female urethral cancer
Introduction
Introduction to female urethral cancer Primary urethral tumors are rare in clinical practice. Female urethra is shorter, but the incidence of cancer is higher than that of male urethral cancer. It occurs in 40 to 60 years old. Malignant tumors include cancer, sarcoma, melanoma, etc. The most common form of squamous cell carcinoma is about 40%. Followed by transitional epithelial cell carcinoma, accounting for 30%, adenocarcinoma accounting for 23%, and undifferentiated cancer accounting for 1%. The incidence rate is 4 to 5 times higher than that of males, accounting for 0.017% of gynecological malignant tumors. In the early stage, there may be symptoms such as urethral bleeding, frequent urination, urgency, and dysuria. The tumor enlarges and causes dysuria. The treatment is difficult and the prognosis is poor. basic knowledge Sickness ratio: 0.0001% Susceptible people: women aged 40 to 60 Mode of infection: non-infectious Complications: urethral stricture
Cause
Female urinary tract cancer cause
The cause of urinary tract cancer is unknown, and the reasons are presumed to be as follows:
Inflammatory stimuli (30%):
Long-term chronic inflammatory stimuli such as chronic urethritis and chronic urethritis can occur in both men and women. Men often have prostatitis, women have short urethra, and germs are more likely to invade. The disease is a common disease, frequently-occurring disease, the incidence rate accounts for about 30% -45% of the population.
Urethral proliferative lesions (25%):
Related to malignant changes of urethral proliferative lesions, such as urethral meat fistula, papilloma, it has been reported that after a total cystectomy for a group of female bladder cancer, 6% to 13% of urinary tract cancer occurs, and the proximal urethra is frequently violated. The cause is as follows: A. Multi-center homologous origin of urothelial cells: The entire urinary system is covered with transitional epithelium, with homology. The incidence of multiple organs in urethral tumors is 46.2%. The order of incidence is in the direction of urinary flow. B. Urinary tumors Lymphatic metastasis, rectal cancer, vaginal cancer, etc. transferred to the urethra; C. Squeeze during surgery, transurethral operation or urination, with the increase of bladder cancer through transurethroscopic surgery, it should be considered that the exfoliated tumor tissue cells are planted The possibility of the urethra.
Birth injury (15%):
It is related to birth injury and sexual life damage factors.
Urinary tract chemical drug perfusion (12%):
Urinary tract chemical drug perfusion secondary or associated with urethral cancer.
Viral infection (10%):
Related to human papilloma virus (HPV), studies have shown that 59% of urethral tumors are HPV positive.
Pathogenesis
The urethral cancer is divided into the distal segmental cancer and the proximal segmental cancer. The former cancerous lesion is located in the anterior 1/3 of the urethra to the urethra. It can also gradually spread to the whole urethra or involve the vulva. The latter is located in the remaining 2/3 of the urethra, which is easier to invade. Total urethra.
Primary urethral cancer is most common in squamous cell carcinoma, followed by adenocarcinoma and transitional cell carcinoma. The metastasis includes blood, lymph and local infiltration. Lymphatic metastasis and local infiltration are the main causes, and distal urethral cancer can be metastasized. To the deep inguinal, shallow lymph nodes, and proximal urethral cancer can be transferred to the pelvic lymph nodes and sacral, extra-orbital and obturator lymph nodes.
Squamous cell carcinoma is derived from the squamous metaplasia caused by repeated stimuli of the distal squamous epithelium or transitional epithelium. The degree of differentiation varies. The well-differentiated ones can see cancerous beads and intercellular bridges, and those with poor differentiation are obvious. Heteromorphism, and see more mitotic figures.
Urinary tract cancer is mostly localized and persistent. Delela reports that 50% of patients have localized lesions at the time of treatment. They can grow to the bladder and vulva at the distal end of the urethra, and can also grow invasively into the vagina.
Grabstald staging is commonly used in female urethral cancer staging:
Stage O: carcinoma in situ, lesions are confined to the mucosa.
Stage A: The lesion reaches the submucosal layer.
Stage B: lesions infiltrate the urethral muscle layer.
Stage C: The lesion infiltrates the surrounding organs of the urethra.
Stage C1: Infiltration of the vaginal wall muscle layer.
Stage C2: Infiltration of the vaginal wall muscle layer and mucosa.
Stage C3: Infiltrate adjacent organs such as the bladder, labia and clitoris.
Stage D: There is a distant shift.
Stage D1: There is metastasis in the inguinal lymph nodes.
Stage D2: There is metastasis of pelvic lymph nodes.
Stage D3: There are metastases in the lymph nodes above the abdominal aortic bifurcation.
Stage D4: distant organ metastasis.
Prevention
Female urinary tract cancer prevention
1. Develop hand-washing habits: The investigation found that people's hands are covered with a large number of pathogenic microorganisms, such as chlamydia and mycoplasma. They can invade the urethra to cause infection by dissolving this link, so it is also important to develop good hygiene habits. Especially before and after meals.
