Overview, disease name, English name, alias, classification, ICD number, epidemiology, incidence rate, mortality rate, sex, age, nationality, skin color, time trend, regional differences, etiology, pathogenesis, clinical manifestations of mucinous adenocarcinoma of bladder, laboratory examination, auxiliary examination, CT examination, cystoscopy, cystography, diagnosis, differential diagnosis, nonspecific cystitis, and so on. Benign prostatic hyperplasia, prostate cancer, cervical cancer, other diseases, treatment and prognosis of bladder mucinous adenocarcinoma, prevention of bladder mucinous adenocarcinoma, related drugs and related examinations. It is concluded that mucinous adenocarcinoma of bladder includes primary mucinous adenocarcinoma of bladder, urachal adenocarcinoma and metastatic adenocarcinoma, among which primary mucinous adenocarcinoma accounts for 0.9% ~ 2% of bladder cancer. Bladder mucinous adenocarcinoma can occur at any age, and the incidence increases gradually after 40 years old, with a male-female ratio of 2.70 ~ 3.20: 1. The most common symptom is gross hematuria. Followed by urinary tract symptoms, manifested as frequent urination, urgency, dysuria, abdominal discomfort and so on. Generally, surgical treatment is the main treatment, and radiotherapy and chemotherapy are not sensitive. Disease name bladder mucinous adenocarcinoma English name bladder adenocarcinoma alias bladder mucinous carcinoma; ; Colloidal carcinoma of bladder; Bladder adenocarcinoma; Classification of signet-ring cell carcinoma of bladder Urology: Urogenital tumors > Bladder tumor oncology >; Epidemiological incidence of abdominal tumor > bladder tumor ICD C67 refers to the number of new cases diagnosed every year per 654.38+ million population. The incidence of bladder cancer varies greatly in different countries, regions and economic conditions. European and American countries, such as the United States, Canada, Britain, Denmark and other countries, have a high incidence of bladder tumors; In Asia, such as India, China, Singapore and Japan, the incidence rate is low. According to Miller's (1979) statistics, the global incidence of bladder cancer is 2.8/65438+ ten thousand for men and 0.2/65438+ ten thousand for women. Catalona (1992)1990 reported 47 10000 new cases of bladder cancer in the United States, including 34500 males and 2600 females, 2.7 times as many males as females. Silverberg (1990) reported that bladder cancer accounts for about 10% of all cancers in men, ranking the fourth most common cancer, and 4% in women, ranking the sixth most common cancer. According to Gu (1982) statistics, the incidence of bladder cancer in Beijing is 1.47/65438+ 10,000 for men and 0.46/65438+ 10,000 for women. Mortality The annual average crude mortality of bladder cancer is 0.63, the adjusted mortality in China is 0.52, the adjusted mortality in the world is 0.89, and the shortened adjusted mortality is 1.05. According to the latest data (199 1), the mortality rate of male bladder cancer in 1988 ranks 4th to 8th in the world. From 65438 to 0988, the mortality rate of male bladder cancer in China was 1.9/65438+ 10,000, ranking sixth. The female is 0.7/65438+ 10,000, ranking 10, but ranking first in the urinary system. Sexual bladder tumor is one of the malignant tumors with great gender difference. The ratio of male to female is 2.70 ~ 3.20: 1. The sex ratio in some provinces and cities in China is relatively high, such as Shanghai (1987) is 3.60: 1, and Zhejiang Province is as high as 650: 1. The mortality difference is more obvious, the crude mortality rate for males is 0.90, the adjusted mortality rate for China is 0.80, the global adjusted mortality rate is 1.4 1, and the shortened adjusted mortality rate is 1.49. The crude mortality rate of women is 0.34, the adjusted mortality rate in China is 0.27, the adjusted mortality rate in the world is 0.45, and the shortened adjusted mortality rate is 0.59. The gender difference in the incidence and mortality of bladder cancer may be related to the active endocrine in adolescence, which can inhibit the decomposition of β -glucuronidase and prevent carcinogens from being reduced to carcinogens. Age Bladder tumors can occur at any age, but the incidence rate is very low before the age of 20, and gradually increases after the age of 40, reaching a peak at the age of 60-70, and then gradually decreases. Rutac( 198 1) reported the