Bladder squamous cell carcinoma
Introduction
Introduction to bladder squamous cell carcinoma Bladder squamous cell carcinoma, also known as epidermoid carcinoma, keratinized carcinoma, and squamous cell carcinoma, is relatively rare, accounting for 1.6% to 7% of bladder tumors. It is more common in Egypt and Africa where schistosomiasis is endemic, they are specifically called "schistosomiasis bladder cancer", and non-schistosomal bladder squamous cell carcinoma is usually caused by chronic irritation caused by bladder stones, long-term indwelling catheter or bladder diverticulum. basic knowledge Sickness ratio: 0.01%-0.02% Susceptible people: no specific people Mode of infection: non-infectious Complications: urinary retention
Cause
Causes of squamous cell carcinoma of the bladder
(1) Causes of the disease
Chronic urinary tract infections (38%):
Chronic urinary tract infection is the main cause of bladder squamous cell carcinoma. In the urine of 90% to 93% of patients with bladder squamous cell carcinoma, pus cells and white blood cells can exist for a long time. Chronic inflammatory stimuli can make the transitional epithelium squamous. Health, intercellular changes, cancer, it is also believed that some bacteria after the infection will convert nitrate into carcinogenic nitrite and nitrosamines, which will cause cancer.
Bladder stones (36%):
Intravesical stones, catheters and other foreign body stimulation are also important causes of squamous cell carcinoma, bladder stones with squamous cell carcinoma rate of 0.074% to 9.9% (Sarma, 1970; Bessette, 1974), but squamous cell carcinoma combined The stone rate is as high as 2.77%~47% (Zhu Liangchun, 1980; Zhang Sixiao, 1987). Long-term stimulation of stones can cause tissue cell proliferation and canceration. Chronic stimulation of long-term indwelling catheter can also cause cancer, Kaufman (1977) report In 62 patients with spinal cord injury, 80% of patients with indwelling catheters had bladder squamous metaplasia for more than 10 years, 42% of patients with 6 months to 10 years had bladder squamous metaplasia, and bladder squamous without catheter placement. The birth rate was only 20%, and 5 of 25 patients with indwelling catheters for more than 10 years developed squamous cell carcinoma, and at the same time, diffuse inflammation, squamous metaplasia and bladder carcinoma in situ, indicating chronic inflammation of the bladder, stones Foreign bodies, such as foreign bodies, often exist at the same time, can cause squamous metaplasia of the bladder transitional epithelium, intercellular changes, atypical hyperplasia, leading to cancer, Egypt, Africa, Middle East, bladder wall of bladder cancer 70% can see schistosomiasis eggs, so think Schistosoma japonicum infection is one of the causes of bladder squamous cell carcinoma, but its carcinogenic mechanism is still unclear. Bladder leukoplakia and other diseases can further develop into cancer under certain factors.
(two) pathogenesis
Bladder squamous cell carcinoma is usually flat or mildly bulging at first, invasive growth, solid mass, ulcerated or papillary, more single, or multiple, pathological examination is more common with pure squamous cell carcinoma, accompanied by migration Mixed cancers such as cell carcinoma and adenocarcinoma account for about 1/3, histological features are keratinocytes, large cancerous squamous cells are flaky, irregularly arranged, concentrically arranged keratinocytes - horn Beads can be divided into grade IV according to the degree of squamous cell differentiation. Grade I: cells are highly differentiated, very similar to normal or metaplastic squamous epithelial cells, with horny bead formation, mild nucleoli abnormalities; Grade II: Cancer is solid growth with extensive keratinization and keratinized bead formation; Grade III: keratinization is limited to individual cells and occasional keratinized beads; Grade IV: large clear cells, rare, poorly differentiated squamous cells, Small cell type squamous cell carcinoma, poor cell differentiation, lung-like brome cell carcinoma, accompanied by typical squamous cell carcinoma beads, squamous cell carcinoma caused by schistosomiasis, two giant cells with nucleus are often seen.
Prevention
Bladder squamous cell carcinoma prevention
The prevention of bladder cancer has the following aspects:
1 Take precautionary measures against the cause. For example, among the foreign carcinogenic factors, dyes, rubber, leather and other types of work can cause bladder cancer, smoking and taking certain drugs, the incidence of bladder cancer is significantly increased, which requires improvement of dyes. , rubber, leather and other industrial production conditions, advocate smoking ban, avoid large, long-term use of drugs that can cause bladder cancer.
2 Pay close attention to the close follow-up of patients with hematuria, especially for unexplained gross hematuria in men over 40 years old. In principle, strict and regular diagnostic tests should be taken to screen bladder tumors, including cystoscopy.
3 Carry out mass census work, especially for high-risk populations.
4 Strengthen basic and clinical research work, including improving non-invasive examination, accuracy of early diagnosis of bladder tumors and developing drugs to prevent bladder tumor recurrence.
5 Carry out the missionary work of cancer, popularize relevant medical knowledge, raise the public's understanding of urinary tumors, and make them seriously participate in regular physical examinations, establish awareness of early treatment, and facilitate the early diagnosis of bladder tumors.
Complication
Bladder squamous cell carcinoma complications Complications, urinary retention
1 obstruction of the urethra, urinary obstruction caused by cancer lumps caused by urinary dysfunction, 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, the pathogen can cause infection of the ureter, kidney through the upper movement; or spread to the scrotum, perineum, form the perineal urethra. Others can be complicated by urinary tract tumor skin metastasis.
