Male urethral cancer

　　1. Etiology

　　It is not yet clear. Chronic urethritis, urethral stricture, and repeated urethral dilation may be predisposing factors. The histological types of primary urethral cancer vary according to the origin site, with squamous epithelial carcinoma being the most common, followed by transitional epithelial carcinoma, and adenocarcinoma is less common. The fossa navicularis of the male urethra is covered with squamous epithelium, the penile and glanular urethra is covered with pseudostratified or columnar epithelium, and the posterior urethra is covered with transitional epithelium. Urethral tumors in the penile urethra originate from the glans in 50% to 70% of cases, about 50% are secondary to distal urethral stricture, accompanied by mucosal squamous metaplasia, so squamous epithelial carcinoma is more common; adenocarcinoma originates from the urethral bulb gland or Littre gland. Tumors in the urethral bulb and glanular region often invade deep perineal structures, including the skin of the penis and scrotum, the urogenital diaphragm, and the prostate; tumors in the fossa navicularis can invade the glans, which is rich in blood vessels and lymphatic vessels. Tumors in the anterior urethra usually metastasize to the superficial and deep inguinal lymph nodes. Tumors in the posterior urethra metastasize to obturator and iliac internal and external lymph nodes, but when the tumor invades the skin of the penis or perineum, it can metastasize to the inguinal lymph nodes. Urethral cancer, especially anterior urethral cancer, rarely occurs distant metastasis. The most common site of distant metastasis is the lung, followed by the liver and stomach, and occasionally it can metastasize to the pleura and bone.

　　Second, Pathogenesis

　　Male urethral cancer can be divided into two types.

　　1. Secondary urethral cancer:Most cases are secondary transitional cell carcinoma, originating from bladder cancer or upper urinary tract cancer, and it is more common in the posterior urethra.

　　2. Primary urethral cancer:The commonly affected sites are the glans or the glanular part of the urethra, accounting for more than half of the cases; followed by the penile urethra, and it is rare to occur in the prostatic urethra. Squamous cell carcinoma is the most common, occurring most frequently in the penile urethra, especially in the fossa navicularis, followed by the glans and the glanular urethra; transitional cell carcinoma is the next most common, often seen in the prostatic urethra; adenocarcinoma is rare and can originate from the prostate.

　　The staging of male urethral cancer commonly uses the Levine staging.

　　Stage O: Limited to mucosa.

　　Stage A: Not beyond the固有mucosal layer.

　　Stage B: Invades the cavernosa or prostate but not穿透.

　　Stage C: Beyond the urethral cavernosal tissue or beyond the prostatic capsule.

　　Stage D: D1 stage: inguinal lymph node or pelvic lymph node metastasis.

　　Stage D2: Distant metastasis.

　　Urethral cancer can cause the following complications:

　　1, Obstructing the urethra:It can cause difficulty in urination, but urinary retention occurs very rarely.

　　2, Infection:It can penetrate through the urethral cavernosa, causing perineal urethritis, or lead to perineal urethral abscess; or spread to the scrotum, perineum, and form perineal urethral fistula.

　　3, Hematuria:Due to the destruction of the urethral mucosa, capillary rupture can cause hematuria, and it is easy to be accompanied by bacterial infection, resulting in symptoms such as frequent urination, urgency, dysuria, and urinary burning.

　　The age of onset of this disease ranges from 13 to 91 years old, with the vast majority over 50 years old. Patients usually seek medical attention due to symptoms such as urethral obstruction, tumor, perineal abscess, urinary extravasation, urethral fistula, and urethral discharge. Some patients have symptoms of pain, hematuria, or seminal blood, and the tumor of the舟状窝 can manifest as ulcers or papillary lesions. Rectal bimanual examination can help understand whether the tumor has spread to the prostate, anus, and urogenital diaphragm. Common symptoms of anterior urethral cancer are difficulty in urination, similar to urethral stricture, and some cases may appear symptoms of urinary urgency, erectile dysfunction, urethral bloody secretion overflow, or associated with hematuria. Urethral cancer can be found with urethral nodules or tumors, and large bulbous urethral cancer can be palpated in the perineum.

　　Clinical staging is made according to the clinical and pathological biopsy results, and rechecked according to the pathological findings of the surgical specimen.

　　Stage 0: Limited to mucosa (in situ carcinoma), Stage A: Lesion extends to the submucosa, Stage B: Lesion invades the urethral cavernosa, Stage C: Direct extension to the extracavernosal tissue of the urethral cavernosa or beyond the prostatic capsule, Stage D1: Regional metastasis including inguinal/pelvic lymph nodes (the primary tumor can be any stage), Stage D2: Distant metastasis (the primary tumor can be any stage).

　　A systematic manual examination of the penis is performed, touching the urethra and corpus cavernosum from the urethral orifice to the perineal bulb, checking the bilateral inguinal lymph nodes, urethral造影 can help determine the size and location of the tumor, and urethral cystoscopy can understand the extent of the tumor and perform biopsy.

　　The prognosis is related to the location and stage of the primary tumor. The prognosis of anterior urethral cancer is better than that of posterior urethral cancer. Kaplan et al. reported that the 5-year survival rate of the former is 22%, and that of the latter is 10%. Hopkins et al. reported that the overall average survival period of male urethral cancer patients is 26 months, with an average of 77 months for anterior urethral cancer and 15 months for bulbous urethral cancer.

　　Urethral secretion, urine sediment, urethral irrigation or brushing material for cytological examination or FCM analysis can detect urethral tumor cells.

