1. Classification
Transitional epithelial cell carcinoma (about 90%)
Squamous cell carcinoma (2 ~ 3%)
Adenocarcinoma (2 ~ 3%)
Sarcoma is rare.
2. Classification: Highly differentiated, moderately differentiated and poorly differentiated.
3. Growth model
In situ tumor
Papillary carcinoma
infiltrating cancer
clinical stages
1. This is in situ.
2. There is no infiltration in the 2.Ta papilla.
3.T 1 is limited to the intrinsic layer.
4.T2 invades the muscle layer
5.T3 invades surrounding tissues.
6.T4 invades adjacent organs
The prognosis is closely related to the depth of infiltration.
1. Infiltration depth is the basis of clinical (T) and pathological (P) staging.
2. superficial tumor: Tis, Ta, T 1.
3. Invasive bladder tumor: T2, T3, T4.
Tumor spread
1. Deep penetration
2. Lymphatic metastasis: common
3. Hematogenous metastasis: mainly to liver, lung and bone in the late stage.
clinical picture
1. Intermittent painless gross hematuria.
2. Some patients have frequent urination, urgency and dysuria.
3. Dysuria: Bladder neck tumor or blood clot blockage can cause dysuria and even urinary retention.
4. Symptoms of tumor metastasis.
Principles of treatment
1. Surgery is the main treatment.
2. Combine chemotherapy, radiotherapy and biotherapy.
3. Superficial bladder cancer was treated by bladder-preserving operation and postoperative bladder perfusion.
4. Total cystectomy for invasive bladder cancer.
5. Take comprehensive treatment measures for advanced bladder cancer.
Superficial tumor (Tis, Ta, T 1)
1. Transurethral resection of bladder tumor and bladder perfusion.
2. Partial cystectomy and bladder perfusion.
3. Bladder perfusion therapy: used for patients with bladder tumor after carcinoma in situ, electrocision or partial cystectomy. The drugs available are BCG, mitomycin, thiosweet potato, adriamycin, hydroxycamptothecin, interleukin II, cytidine and so on.
Invasive bladder tumor (T2, T3, T4)
1. Partial cystectomy+bladder perfusion
2. Total cystectomy+urinary diversion
Second, renal pelvis cancer
1. The onset age is mostly 40 ~ 70 years old.
2. Male: The incidence of female ≈ 2: 1.
3. Most of them are transitional cell papillomas.
4. Squamous cell carcinoma and adenocarcinoma are rare.
5. Squamous cell carcinoma is mostly related to long-term urolithiasis and infection stimulation.
6. There are often early lymphatic metastasis.
clinical picture
1. Intermittent painless gross hematuria.
2. Low back pain: dull pain or dull pain, and blood clots blocking the ureter can cause renal colic.
3. Symptoms of tumor metastasis.
diagnose
1. Clinical manifestations
2. Imaging examination (B-ultrasound, IVU, CT, MRI)
3. exfoliative cytology
Principles of treatment
1. Surgery is the main treatment.
2. The scope of radical resection includes the affected kidney, perirenal fat, fascia, hilar lymph nodes, the whole ureter and part of the bladder wall around the ureter opening.
3. Radiotherapy and chemotherapy are ineffective.
Section 3 Prostate Cancer
1. More common in elderly men (> 60 years old).
The cause of this disease is not completely clear at present.
3. It is closely related to androgen.
High-fat diet is an important carcinogen.
5. Adenocarcinoma is the most common (98%).
6. Transitional cell carcinoma, squamous cell carcinoma and undifferentiated carcinoma are rare.
Gleason score
1. Prostate cancer cells are divided into 1 ~ 5 grades according to the degree of differentiation.
2. 1 grade differentiation is the best, and grade 5 (undifferentiated) is the worst.
3. Gleason score = major type+minor type series.
4. The best differentiation score is 2, and the worst differentiation score is 10. A score of > 4 has a poor prognosis.
Clinical stage
1.Ⅰ: Unexpected discovery of surgical specimens.
2. Ⅱ: Limited to the prostate capsule.
3. Ⅲ: The tumor penetrated the capsule and invaded the adjacent tissues.
4. Ⅳ: Local lymph nodes or distant metastasis.