Symptom
Bladder squamous cell cancer symptoms common symptoms poor urination dysuria squamous cell carcinoma bladder irritation
Hematuria and bladder irritation, about 80% of hematuria, mainly gross hematuria, 70% of patients with bladder irritation, mainly dysuria, characterized by severe symptoms, drug can not be relieved, poor urination and urine flow The incidence of obstruction is also more common than transitional cell carcinoma.
Examine
Examination of bladder squamous cell carcinoma
1. Urine routine examination of occult blood positive.
2. The positive rate of urine cytology of bladder squamous cell carcinoma is higher than that of transitional cell carcinoma.
3. Cystoscopy can identify the location, number and size of cancer, often as a mass, ulcer, cauliflower or broad-based papillary, surface is not smooth, may have bleeding, necrosis, congestion around, edema and other inflammation Performance, accompanied by stones can be seen in the calculus of the bladder wall flaky bulge or ulcer.
4. IVU can show the filling defect in the bladder and understand the upper urinary tract, which is helpful for clinical staging.
5. B-scan showed that the bladder was solid, the echo was uneven and the boundary was unclear.
Diagnosis
Diagnosis and differentiation of bladder squamous cell carcinoma
diagnosis
Mainly based on clinical manifestations, imaging and histological examination can confirm the diagnosis.
Differential diagnosis
The main symptom of bladder cancer is hematuria. The differential diagnosis of bladder cancer is mainly the identification of hematuria. The diseases and causes of hematuria are very numerous. In addition to the urinary system and its adjacent organs, there are various diseases of the system. The identification points of common major diseases are briefly described as follows:
1. Kidney, ureteral tumor: The embryonic source of the kidney, ureter and bladder is the same, the histological morphology and function of the epithelium are basically similar, the pathogenesis of epithelial tumors, biological behavior is also the same, the main cause of renal and ureteral epithelial tumors It is characterized by hematuria. Hematuria is characterized by painless intermittent whole hematuria, similar to bladder tumors, and these tumors can exist simultaneously or separately. It is necessary to pay attention to the difference. The hematuria of bladder cancer may be accompanied by bladder irritation or poor urination. Hematuria is flaky or irregular, with many reddish colors, which can be accompanied by cancer and necrosis and excretion of "carrion" blocks. The hematuria of the kidney and ureter is not accompanied by bladder irritation, the color is dark red, and the blood clot is ureteral cast. Strip or scorpion, no "carrion" block, renal parenchymal cancer often accompanied by lumbar pain and mass, generally after B-ultrasound, CT, urography, bladder urethroscopy can be distinguished, but need to pay attention At the same time, there are many parts of urothelial tumors, so don't take care of them and miss them.
2. Urinary tuberculosis: most of the urinary tuberculosis occurs first in the kidney, with chronic bladder irritation and gradually worsening as the main symptom. Hematuria often occurs after bladder irritation, characterized by terminal hematuria, low in amount, often accompanied by low fever. Systemic symptoms such as night sweats, fatigue, weight loss, urine turbidity and the detection of acid-fast bacilli, granuloma or ulcers formed by bladder tuberculosis are sometimes mistaken for cancer, and need to be distinguished by biopsy.
3. urolithiasis: the main symptoms of kidney, ureteral calculi are pain, mild hematuria, manifested as pain after microscopic hematuria or slight gross hematuria, and the onset of pain often occurs after activity or labor, except with infection and bladder and In addition to urinary bladder wall stones, there is generally no bladder irritation. X-ray and B-ultrasound are easy to distinguish from bladder tumors, but the local mucosal damage and long-term chronic stimulation can make the transitional epithelium with strong proliferation and regeneration ability. Proliferative changes, papillary hyperplasia, squamous metaplasia, and finally lead to squamous cell carcinoma, the amount of hematuria increased significantly after the onset of cancer, therefore, for long-term urolithiasis, especially those with obvious hematuria should think of the possibility of cancer , diagnosed by urinary cytology, X-ray and biopsy.
4. Non-specific cystitis: mostly married women, acute onset, short course, the main symptoms are frequent urination, urgency, dysuria, turbid urine, hematuria occurs after severe bladder irritation.
5. Glandular cystitis: The relationship between cystitis glandularis and bladder cancer is still difficult to determine, and a few have been reported as bladder adenocarcinoma. The clinical manifestations of the two are similar. It is often difficult to distinguish between cystoscopy and puncture. It is often necessary to confirm the biopsy. .
6. Radiation cystitis: occurs after radiotherapy of pelvic cancer, usually occurs within 2 years of radiation therapy, or after 10 to 30 years, the main symptoms are painless hematuria, sometimes ulcers and granuloma in the bladder Radiation therapy is also one of the causes of bladder cancer, so ulcers and granulomas in the bladder need to be confirmed by biopsy.
7. Prostate cancer: The main symptoms are dysuria. Hematuria occurs when the cancer invades the bladder. The rectal examination, B-ultrasound, CT, biopsy can determine the prostate cancer and whether it involves the adjacent tissues such as the bladder.
8. Benign prostatic hyperplasia: The earliest symptom of benign prostatic hyperplasia is frequent urination. The main symptoms are progressive dysuria, capillary congestion of the prostate mucosa and small blood vessel dilation and increased traction by the gland. Hematuria can occur when the bladder contracts. Secondary infection, hematuria increased when stones, occasionally a large amount of hematuria, mostly transient, but urine retention is the cause of bladder cancer, the author has benign prostatic hyperplasia and cancer at the same time or short-term discovery of bladder cancer after prostate surgery Cases, therefore, patients with benign prostatic hyperplasia with obvious hematuria should be performed urine cytology, B-ultrasound, cystoscopy to determine the presence of cancer.
