Деякі епідеміологічні та клініко-морфологічні особливості раку сечового міхура

Abstract

У статті наведені сучасні дані щодо етіології, захворюваності та смертності від раку сечового мі¬хура (РСМ). Проведено аналіз показників захворюваності та смертності від даної патології в Полтавській об¬ласті. Встановлено, що в Полтавській області, в цілому, показники захворюваності і смертності від РСМ не має значних відмінностей від загальнодержавних показників і відповідають загальній світовій тенденції. Обґрунтовано необхідність патогістологічного і доцільність застосування імуногістохімічного методів до¬слідження для уточнення ступеня злоякісності і інвазивного потенціалу РСМ, визначення стадії пухлинного процесу і вибору оптимального методу лікування.; The article presents the current data on the etiology, morbidity and mortality caused by bladder cancer (BC). According to the literature data BC ranks the second place after prostate cancer among all urological cancer diseases. The incidence ratio among men and women in different countries varies within 3.5-5:1. In Ukraine an average of 11.9 cases of BC incidence and 5.1 deaths per 100.000 people are recorded annually. Bladder cancer incidence is about 4 times higher in men than in women in Ukraine. It ranks the seventh among men and the fifteenth among women in the structure of cancer diseases. The main causes leading to the development of this pathology include the effect of occupational factors (long-term contact with oil products), smoking, eating and drinking habits, genetic determination, presence of chronic inflammatory diseases of the genitourinary system and diseases leading to infravesicular obstruction. Every year 154 patients are diagnosed with this disease in Poltava region, among them 139 cases of tumor lo¬calized in this area were diagnosed for the first time. Thus, 10.5 incidence cases were detected averagely per 100. 000 population in the region annually, which is somewhat lower than the average in Ukraine. In the overwhelming majority of cases (78%) the tumors were detected at 1-2 stages by TNM system, in 13% − at the third stage and in 9% − at the fourth one. The incidence of BC among men in Poltava region was 4.3 times higher than among women, which is consistent with the average rate in Ukraine and the world tendency. Most of men presented with this disease (89 patients) were 75-79 years old at the time of disease detection. Many patients were also registered (28 individuals) among the women of this age group, but at the same time the high rate (22 patients) was observed in the group aged 60-64 years. The BC cases were also detected at a young age during research period. Thus, one BC case was registered in a woman of the age group up to 25 and one men of 25-29 age group. The bladder cancer mortality rate in Poltava region averaged 5.23 per 100 000 population, which is higher than the corresponding average rate in Ukraine. The mortality rate among men was 5 times higher than among women. Invasive forms predominated in the histological variants of BC (70%) in our research, which differs from the data of some researchers. Non-invasive papillary urothelial carcinoma was diagnosed significantly less often − in 30% of cases. In case of invasive forms of urothelial carcinoma the tumor invasion could be more often microscopic detected in the muscular layer of the bladder (in 47% of cases) and in submucosa – in 27% of cases. In 26% of observed cases the invasion depth was not possible to determine in histological verification due to technical reasons (insufficient amount of investigation material, significant necrotic changes in the tumor tissue). While determining the differentiation degree, moderately differentiated variants prevailed both in invasive and non-invasive BC forms related to the second stage of anaplasia (G2) − 53%, the tumors with the first anaplasia de¬gree were observed less frequently (G 1) − 30%, the tumors with the third degree of anaplasia (G 3) amounted to 17%.