Transfer pathway
1. Hematogenous metastasis: spine and pelvis are more common.
2. Lymphatic metastasis
3. Local infringement
clinical picture
1. Most patients with prostate cancer have no clinical symptoms, but they are found in physical examination or surgical specimens of benign prostatic hyperplasia (BPH).
2. Dysuria, urinary retention, urinary incontinence or hematuria may occur.
3. Late bone metastasis can cause pain or pathological fracture, and some patients have metastatic symptoms such as bone pain when they are first diagnosed.
Pathology/physical signs
Digital rectal examination: Touching prostate nodules, as hard as stone, can be single or multiple.
diagnose
1. Clinical symptoms.
2. Anal diagnosis found typical signs.
3. Determination of serum prostate specific antigen (PSA).
4. Transrectal ultrasound: hypoechoic lesions.
5.x-ray and radionuclide scanning can find bone metastasis.
6.CT and MRI are of little value in early diagnosis, and are helpful to understand the infiltration around advanced tumors.
7. Prostate biopsy is a method of pathological diagnosis.
The important value of PSA in the diagnosis and treatment of prostate cancer
1. Normal PSA
2.PSA & gt 10ng/ml, and puncture biopsy is recommended.
3.PSA 4 ~ 10 ng/ml, free PSA >；; 25% may be benign,
4. Digital rectal examination +PSA determination is recognized as an effective method for prostate cancer screening.
5.PSA monitoring is an important index for postoperative follow-up of prostate cancer.
treat cordially
1.Ⅰ stage: strict follow-up.
2. Stage Ⅱ: Radical prostatectomy.
3.ⅲ and ⅳ: Endocrine therapy
4. Radiotherapy has a good local control effect on prostate cancer.
5. Chemotherapy can be used for advanced tumors, but the overall effect is not ideal.
Endocrine therapy of prostate cancer
1. castration therapy: bilateral orchiectomy or LHRH-A, a luteinizing hormone analogue, such as noride and etanerceptone, can play the role of drug castration.
2. Anti-androgen therapy: flutamide (slow onset), Constance, etc.
3. Estrogen therapy: diethylstilbestrol.
The fourth quarter testicular tumor
? Rare, accounting for 1% of all malignant tumors.
? Most of them are in their twenties to forties.
? 95% is malignant.
? Cryptorchidism is an important carcinogen.
pathology
1. Histological manifestations are diverse.
2. Germ cell tumors account for 90 ~ 95%, which are further divided into:
I. seminoma
Two. Non-seminoma
3. Non-germ cell tumor accounts for 5 ~ 10%.
4. Secondary tumors mainly come from reticuloendothelial system tumors and leukemia.
transfer
6. Most tumors can have lymphatic metastasis in the early stage.
7. Lymphatic metastasis first reaches around the renal pedicle.
Clinical stage
Phase 1. Group I: The tumor was confined to testis and no metastasis was found.
2. The second stage: subphrenic lymph node metastasis.
3. Stage III: lymph node metastasis, lung metastasis or extrapulmonary organ metastasis above diaphragm.
clinical picture
1. testicular swelling, heavy or have a sense of decline;
2. A small amount of HCG-secreting testicular tumors may have breasts.
A) Abdominal pain and feminization of breasts.
3. Symptoms of tumor metastasis.
diagnose
1. Signs: Testis enlarged, hard and solid tumor can be touched, and the light transmission test is negative.
2. Tumor markers: When the tumor contains non-spermatogonial components, AFP and β-HCG often increase.
3.b-ultrasound: distinguish whether the tumor comes from inside or outside the testis and whether there is metastasis in the abdomen.
4. Chest X-ray: Understand whether there is metastasis in lung and mediastinum.
5.CT or MRI: Understand the metastasis of chest and abdomen.
treat cordially
1. Choose the treatment method according to the pathological nature and clinical stages.
2. Radical excision of diseased testis.
3. Retroperitoneal lymphadenectomy is suitable for stage ⅱ tumors other than choriocarcinoma.
4. Radiotherapy: sensitive to seminoma, and can be used as adjuvant therapy for stage I and II seminoma.
5. Chemotherapy: It has a good effect on seminoma and a certain effect on non-seminoma. It is mainly used for the treatment of stage III testicular tumor and the adjuvant treatment of stage II non-seminoma.