What is Urachal Adenocarcinoma?Urachal Adenocarcinoma is a rare cancer that usually develops in the dome of the bladder, urachus and accounts for 0.35% to 0.7% of all bladder cancers. The bladder is a muscle sac that stores urine; it is located in the pelvis and also controls the frequency of urination. In 40-50% cases, it can recur locally after treatment. Urachal adenocarcinoma is a high-grade tumour and in 15% of patients can spread to the distant parts of the body. The most common sites of distant metastasis (spread of the tumour to the distant parts of the body) are lymph nodes, lungs, abdomen, and liver
Disease EpidemiologyIt accounts for 0.35% to 0.7% of all bladder cancers. The average age at diagnosis is 52 years, ranging from 26 to 68 years. According to the clinical data of 67 cases of dome based bladder cancers, it is slightly more prevalent in men than in women.
Disease Etiology (Cause)The urachus is an embryological remnant of the urinary and genital sinus that connects the bladder to the umbilicus during the life of the fetus, later it became the umbilical cord and is no longer part of the adult bladder. But in some individuals, it remains as a residue and develops into a cyst or tumour.
Signs and SymptomsThe patient may suffer from the following signs and symptoms. These are
- A palpable (felt able) pelvic mass
- Urinary retention (it is impossible to empty the bladder completely
- Passage of blood or blood particles in urine
- Blood spotting from the vagina or urethra
- Pain at the perineum (pelvis)
- Unexplained weight loss
- Night sweats
DiagnosisThe following diagnostic tests and procedures can be used to make a diagnosis. These are
- Urine complete examination (UCE) to detect any urinary tract infection and blood in the urine
- Complete blood count (CBC)
- Renal Function Test (RFT’s) to check the serum urea and creatinine
- Liver function tests (LFT’s)
- Imaging techniques like CT-abdomen and pelvis, USG abdomen and pelvis, MRI, CT-chest, and X-ray to assess the site, size, extent, and distant metastasis of the tumour.
- Cystoscopy; is similar to an ultrasound examination of the urinary bladder, which allows direct visualization of the ureter with cystoscopy.
- Urinary cytology; is a microscopic examination of the cells present in urine and their characteristics.
- Tumour biopsy and histopathological examination