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題名 | Primary Female Urethral Carcinoma=女性原發性尿道癌 |
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作者 | 陳日昇; 楊緒棣; 賴明坤; 蔡崇璋; | 書刊名 | 中華民國泌尿科醫學會雜誌 |
卷期 | 8:4 1997.12[民86.12] |
頁次 | 頁197-201 |
分類號 | 416.274 |
關鍵詞 | 女性尿道; 尿道癌; Female urethra; Carcinoma; |
語文 | 英文(English) |
中文摘要 | 在1981到1996年之間,我們發現了十例女性原發性尿道癌:其年齡為50~73歲, 平均六十六歲;主要症狀為尿道出血<80%>和解尿困難<50%>;理學檢查發現有九例腫 瘤位於前尿道。在病理組織學上,類上皮細胞癌/鱗狀細胞癌有三例;移形上皮細胞癌三例; 腺癌三例;未分化癌一例。有八位病人接受完整的檢查和治療,其中五例為初期癌<stage A >,另三例為晚期癌<stage D1>。治療以手術為主,其中五例並接受輔助性的放射線治療。 結果在初期癌中,有一例在術後第四年死於癌轉移,其他四例責無癌跡象;在晚期癌中,一 例在術後第一年死於癌轉移,一例<唯一的後尿道癌>在術後十個月內癌復發,另一例則無 癌跡象。病人術後追蹤時間為12~189個月,平均八十八個月,由治療結果顯示,病人的存 活率與癌的分期有關;與細胞形態較無關。同時癌的解剖位置亦間接影響預後,因為前尿道 癌容易被早期診斷。從相關文獻可知,無論採用何種治療方式,愈早期則存活率愈高,愈晚 期則存活率低。因此,我們認為對於中老年女性併有尿道出血現象或膀胱出口阻塞症狀者, 應該考慮尿道癌的可能性,並儘早施行骨盆腔檢查;對於所有的尿道腫瘤加以切片,確立診 斷。如此才能早期治療,提高病人的存活率。 |
英文摘要 | Between July 1981 and May 1996, we had encountered ten cases of primary female urethral carcinoma on an average age of 66 years. The predominant symptoms were urethral bloody spotting or hematuria (80%) and voiding difficulty (50%). All but one lesions were located at the anterior urethra that could be easily detected during pelvic examination. Histologically there were 3 epidermoid/squamous cell carcinomas, 3 transitional cell carcinomas, 3 adenocarcinomas, and 1 undifferentiated carcinoma. Two patients dropped out after biopsy. The other eight patients received complete staging according to the modified Grabstald's classification. Five stage A and three stage D1 urethral cancers were noted. Surgical intervention, including local excision, urethrectomy and regional lymph nodes dissection, was the mainstay of treatment. Adjuvant radiotherapy was administrated in five patients. Of the five stage A cancers, on patient died of metastases four years later. The other four patients were disease-free for 38 to 189 months. Of the three stage D1 cancers, on patient died of metastases within one year. Another one, the only posterior urethral carcinoma, suffered from local recurrence ten months later. The other one was disease-free for 24 months. The average follow-up period for survival patients was 88 months. The result reveals that the anterior urethral cancers tend to be of a lower stage at diagnosis. The prognosis for urethral cancers is related to the stage at diagnosis instead of cell type, regardless of treatment modalities. In conclusion, the diagnosis of female urethral carcinoma should be considered in women who have bladder outlet obstruction or who complain of urethral bleeding. Careful history taking, pelvic examination and biopsy can provide early diagnosis and treatment to improve the survival rate. |
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