bladder adenocarcinoma
Introduction
Introduction to bladder adenocarcinoma Bladder adenocarcinoma refers to a glandular structure in the whole tumor. Bladder adenocarcinoma is also called bladder gelatinous carcinoma, bladder mucinous adenocarcinoma or bladder signet ring cell carcinoma. Including primary bladder adenocarcinoma, urachal adenocarcinoma and metastatic adenocarcinoma, which are mainly primary bladder adenocarcinoma, accounting for 0.9% to 2% of bladder cancer. basic knowledge The proportion of illness: the incidence rate is 0.01% - 0.03% Susceptible people: no special people Mode of infection: non-infectious Complications: renal insufficiency hematuria acute hemorrhagic anemia
Cause
Causes of bladder adenocarcinoma
(1) Causes of the disease
Chemical carcinogen-induced bladder cancer has been confirmed, but many bladder cancer patients have no history of exposure to chemical carcinogens. The more common view is that viruses or certain chemical carcinogens act on human protooncogenes to activate cancer. Genes are related to the following factors:
1 Long-term exposure to aromatic substances, such as dyes, leather, rubber, painters, etc., the incidence of bladder tumors increased, according to scholars before 1954, in the exposure of aniline workers, the incidence of bladder cancer is higher than the general population 30 times higher, benzidine, 4,4-diaminobiphenyl, 4-aminobiphenyl, -naphthylamine, etc. They are considered to be more affirmative foreign chemical carcinogens. These substances enter the body, are metabolized by the liver, and are excreted by the kidneys into the bladder, and then decomposed into -aminonaphthoic acid by -glucuronidase. It has carcinogenic effects, leading to occupational bladder cancer. The incubation period of these substances is longer, reaching about 20 years.
2 Smoking is also a cause of increased bladder cancer incidence. Recent studies have shown that smokers' metabolism of carcinogenic tryptophan in the urine increases by 50%. When smoking stops, tryptophan levels return to normal, Rose and Walleace (1973) The study found that there were higher levels of tryptophan in the urine of the two groups of patients with and without smoking. Among them, smokers were high and non-smokers were low. They also found that vitamin C can reduce smoking. And the activity of tryptophan in non-smokers.
3 abnormal metabolism of tryptophan in the body, abnormal metabolism of oxyacid can produce some metabolites, such as 3-hydroxy-2-aminoacetophenone, 3-hydroxy-o-phenylene Formic acid (3-hydroxy-anthrenilic acid) can directly affect the DNA and RNA synthesis of cells. These metabolites are excreted into the bladder after being metabolized by the liver. After -glucuronidase, they are carcinogenic, often these are carcinogenic. The concentration of the substance in the urine of patients with bladder tumors increased significantly.
4 long-term local irritation of the bladder mucosa, such as long-term chronic infection, long-term stimulation of bladder stones and urinary tract obstruction, may be the factors that induce tumors, and glandular cystitis, mucosal leukoplakia is considered precancerous lesions.
5 drugs, in recent years, taking drugs to cause bladder cancer has also attracted attention, such as the large dose of phenacetine drugs, has been proven to cause bladder cancer.
6 Parasitic diseases, the incidence of bladder cancer is quite high in patients with severe Egyptian schistosomiasis.
Seven human papillomavirus DNA may bind to certain DNA fragments that regulate apoptosis, interfere with the transmission, transcription, and replication of these gene information, and regulate the cell cycle in various aspects to exert its carcinogenic effect.
8 The incidence of bladder cancer is also related to ethnic and environmental factors.
(two) pathogenesis
Adenocarcinoma accounts for less than 2% of primary bladder cancer, and is divided into three categories: primary bladder adenocarcinoma, urachal carcinoma and metastatic adenocarcinoma. Adenocarcinoma can also occur in the intestinal urethra passage, enlarge the bladder, etc., primary Bladder adenocarcinoma occurs in the bottom of the bladder (triangle, neck, side wall), the top of the bladder, adenocarcinoma has the highest incidence in bladder eversion, histological types of intestinal adenocarcinoma such as signet ring cell carcinoma, colloidal carcinoma It can occur in the bladder. Adenocarcinoma may be papillary or solid. Most adenocarcinomas are poorly differentiated and infiltrated. Umbilical urinary tract cancer is extremely rare. Most of the adenocarcinomas originate from the outer wall of the bladder and infiltrate into the bladder. Urinary tract cancer can spread around the bladder, bloody or mucus secretions or mucous cysts can appear in the umbilicus. If the bladder cavity is involved, mucus can appear in the urine. Metastatic adenocarcinoma is mainly from the rectum, stomach, breast, prostate and ovary.
Prevention
Bladder adenocarcinoma prevention
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 quantities, 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, early diagnosis of bladder tumor accuracy 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 adenocarcinoma complications Complications, renal insufficiency, hematuria, acute hemorrhagic anemia
Cancer involves the ureteral orifice, causing ureteral orifice occlusion, and there may be occlusion of hydronephrosis. In severe cases, the pressure in the sac can be significantly increased, resulting in lower glomerular filtration rate, dysfunction of creatinine and urea nitrogen, and even renal insufficiency. . If the infection is combined, hematuria may be aggravated, and frequent urination, urgency, and fever may occur. Patients with persistent hematuria can also have hemorrhagic anemia.