incidence of bladder cancer in different age groups at the time of initial diagnosis. According to American (1989) statistics, the average standardized incidence of bladder cancer in 1987 is less than 1.0 before the age of 35, 9.9 ~19 in the 40-year-old group and 3/kloc-0 in the 50-year-old group. Deng Jie reported that the standardized incidence of bladder cancer in Shanghai was less than 8.00 before the age of 50, and suddenly increased to 13.76 at the age of 55, and gradually increased with age, reaching 1 14.82 at the age of 85. The incidence and rising rate of female is low, which is 7.93 in 60 years old and 18.06 in 75 ~ 80 years old. The mortality rate of bladder tumor is closely related to age, and the starting point of death age is later than other malignant tumors. The death growth rate of male age group in China starts from 15 years old and gradually rises, and the older the age, the higher it is. The increase rate of death in all age groups is basically the same, and the increase rate of death in all age groups from 30 to 64 is about 80%. The trend of death growth rate of female age group is the same as that of male, but the starting point is 20 years later than that of male, and the growth rate is also slower than that of male. The sex ratio of death growth rate in all age groups also increases with age. The average age of death was 65.70 years, 66.0 1 year for males and 64.85 years for females. /kloc-Most patients before the age of 0/5 are non-epithelial tumors such as sarcoma, most middle-aged and young patients are superficial tumors with high differentiation and low stage, and most elderly patients are poorly differentiated and invasive tumors. The incidence and mortality of bladder cancer are different among different nationalities and races. From 1950 to 1985, the annual average standardized incidence of bladder cancer in Caucasians was 17.5, including 30.4 in males and 8. 1 in females. Black 9.9, including male 15.4 and female 6.0. During the same period, the mortality rate of Caucasians was 3.4, including 6.2 for males and 1.7 for females. Black 3.3, including 4.9 males and 2.2 females. There are more superficial tumors with high grade and low stage in whites, and more invasive cancers with low grade and high stage in blacks. According to the statistics of bladder tumor mortality of some ethnic minorities in China, Kazak is the highest, which is 0.94, Hui is 0.89, Korean is 0.80 and Mongolian is 0.63. Miao, Uygur, Tibetan and Yi are lower. There are also great gender differences, especially among ethnic groups with high mortality. The sex ratio of Koreans is 5.03, and that of Kazakhs is 4.55. Time trend With the change of time, the epidemic trend of bladder cancer is also changing. Since 1950s, the incidence and mortality of bladder cancer have changed greatly. In the United States, from 1950 to 1985, the annual average incidence rate has been increasing at the rate of 0.8%, and the total growth rate is close to 5%. During the same period, the mortality rate decreased gradually, and the total decline rate was about 33%. Compared with 1963 ~ 1965, the annual standardized incidence of bladder cancer in Shanghai increased by 29%. During the same period, the mortality rate of bladder cancer also increased. According to the statistics of Wang Qijun (1988), the mortality rate of bladder cancer in Beijing suburbs fluctuated between 1977 ~ 1983, but it tended to be stable and decreased slightly. The increase in the incidence of bladder cancer is related to the development of industry, the change of environment and the extension of human survival time, but it is mainly due to the improvement of diagnostic methods, which improves the diagnostic rate; The decrease of mortality rate is mainly due to the improvement of early diagnosis rate and treatment effect. The epidemiological characteristics of bladder tumors vary greatly in different countries and regions, and there are also differences in different regions of the same country. According to statistics, the overall situation is that the morbidity and mortality in industrialized countries are higher, and the urban areas are higher than those in rural areas. The mortality rate of bladder cancer in urban and rural areas in China is also very different, which is 0.98 in big cities, 0.65 in medium cities, 0.79 in small cities and 0.49 in rural areas, about twice as high as that in big cities. The sex ratio in rural