　　1. Urethrogram:Can help determine the size and location of the tumor, but cannot estimate the range of the tumor.

　　2. Urethral bladderoscopy:Can observe the range of the tumor and take a biopsy for further diagnosis.

　　3. CT and MRI examination:Can understand whether there is pelvic and retroperitoneal lymph node metastasis, which is helpful for tumor staging.

　　One, dietary therapy for male urethral cancer

　　1. Yinchen tea: 10 grams of Yinchen, washed and chopped, infused with boiling water, and taken frequently as tea.

　　2. Diuretic tea: 45 grams of Mayiai (rhizome), 15 grams of Fengweicao, 15 grams of Baimaogen, 10 grams of honey. After the first three drugs are made into coarse powder and decocted to obtain the medicine juice, add honey and take it as tea. Twice a day, before meals.

　　3. Urinary infection tea: 15 grams of Niujiu, 15 grams of Cao, 15 grams of Lianqiancao, 30 grams of Fengweicao, decocted as tea; or the above drugs made into coarse powder, infused with boiling water, and taken as tea. One dose per day.

　　4. Ganzhu tea: 6-9 grams of licorice root, 3-5 grams of bamboo leaves, made into coarse powder, infused with boiling water, and taken frequently as tea.

　　5. Xianqiancao tea: 20 grams of Xianqiancao, made into coarse powder, decocted or infused with water, and taken as tea.

　　Two, what foods are good for male urethral cancer patients

　　1. Eat more foods that have an anti-bladder and urethral tumor effect, such as toads, frogs, snails, kelp, seaweed, tortoise shell, turtle, sea cucumber, water snake, Job's tears, water caltrop, walnuts, goat kidney, pork kidney, dolichos, sand worm, perch, mackerel.

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

　　3. For infection, eat yellowfish bladder, shark fin, water snake, pigeon, jellyfish, lotus root powder, buckwheat, malan head, earth ear,大头菜, olive, eggplant, fig, mung bean sprouts, soy milk, amaranth, seaweed, loach.

　　4. For bleeding, eat celery, chrysanthemum, leek, winter melon, black plum, dried persimmon, sesame, lotus seeds, sea cucumber, and rat meat.

　　Three, what foods should male urethral cancer patients avoid eating

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

　　2. Avoid spicy, hot, and blood-activating foods.

　　3. Avoid moldy, fried, and greasy foods.

　　1. Drink more water:Drinking plenty of water will increase urination. Highly concentrated urine can cause some irritation to the prostate, and long-term adverse stimulation is harmful to the prostate. Drinking plenty of water can not only dilute the blood but also effectively dilute the concentration of urine.

　　2. Avoid holding urine:Once the bladder is full and the urge to urinate arises, it should be done so. Holding urine is harmful to the bladder and prostate. Before taking a long-distance bus, it is advisable to empty the bladder before getting on the bus. If the need to urinate urgently arises during the journey, it should be signaled to the driver, and do not hold it in when getting off the bus to urinate.

　　3. Moderate Sexual Activity:To prevent benign prostatic hyperplasia, it is necessary to start paying attention from young adulthood. The key is to have moderate sexual activity, neither indulging nor abstaining. Frequent sexual activity can keep the prostate in a state of congestion for a long time, leading to prostate enlargement. Therefore, especially in the period of youth when sexual desire is strong, attention should be paid to节制性生活 to avoid recurrent congestion of the prostate, and to give the prostate sufficient time for recovery and repair. Of course, excessive abstinence can also cause a feeling of fullness and discomfort, which is also not good for the prostate.

　　4. Relax More:Life stress may increase the chance of benign prostatic hyperplasia. Clinical studies have shown that when life stress is reduced, the symptoms of the prostate will be alleviated, so it is advisable to maintain a relaxed state in daily life.

　　5. Take a Warm Bath:Taking a warm bath can relieve muscle and prostate tension, alleviate discomfort symptoms, and taking a warm bath regularly is undoubtedly very beneficial for patients with prostatitis. If you take a warm bath for the perineum 1-2 times a day, the same good results can be achieved.

　　6. Keep Clean:The scrotum of males has a large degree of elasticity and produces a lot of sweat. Added to the poor ventilation of the perineum, it is easy to accumulate dirt and impurities, which can lead to prostatitis, benign prostatic hyperplasia, decreased sexual function, and may cause serious infection if not paid attention to in time. Therefore,坚持清洗会阴部 is an important link in preventing prostatitis. In addition, it is very necessary to rinse the external genitalia every time sexual intercourse occurs.

　　7. Prevent Cold Exposure:Do not sit for a long time on cold stones, because coldness can enhance the excitation of the sympathetic nerves, leading to increased intravesical pressure and causing backflow.

　　8. Avoid Friction:Friction in the perineum will aggravate the symptoms of the prostate, causing obvious discomfort to the patient. To prevent harmful friction locally, it is advisable to ride a bicycle less often, and never ride a bicycle or motorcycle for a long time or over a long distance.

　　9. Adjust Life:It is best to avoid drinking alcohol, eating spicy foods such as chili and ginger, etc., to prevent recurrent congestion of the prostate and bladder neck, and to worsen the local feeling of swelling and pain. Since constipation may worsen the symptoms of prostate prolapse, it is advisable to eat more vegetables and fruits regularly to reduce the occurrence of constipation, and to use laxatives such as Maren pills to help defecate when necessary.