes. Urinary tract cancer (especially anterior urethral cancer) rarely undergoes a transfer. Parts of the transfer of a maximum of lung, liver and stomach times, can be transferred to the pleura and even bone.
(two) pathogenesis
Male urethral cancer can be divided into two categories:
1 secondary urethral cancer: most of the transitional cell carcinoma secondary to bladder cancer or upper urinary tract cancer, the urethra is more common.
2 primary urethral cancer: the predilection site in the bulb or the urethra of the glomerulus, accounting for more than half; followed by the penis urethra, occurs in the prostate urethra, rarely, squamous cell carcinoma is most common, occurs in the penis The urethra, especially the sinus of the scaphoid, followed by the urethra of the bulb and the bulba; the transitional cell carcinoma is more common in the urethra of the prostate; the adenocarcinoma is rare and can be derived from the prostate.
Levine staging is commonly used in male urethral cancer staging.
Phase O: limited to the mucosa.
Stage A: does not exceed the lamina propria.
Stage B: Invading the corpus cavernosum or prostate, but not penetrating.
Stage C: Exceeding the corpus cavernosum tissue or exceeding the prostate capsule.
Stage D: Stage D1: Inguinal lymph node or pelvic lymph node metastasis.
D2: distant transfer.
Prevention
Male urethral cancer prevention
1. Drink more water: If you drink more water, you will have more urine. The high concentration of urine will cause some stimulation to the prostate. Long-term adverse stimuli are harmful to the prostate. Drinking more water can not only dilute the blood but also effectively dilute the concentration of urine.
2. Do not urinate: once the bladder is filled with urine, it should be urinated. Hemorrhoids are not good for the bladder and prostate. Before taking a long-distance bus, you should empty the urination and then take the bus. If you are urinating on the way, you should say hello to the driver and get rid of the urination.
3. Moderate life: prevention of prostatic hypertrophy, need to start from the young and middle-aged, the key is to have a moderate sexual life, do not want to abstain from sex, frequent sexual life will cause the prostate to be in a state of hyperemia for a long time and cause prostate enlargement. Therefore, it is especially necessary to pay attention to the restraint life in the youth with strong sexual desire, avoid repeated hyperemia of the prostate, and give the prostate full recovery and dressing time. Of course, excessive abstinence will cause discomfort and discomfort, which is also unfavorable to the prostate.
4. More relaxation: life stress may increase the chance of prostate enlargement. Clinically, prostate symptoms are relieved when life stress slows. Therefore, you should try to stay relaxed as usual.
5. Washing the warm bath: Washing the warm bath can relieve the tension between the muscles and the prostate and slow down the symptoms. Regular warm baths are undoubtedly beneficial for patients with prostate disease. If you take a bath with a warm water every day, you can also get good results.
6. Keep clean: male scrotum stretches more secretion of sweat, combined with poor ventilation of the genitals, easy to hide dirt. Local bacteria often take advantage of it, which can lead to prostatitis. If the prostatic hypertrophic function declines, serious infections may occur if not noticed in time. Therefore, insisting on cleaning the perineum is an important part of preventing prostatitis. In addition, it is necessary to wash the external genitalia every time in the same room.
Complication
Male urethral cancer complications Complications
Urinary tract cancer can have the following complications:
1. Blocking the urethra, causing difficulty in urinating, but rarely occurs in urinary retention.
2. Infection, can pass through the corpus cavernosum, form inflammation around the urethra, or cause abscess around the urethra; or spread to the scrotum, perineum, and form the perineal urethra.
3. Hematuria, due to the destruction of the urethral mucosa, capillary rupture can cause hematuria, and it is easy to combine bacterial infection with frequent urination, urgency, dysuria, and urinary burning.