2, pay attention to personal hygiene: to bathe, do not advocate bathing, clothing should be stored separately; often change underwear, especially new underwear or long-wearing underwear, before cleaning, drying, penetration, gas absorption, strong moisture absorption Cotton underwear, as little as possible to wear tight pants or jeans, more penetrating skirts, which is very important to protect women's health.
Complication
Female urethral cancer complications Complications urethral stricture
There may be urethral hemorrhage, obstruction, urethral stricture and other diseases. The most common sites of distant metastasis are the lung, liver, bone and brain. The urethral cancer can form a urethral fistula.
Symptom
Female urethra cancer symptoms Common symptoms Sexual intercourse difficulty Urinary frequency dysuria Abscess Hematuria Urinary sinus Urinary incontinence Urgency
Female urethral cancer is more common in older women, 3/4 occurs in people over 50 years old, common symptoms are urinary tract bleeding and hematuria, other symptoms are frequent urination, dysuria, urinary burning, dysuria, pain, itching, itching or sexy unpleasant, etc. Partially visible or touching the mass, tumor necrosis, ulcers and infections are seen in the urethra or vaginal discharge of yellow or bloody odorous secretions, late symptoms are weight loss, pelvic pain, periurethal abscess, urinary incontinence, urethra vagina or Urinary retention, a small number of patients were all asymptomatic, because he had a physical examination to find a tumor.
In the early stage of the urethra, a papillary mass or superficial small ulcer can be seen, which gradually develops into a flower-like mass, which protrudes from the urethra. The tumor has different hardness, ulcers and hemorrhage on the surface, and the proximal urethra has local tumors. Swelling, hardening and tenderness, vaginal palpation can estimate the extent of the lesion. Tumors located in the proximal urethra sometimes show diffuse infiltration of the urethra. The pathological examination of the living tissue can confirm the diagnosis.
It is generally believed that female urethral cancer is derived from the gut of the urethra. Immunohistochemistry shows PSA positive staining. The PSA in the patient's serum is elevated, and the tumor is rapidly decreased after surgical removal. Therefore, serum PSA monitoring before and after surgery is helpful for diagnosis and judgment.
Female urethral cancer staging: stage O: carcinoma in situ, stage A: infiltrating submucosa, stage B: infiltration of muscles around the urethra, stage C: around the urethra (C1 vaginal muscle layer, C2 vaginal muscle and mucous membrane, C3 adjacent structure such as bladder, Labia, clitoris), stage D: metastasis (D1 inguinal lymph nodes, pelvic lymph nodes under D2 aortic bifurcation, lymph nodes above D3 aortic bifurcation, D4 distant metastasis.
Early often asymptomatic, easy to be ignored, once symptoms appear, there are frequent urination, urgency and dysuria, and even urinary retention, often urinary tract bleeding or pancreatic blood stains, gross hematuria is rare, sometimes vaginal secretions increase, urinary incontinence and sexual intercourse Difficulties, cauliflower-like masses appear in the late urethra, and there is a foul smell when infected.
Any urethral fistula should be alert to the possibility of urinary tract cancer. If necessary, biopsy can confirm that the vaginal finger can touch the urethral mass.
Examine
Female urethral cancer examination
1, X-ray examination of proximal urethral cancer can directly invade the pubic bone, causing bone destruction.
2, CT and MR examinations can help to check the pelvic lymph nodes, determine the stage, and understand the pelvic lymph nodes with or without metastasis.
3, lymphangiography is helpful in the diagnosis of pelvic lymph node metastasis.
4, endoscopy, urethra cystoscopy can observe the lesion and take biopsy.
5, pathological examination
(1) When any urethral fistula is suspected of urinary cancer, a biopsy should be performed directly.
(2) The urethral swab is excised and cytologically examined after deep urethral wiping.
(3) urethral secretions, urine sediment, urethral irrigation or brushing cytology or FCM analysis can be found in urethral tumor cells.
Diagnosis
Diagnosis and diagnosis of female urethral cancer
Differential diagnosis
1, urethral meat mites: for the benign polypoid tissue that occurs in the female urethra, sometimes confused with urethral cancer protruding to the external urethra, urethral meat is more common in postmenopausal women, with burning sensation, bright red, It is a soft, easily bleeding polypoid mass with a wide base and abundant blood vessels. There are no ulcers and secretions on the surface. It has obvious tenderness and does not infiltrate outward.
2, urethra condyloma: for sexually transmitted diseases, proliferative lesions caused by human papillomavirus, mostly located on the mucosa, in addition to the external urethra, more often in the vulva, vagina, around the anus, etc., there is urinary burning pain And urethral secretions, urethral microscopic examination of papillary, reddish mass, when the identification is difficult, take a biopsy.
