Par尿道旁腺癌

　　First, Etiology

　　The etiology of par尿道旁腺癌 is not yet fully clear. Some scholars believe that micturition, sexual intercourse, pregnancy, or recurrent urinary tract infections may be some triggers for urinary tract cancer. Benign proliferative diseases, such as fibroids, papillomas, adenomas, and polyps, may undergo malignant transformation. Leukoplakia of the urethral mucosa is considered to be a precancerous lesion.

　　Second, Pathogenesis

　　Par尿道旁腺癌 is mainly composed of adenocarcinoma structures, with clear cell and papillary types. Squamous cell carcinoma may appear at the urethral orifice, and transitional cell carcinoma may appear in the urethra. The female urethra is 3 to 4 cm long and 8 to 10 mm in diameter. From the bladder neck to the external urethral orifice, the urethra can be divided into three segments, namely the proximal 1/3, middle 1/3, and distal 1/3. The proximal 1/3 urethra is covered with transitional epithelium, and the distal 2/3 urethra is covered with stratified squamous epithelium. The lymphatic drainage of the distal 1/3 is to the superficial and deep inguinal lymph nodes, and the lymphatic drainage of the proximal 2/3 is to the pelvic lymph nodes. Approximately 52% of primary lesions occur in the distal urethra, 39% in the middle segment urethra, and 9% originate in the proximal urethra.

　　Female urethral malignant tumors originate most commonly from squamous epithelial cells and transitional epithelial cells, with epidermoid carcinomas originating from the surrounding urethral glands being rare, and other types of urethral cancer are very rare. It is reported that squamous cell carcinoma accounts for 41% to 70%, transitional cell carcinoma accounts for 8% to 30%, malignant melanoma accounts for 2% to 4%, and other types account for 2% to 4%. Urethral cancer can be grossly divided into fungiform, annular, and narrowed or ulcerative types.

　　Urethral cancer usually presents as localized growth. Delcos reported that about 50% of female patients with urethral cancer presenting for treatment have localized lesions. When the condition progresses, the lesions can involve the entire urethra, and can invade the bladder upwards, the vulva downwards, and the vagina backwards. The main route of metastasis for female urethral cancer is lymphatic metastasis, with lymphatic drainage pathways including the proximal urethra draining to obturator lymph nodes, iliac external lymph nodes, and iliac internal lymph nodes; and the distal urethra draining to superficial inguinal lymph nodes and deep inguinal lymph nodes. It is difficult to diagnose the presence of regional lymph node metastasis by routine clinical examination. Grabstald reported that 22.8% of patients experience lymph node metastasis during the course of the disease. Delclos reported that the rate of clinical diagnosis of inguinal lymph node metastasis in female urethral cancer is generally less than 15%, and the rate of pelvic lymph node metastasis is unknown due to the difficulty in diagnosis. Ray and Guinan proposed that there is no close relationship between the size of the primary tumor and lymph node metastasis. Distant metastasis in female urethral cancer is rare, and 14% of patients die from distant metastasis. The main sites of distant metastasis are the lungs, liver, bones, and brain.

　　Currently, the most commonly used staging method is the Grabstald staging:

　　1, Stage 0: In situ cancer (cancer confined to the mucosal layer).

　　2, Cancer in stage A invades only the submucosal layer.

　　3, Cancer in stage B invades the muscle layer of the urethra.

　　4, Cancer in stage C invades the surrounding organs of the urethra.

　　C1: Invasion of the muscle layer of the vaginal wall.

　　C2: Invasion of the muscle layer of the vaginal wall and its mucosa.

　　C3: Invasion of adjacent organs (such as the labia, clitoris, and bladder).

　　5, Distant metastasis in stage D.

　　D1: Metastasis to inguinal lymph nodes.

　　D2: Metastasis to pelvic lymph nodes.

　　D3: Metastasis to para-aortic lymph nodes.

　　D4: Metastasis to organs such as the lungs, liver, and kidneys.

　　The following complications may occur:

　　1, Obstruction of the urethra can cause difficulty in urination, but urinary retention occurs very rarely.

　　2, Infection can penetrate through the urethral corpus cavernosum to form perineal urethritis or lead to perineal abscess; or it can spread to the scrotum and perineum, forming a perineal urethral fistula. Complications such as urethral bleeding, obstruction, and stricture may occur, and the most common distant metastatic sites are the lungs, liver, bones, and brain.

　　Early symptoms of urethral adenocarcinoma include difficulty urinating, urethral bleeding, frequent urination, dysuria, nodular or red hemorrhagic tumors appearing at the distal urethra or urethral orifice, local swelling of the urethra can be palpated for tumors. When the tumor mass increases, it can block the urethra or extend to the vulvar vestibule, vaginal orifice, resulting in obvious ulcers, hemorrhagic tumors, accompanied by pain, and may be associated with inguinal, pelvic lymph node metastasis. Lymph node metastasis in early urethral cancer is rare. At the time of diagnosis, 20%-50% have lymph node metastasis. About half of advanced or proximal urethral cancer cases have lymph node metastasis. It is generally believed that palpable enlarged lymph nodes are mostly metastatic rather than infected. Adenocarcinoma tends to metastasize to distant sites, with the most common distant metastases being lung, liver, bone, and brain. Proximal urethral cancer invades the bladder, and the posterior involvement of the vagina can cause clinical symptoms such as urethrovaginal fistula or vesicovaginal fistula. Lymph node metastasis is not correlated with hematogenous metastasis.