Symptom
Male urethral cancer symptoms Common symptoms Bloody urethra, urethral opening, nodules... Local urethral swelling, hematuria, extravasation, urethral discharge
The age of onset of this disease is from 13 to 91 years old, most of them are over 50 years old. Patients usually seek medical treatment for urinary tract obstruction, mass, periurethal abscess, urinary extravasation, urethral fistula and urethral discharge and other symptoms. Some patients have pain. , hematuria or blood essence symptoms, scaphoid tumors can be expressed as ulcers or papillary lesions, rectal double examination can understand whether the tumor extends to the prostate, anus and urogenital fistula, common symptoms of the anterior urethra are dysuria, and urethra Similar to the stenosis, some cases may have urinary irritation, erectile dysfunction, urethral bloody secretions or hematuria, urethral cancer can be found in urethral nodules or masses, and large tunica urethral cancer can reach the mass in the perineum.
According to the clinical and pathological biopsy results, the clinical staging was performed, and the review was performed according to the pathological findings of the surgical specimens.
Stage O: limited to mucosa (in situ carcinoma), stage A: lesion to submucosa, layer B: lesion invading the corpus cavernosum, stage C: directly extending to the extracorporeal tissue of the urethra sponge or beyond the prostate capsule, D1: regional Metastasis includes groin/pelvic lymph nodes (primary tumor can be any period), stage D2: distant metastasis (primary tumor can be any period).
Systematic examination of the penis, from the external urethra to the perineal sacral membrane touch the urethra and the corpus cavernosum with or without induration, check the bilateral inguinal lymph nodes, urethrography can help determine the size of the tumor, the location, urethra cystoscopy can understand The extent of the tumor and biopsy.
Examine
Male urethral cancer examination
Urethral tumor cells can be found in urethral secretions, urine sediments, urethral irrigation or brushing cytology or FCM analysis.
1. Urethral angiography can help determine the size and location of the tumor, but can not estimate the extent of the tumor.
2. Urethroscopy can observe the extent of the tumor and further confirm the diagnosis by biopsy.
3. CT and MRI examination can understand the presence or absence of pelvic and retroperitoneal lymph node metastasis, which is helpful for tumor staging.
Diagnosis
Diagnosis and diagnosis of male urethral cancer
diagnosis
Diagnosis can be based on the cause, symptoms and related tests.
Differential diagnosis
Urethral cancer should be differentiated from sharp sputum, urethral stricture, periurethal abscess, tuberculosis, penile cavernous sclerosis, and biopsy should be performed if necessary.
1. Urethral stricture: divided into congenital and acquired urethral stricture, acquired urethral stricture often has traumatic, instrumental examination, gonorrhea and other obvious pathogenic factors, which are mainly characterized by fine urinary line, weak urine flow, difficulty in urinating, and even Urinary retention occurs, generally without urethral bloody secretions, no urethral mass, stenosis that is obviously blocked when the urethra is dilated, bladder urethrography shows urethral stricture, not urethral filling defect, urethroscopic examination helps Identification.
2. Benign prostatic hyperplasia: more common in older men, with progressive dysuria as the main manifestation, acute urinary retention can occur, rectal examination can touch the enlarged prostate, the middle groove disappears, can not touch the urethral mass, bladder urethra angiography shows pubic bone There is an enlarged prostate shadow on the upper side, no filling defect in the urethra, cystoscopy of the urethra can be seen in the neck of the bladder, and the middle or both sides of the prostate enlarge and protrude into the urethra.
3. urethral papilloma: a benign tumor of the urethra, mostly located in the urethra of the prostate, often with vesicular papilloma, frequent urination, dysuria, initial or terminal hematuria, bladder urethroscopic examination, Visible in the urethra, there is a pedunculated papillary tumor near the fine sputum, the terminal branch is fluffy, can drift with the perfusate, no ulcer on the surface.
4. Urethral condyloma: It is a viral disease transmitted by sexual contact, which occurs at the same time as other sexually transmitted diseases. It occurs mostly in the sac of the scaphoid or other part of the urethra. It has burning pain and urethral secretion during urination. There are penile wet sputum, penis head and foreskin wet sputum, scrotal wet tissue, anal wet sputum and other lesions, urethroscopic observation is papillary, sharp needle-shaped, reddish, soft new organisms, when identification is difficult, biopsy can be taken.