Symptom
Bladder gland cancer symptoms common symptoms urinary pain urinary frequency urinary urinary mucus urinary gland or cystic cystitis transitional lesion urachal residual ulcer
1. The most common symptoms of clinical manifestations are gross hematuria, followed by urinary tract irritation, which is characterized by frequent urination, urgency, dysuria, lower abdominal discomfort, etc. Some patients have mucous urine, mucus volume, and thick mucus. Blocking the urethra and causing urinary retention is one of the characteristics of bladder adenocarcinoma.
2. Adenocarcinoma originating from the urinary tract of the top of the bladder, the location is concealed, and more asymptomatic, but some patients may touch the mass in the lower abdomen, and infiltration and metastasis may occur in the late stage.
According to the clinical manifestations and diagnosis of bladder adenocarcinoma, there is no difficulty, but the diagnosis of early bladder adenocarcinoma is not easy. It is necessary to pay attention to the characteristics of the medical history and the related auxiliary examination to comprehensively judge and strive for early diagnosis.
Examine
Examination of bladder adenocarcinoma
Urine turbidity, mucus volume, mucus in the urine, necrotic shedding, tumor cells, the positive rate is higher.
1. CT examination of the solid base of the tumor, a solid mass growing inside and outside the bladder wall.
2. Cystoscopy Primary adenocarcinoma is more common in the bottom of the bladder, including the trigone of the bladder and adjacent sidewalls and the top of the bladder. It can also occur in any part of the bladder. The bladder adenocarcinoma can be papillary, polypoid or nodular. Can also be flat, ulcer type, tumor tissue is often soft and mucus, common bleeding, necrosis, some cases can be diffuse fibrosis and muscle thickening, similar to leather.
3. Cyst angiography, especially the low-level radiograph, can not only find the filling defect in the bladder, but also the lumps of the extra-bladder. This sign is more common in urachal adenocarcinoma.
Diagnosis
Diagnosis and diagnosis of bladder adenocarcinoma
Diagnostic criteria for primary bladder adenocarcinoma:
1 Tumors occur mostly in the side walls and bottom of the bladder.
2 often accompanied by glandular or cystic cystitis.
3 There is a transitional lesion between the cancer and the normal bladder epithelium.
4 no other primary cancer.
Diagnostic criteria for urachal adenocarcinoma:
1 The tumor is located at the top or anterior wall of the bladder.
2 no cystic or glandular cystitis.
3 The tumor begins in the inner segment of the bladder wall of the urachal catheter, infiltrates the muscle layer or deeper, and the bladder mucosa is often intact or ulcerated.
4 The tumor is clearly demarcated from the surrounding or surface, but branches extend into the bladder space.
5 have vaginal canal residual found.
6 and pubic mass.
7 no other primary cancer in the body.
Differential diagnosis
Hematuria is the main symptom of bladder tumors. The differential diagnosis of bladder tumors is mainly the differential diagnosis of hematuria.
1. Non-specific cystitis is mostly married women, hematuria occurs suddenly, may be associated with bladder irritation, frequent urination, urgency, dysuria, hematuria often occurs after or at the same time as bladder irritation, non-specific cystitis can be seen without pain Whole blood urine, bacteria in the urine.
2. Renal tuberculosis hematuria appears in the long-term urinary frequency, the terminal is aggravated, also known as terminal hematuria, generally less urine, may be associated with low fever, night sweats, weight loss, weakness, increased erythrocyte sedimentation rate, tuberculosis in the urine, bladder tuberculosis Sexual granuloma can sometimes be mistaken for a bladder tumor and can be identified by biopsy.
3. Urinary tract general hematuria is relatively light, increased after labor, also known as "hematuria after labor", in addition to bladder stones, generally no bladder irritation symptoms, urolithiasis may appear accompanied by pain, such as urinary calculi have nausea, Vomiting.
4. The clinical manifestations of cystitis glandularis are very similar to those of bladder tumors. They are generally identified by cystoscopy and biopsy. Urine cytology and tumor markers are also helpful for identification.
5. Radiation cystitis pelvic organs such as uterus, ovary, rectum, prostate, seminal vesicles and other tumors can cause radiation cystitis after radiotherapy, usually at the same time or within 2 years of radiation therapy, may have hematuria, bladder irritation, even visible Painless hematuria occurred 10 to 30 years after treatment, and cystoscopy revealed mucosal radioactive telangiectasia, sometimes ulceration and granuloma.
6. Benign prostatic hyperplasia of prostatic hyperplasia often causes urinary obstruction, mucosal congestion, such as bladder stones and infection, its hematuria symptoms resemble bladder cancer, and sometimes both can exist, urinary retention and stones are the cause of bladder cancer, cytology Examination, urinary tumors are helpful for identification, and cystoscopy can confirm the diagnosis.
Most of the benign prostatic hyperplasia caused by hematuria is transient. There is no red blood cells in the urine during the interval, and the interval can be several months or even several years.
7. Prostate cancer is a geriatric disease. Invasion of the bladder can cause hematuria and dysuria. Generally, a digital nodule can be found in the rectal examination. The serum PSA (prostatic specific antigen) increases, MRI, ultrasound, CT can A lesion in the prostate was found.
8. Cervical cancer is easy to invade the bladder, causing hematuria, painless whole hematuria, but there is vaginal bleeding before hematuria. Cystoscopy is very similar to invasive cancer. It can be identified by biopsy and gynecological vaginal examination.
9. Other diseases Nephritis, hematuria is often accompanied by protein, and there are red blood cell morphology changes, hemorrhagic disease, phenylbutazone, sulfa drugs can also cause hematuria, combined with medical history can be identified.
The differential diagnosis of bladder cancer can be first identified by non-invasive urine cytology, BTA, NMP-22, BLCA-4, telomerase and other tests.