areas is higher than that in cities. The cause of bladder cancer induced by chemical carcinogens has been confirmed, but many patients with bladder cancer have no history of exposure to chemical carcinogens. At present, the general view is that viruses or some chemical carcinogens act on human proto-oncogenes to activate them into oncogenes. It is related to the following factors: ① The incidence of bladder tumor is increased in jobs that have been exposed to aromatic substances for a long time, such as dyes, leather, rubber and painters. There are scholars' statistics before 1954. Among workers exposed to aniline, the incidence of bladder cancer is 30 times higher than that of the general population. Benzidine, 4,4- diaminobiphenyl (4,4-diaminobiphenyl), 4-oxybiphenyl (4-aminobiphenyl) and β-naphthylamine (β-naphthylamine) are all considered as relatively certain foreign chemical carcinogens. These substances enter the body. After being metabolized by the liver, it is excreted into the bladder by the kidney, and then decomposed into α-aminonaphthalene acid by β-glucuronidase, which causes cancer and leads to occupational bladder cancer. These substances have a long carcinogenic incubation period, reaching about 20 years. ② Smoking is also a reason to increase the incidence of bladder tumor. Recent research shows that the metabolism of tryptophan, a carcinogen in the urine of smokers, increases by 50%. After quitting smoking, tryptophan levels will return to normal. Rose and Walleace( 1973) found that the urinary tryptophan levels of bladder cancer patients in smoking group and non-smoking group were higher, among which smokers showed higher levels. And people who don't smoke, the level is very low. They also found that vitamin C can reduce the activity of tryptophan in smokers and non-smokers. ③ Abnormal tryptophan metabolism in the body. Abnormal metabolism of chromotropic acid can produce some metabolites, such as 3- hydroxy -2- aminoacetophenone (3- hydroxy -2- aminoacetophenone) and 3- hydroxy-anthranilic acid (3- hydroxy-anthranilic acid), which can directly affect the DNA and RNA synthesis of cells. These metabolites are excreted into the bladder after liver metabolism and pass through β -glucuronidase. Usually, the concentration of these carcinogens in urine of patients with bladder tumor increases significantly. ④ Long-term local lesions of bladder mucosa, such as long-term chronic infection, long-term bladder stones and urinary tract obstruction, may be the factors inducing tumors. Cystitis glandularis and leukoplakia mucosa are considered as precancerous lesions. ⑤ drugs. In recent years, bladder cancer caused by drug abuse has also attracted people's attention. For example, taking a large number of phenacetin drugs has been proved to cause bladder cancer. ⑥ Parasitic diseases. Among patients with severe schistosomiasis, the incidence of bladder cancer is quite high. ⑦ Human tumor virus DNA may combine with some DNA fragments that regulate cell apoptosis, interfere with the transmission, transcription and replication of these gene information, regulate cell cycle in many links, and play its carcinogenic role. The incidence of bladder cancer is also related to ethnic and environmental factors. Pathogenesis adenocarcinoma accounts for less than 2% of primary bladder cancer, which is divided into three categories: primary bladder mucinous adenocarcinoma, urachal carcinoma and metastatic adenocarcinoma. Adenocarcinoma can also occur in the intestine rather than the urethral passage, dilating the bladder and so on. Primary mucinous adenocarcinoma of bladder mostly occurs at the bottom of bladder (triangle, neck, lateral wall) and the top of bladder. The incidence of adenocarcinoma is the highest in eversion of bladder. Histological types of intestinal adenocarcinoma, such as signet ring cell carcinoma and mucinous carcinoma, can occur in bladder. Adenocarcinoma may be * * shaped or solid. Most adenocarcinoma is poorly differentiated and deeply infiltrated, and urachal carcinoma is extremely rare. Adenocarcinoma originates from the outer wall of bladder and infiltrates into bladder, and urachal carcinoma can spread to the space around bladder. There may be bloody or mucinous secretions or mucinous cysts in the umbilical region. If the bladder cavity is involved, mucus may appear in the urine. Metastatic adenocarcinoma mainly comes from rectum, stomach, * *, prostate and ovary. The clinical manifestation of mucinous adenocarcinoma of bladder is 1. The most common clinical symptom is gross hematuria. Followed by urinary tract symptoms, manifested as frequent urination, urgency, dysuria, lower abdominal discomfort and so on. Some patients have mucinous urine, and the amount of mucus varies. Thick mucus can also block the urethra and cause urinary retention, which is one of the characteristics of mucinous adenocarcinoma of bladder. 