　　Urethral adenocarcinoma is very rare. The proportion of adenocarcinoma in female urethral cancer in China is significantly higher than that in other countries. Tumors can occur in any age group, from the minimum age of 4 to the maximum age of 80, but are more common in postmenopausal and elderly women, most commonly in patients aged 50-70, with 75% of patients aged over 50, with an average age of 60. Whites are more prone to this disease than blacks.

　　Prognosis:

　　1, Tumor location The prognosis of lower urethral cancer is better than that of upper urethral cancer. The local control rate of early urethral cancer located in the lower segment can reach 70%-90%, and the 5-year survival rate of lower urethral cancer is more than 50%. The 5-year survival rate of upper urethral cancer or those with the entire urethra involved is only below 20%.

　　2, Tumor size The size of the primary tumor in urethral cancer is related to survival time. When the diameter of the primary tumor is less than 2 cm, the 5-year survival rate reaches 60%. When the tumor size is 2-4 cm, the 5-year survival rate is 46%. When the tumor size is above 5 cm, the 5-year survival rate is only 1.3%.

　　3, The prognosis of patients with adenocarcinoma, squamous cell carcinoma, and transitional cell carcinoma is similar in terms of histological type and differentiation degree. Undifferentiated type (histological grade III) accounts for about 2/3, with a 2-year survival rate of about 33%. The 2-year survival rate of well-differentiated patients is 80%.

　　The diagnosis of urethral adenocarcinoma, in addition to clinical manifestations, also requires necessary related examinations, such as urinalysis, secretion examination, tumor marker examination, polymerase chain reaction detection, and histopathological examination.

　　First, a dietetic recipe for urethral adenocarcinoma

　　1, Astragalus and mugwort root drink

　　Astragalus 30 grams, white mugwort root 30 grams, Cistanche deserticola 20 grams, watermelon rind 60 grams. Wash the four herbs and place them in a pot, add an appropriate amount of water, and boil into a concentrated juice. Add an appropriate amount of sugar to taste. Take one dose a day, divided into two servings, which can benefit the spleen and kidneys, promote diuresis and relieve stranguria.

　　2, Goji and Poria tea

　　Goji berries 50 grams, Poria cocos 100 grams, black tea in appropriate quantity. Grind goji berries and Poria cocos into coarse powder for later use. Take 10 grams of the coarse powder once a day, add appropriate amount of black tea, and infuse with boiling water as a herbal tea. It has the effects of invigorating the spleen and kidneys, and promoting diuresis and relieving stranguria.

　　3. Other

　　Millet 100 grams, boiled into porridge, served as breakfast and dinner, and taken for 1-2 months. It can benefit the spleen and kidney, and promote diuresis.

　　4. Lotus Honey Drink

　　Fresh lotus juice 100 milliliters, white honey 30 milliliters, and fresh rhizome juice 60 milliliters. Mix the above three juices, simmer over low heat for 10-15 minutes. Take 10 milliliters four times a day, slowly swallow, and take for 3 days. It can nourish Yin, clear heat, and cool blood to stop bleeding.

　　5. Celery Stewed with Dried Mussels

　　Dried mussel 15 grams, fresh celery 60 grams. Boil the dried mussel with a small amount of water first, then add celery to cook together, and add seasonings when eating. It nourishes the Yin and calms the liver, clears heat and promotes diuresis.

　　Second, What is good to eat for urethral adenocarcinoma patients

　　1. Eat more foods with anti-bladder and urethral tumor effects, such as toads, frogs, snails, kelp, seaweed, tortoise shell, turtle, sea cucumber, water snake, Job's tears, water chestnut, walnut, goat kidney, pork kidney, broad bean, sand worm, perch, mackerel.

　　2. For urethral obstruction, eat kelp, wakame, seaweed, green crab.

　　3. For infection, eat yellowfish bladder, shark fin, water snake, pigeon, jellyfish, lotus starch, buckwheat, Malan head, earth ear, turnip, olive, eggplant, fig, mung bean sprouts, soy milk, amaranth, seaweed.

　　4. For bleeding, eat celery, chrysanthemum, leek, winter melon, black plum, persimmon cake, sesame, lotus seeds, sea cucumber.

　　Third, What not to eat for urethral adenocarcinoma

　　1. Avoid smoking, alcohol, coffee, and cocoa.

　　2. Avoid spicy and hot foods that stir up blood.

　　3. Avoid moldy, fried, and greasy foods.

　　First, Prevention

　　Actively prevent and treat urinary system infections. Regular physical examinations, early detection, and early treatment.

　　Second, Preoperative Preparation 

　　1. The first three stages of distal urethral cancer can be completely exposed for direct surgery, such as preparing cystoscopy for mid-later urethral cancer. Start the laser machine, adjust the output power, and check for fiber breakage. Remove the outer protective layer of the fiber head and expose 2mm of bare fiber. Prepare敷料 according to different surgical routes for the later two stages.

　　2. Anesthesia: Local injection anesthesia for the distal O, A, B stages of urethral cancer (a few drops of 2% lidocaine mixed with 1:1000 epinephrine, injected around the urethra. For posterior urethral cancer, lumbar and saddle anesthesia are used.)