2. Adenocarcinoma originated from the urachal duct at the top of the bladder, which is asymptomatic, but some patients can touch the lower abdominal mass. There may be symptoms of infiltration and metastasis in the late stage. Laboratory examination showed that the urine was turbid and rich in mucus. The positive rate of mucus-like substances and necrotic substances in urine is higher than that of tumor cells. Auxiliary examination CT examined the solid masses with wide tumor base and growing inside and outside the bladder wall. Cystoscopy showed that primary adenocarcinoma was mostly found in the bottom of the bladder, including the triangular area of the bladder, adjacent lateral walls and the top of the bladder, and could also occur in any part of the bladder. Mucinous adenocarcinoma of the bladder can be * * * like, polypoid or nodular, or flat ulcer. Tumor tissues are often soft and have mucus. Common bleeding and necrotic lesions. In some cases, diffuse fibrosis may lead to muscle hypertrophy, which is similar to leather. Cystography, especially head-down photography, can not only find the filling defect in the bladder, but also the imprint of the mass outside the bladder, which is more common in urachal adenocarcinoma. According to its clinical manifestations and examination, it is generally not difficult to diagnose bladder mucinous adenocarcinoma, but it is not easy to diagnose bladder mucinous adenocarcinoma early. We should pay attention to the characteristics of medical history and make a comprehensive judgment with relevant auxiliary examinations, so as to make an early diagnosis. Diagnostic criteria of primary mucinous adenocarcinoma of bladder: ① Tumors mostly occur in the lateral wall and bottom of bladder; ② Often accompanied by glandular or cystic cystitis; ③ There are transitional lesions between cancer and normal bladder epithelium; ④ No other primary cancer. Diagnostic criteria of urachal adenocarcinoma: ① the tumor is located at the top or anterior wall of bladder; ② No cystic cystitis or cystitis glandularis; ③ The tumor started from the inner segment of urachal bladder wall and infiltrated into the muscle layer or deeper, while the bladder mucosa was always intact or ulcerated; ④ The tumor is clearly demarcated from the periphery or surface, but there are branches extending to the bladder space; ⑤ Discovery of urachal residue; ⑥ palpation of suprapubic mass; ⑦ There is no other primary cancer in the whole body. Differential diagnosis of hematuria is the main symptom of bladder tumor, and hematuria is the main differential diagnosis of bladder tumor. Nonspecific cystitis is mostly married women, and hematuria suddenly appears, which may be accompanied by bladder symptoms, frequent urination, urgency and pain. Hematuria often occurs after or at the same time as bladder symptoms. Nonspecific cystitis occasionally shows painless hematuria. There may be bacteria in urine. Hematuria of renal tuberculosis appears after long-term frequent urination, and the terminal aggravation is also called terminal hematuria. Generally, the amount of urine is small, which may be accompanied by low fever, night sweats, emaciation, fatigue and increased ESR. There is mycobacterium tuberculosis in urine. Tuberculous granuloma of bladder is sometimes misdiagnosed as bladder tumor, which can be differentiated by biopsy. Urolithiasis is generally mild hematuria, which is aggravated after delivery, also known as "postpartum hematuria". Except for bladder stones, there are generally no bladder symptoms. Urolithiasis hematuria can be accompanied by pain, such as upper urinary calculi with nausea and vomiting. The clinical manifestations of cystitis glandularis are very similar to bladder tumors, which generally need to be differentiated by cystoscopy and biopsy. Urine cytology and tumor markers are also helpful for differentiation. Radiation cystitis pelvic organs such as uterus, ovary, rectum, prostate, seminal vesicle and other tumors can cause radiation cystitis after radiotherapy, usually occurring at the same time or within 2 years after radiotherapy, and may have hematuria and bladder symptoms. Painless hematuria occasionally occurs 65,438+00 ~ 30 years after treatment. Cystoscopy showed that mucosal radioactive capillaries were dilated, and sometimes ulcers and granulomas appeared. Benign prostatic hyperplasia Prostatic hyperplasia often causes urinary tract obstruction and mucosal congestion, such as bladder stones and infection. Its hematuria symptoms are similar to those of bladder cancer, and sometimes they can coexist. Urinary retention and stones are both causes of bladder cancer. Cytological examination and urinary tumor markers are helpful for differentiation, and cystoscopy can make a definite diagnosis. Hematuria caused by benign prostatic hyperplasia is mostly transient, and there are no red blood cells in the urine during the intermittent period, which can last for months or even years. Prostate cancer is a senile disease. Invasion of bladder can lead to hematuria and dysuria. General rectal digital examination can find nodular changes in prostate and elevated serum PSA. Magnetic resonance, ultrasound and CT can find prostate lesions. Cervical cancer easily invades the bladder, causing hematuria and painless hematuria, but there is bleeding before hematuria. Cystoscopy is very similar to invasive cancer and can be distinguished by biopsy and gynecological examination. Other diseases nephritis hematuria is often accompanied by protein and morphological changes of red blood cells. Hemorrhagic diseases, phenylbutazone and sulfonamides can also cause hematuria, which can be distinguished by combining medical history. The differential diagnosis of bladder cancer can be made by non-invasive urine cytology, BTA, NMP-22, BLCA-4 and telomerase. Treatment of mucinous adenocarcinoma of bladder. Total cystectomy plus pelvic lymph node dissection is the first choice for the treatment of mucinous adenocarcinoma of bladder, but TURBT is generally not feasible. 2. For small tumors confined to the top, lateral wall and anterior wall of the bladder, partial cystectomy can be considered, and the cutting edge should be more than 3cm away from the tumor. Partial cystectomy can also be selected for well-differentiated urachal carcinoma. 3. Bladder mucinous adenocarcinoma is not sensitive to radiotherapy and chemotherapy. Adjuvant therapy has a certain effect. Prognosis The prognosis of mucinous adenocarcinoma of bladder is poor, and the 5-year survival rate is about 33%. The reasons are as follows: ① Early diagnosis; ② The tumor has deep infiltration and early metastasis; ③ Tumor cells are highly malignant and easy to metastasize; ④ Adenocarcinoma was not diagnosed before operation, which led to incomplete surgical resection; ⑤ Neither chemotherapy nor radiotherapy is sensitive. Prevention of mucinous adenocarcinoma of bladder There are five aspects to prevent bladder cancer: ① Take preventive measures according to the cause. For example, it has been proved that among the external carcinogenic factors, dyes, rubber, leather and other work can cause bladder cancer, and smoking and taking certain drugs significantly increase the incidence of bladder cancer. Therefore, it is necessary to improve the production conditions of dyes, rubber, leather and other industries, advocate smoking ban, and avoid taking a large number of drugs that can cause bladder cancer for a long time. ② Pay great attention to the close follow-up of hematuria patients, especially male patients over 40 years old with unexplained gross hematuria. In principle, strict and formal diagnostic examination should be taken to screen bladder tumors, including cystoscopy. (3) to carry out large-scale census work, especially for high-risk groups. ④ Strengthening basic and clinical research, including improving the accuracy of non-invasive examination, early diagnosis of bladder tumor and developing drugs to prevent recurrence of bladder tumor. ⑤ Carry out tumor education, popularize relevant medical knowledge, improve people's understanding of urinary system tumors, make them take part in regular physical examination seriously, and establish the consciousness of early treatment, so as to facilitate the early diagnosis of bladder tumors. Related drugs: glucose, oxygen, vitamin C, benzoic acid, tryptophan, vitamin C.