Cancer of the scrotum

　　Cancer is a disease that is terrifying to people. After a person is diagnosed with cancer, there is no doubt that they are surrendering to death. There are many types of cancer, in addition to common liver cancer and stomach cancer, there is also one that has a greater impact, which is scrotal cancer. This type of cancer mainly affects males. So, what are the causes of scrotal cancer?

　　(I) Etiology

　　Scrotal squamous cell carcinoma is the first example of human recognition of environmental carcinogenic factors leading to occupational cancer, and it is the basis for the beginning of chemical carcinogenesis experiments. In 1774, British surgeon Pott noticed that some young chimney sweep assistants who had been working since childhood often developed chronic, non-healing ulcers in the scrotum in adulthood, which were confirmed as carcinoma by pathology, thus proposing the relationship between scrotal cancer and occupation. In 1784, Bell further found that workers engaged in activities containing soot and dust were also prone to this type of cancer. In 1922, Southan reported 141 cases of scrotal cancer, 69 of whom were involved in fine spinning, 22 had long-term contact with asphalt or paraffin, and at this time, due to the elimination of the chimney sweep trade, only one case was a chimney sweep. Subsequent reports have continued to increase, proving that scrotal cancer is related to occupations such as oil, tar, asphalt, fine spinning, and machinery. Due to the lack of labor protection, the skin of the scrotum, perineum, and penis is easily contaminated by various mineral oils and dust, which accumulate in the sebaceous gland-rich skin folds, leading to carcinogenesis from long-term contact with the main carcinogen 3,4-benzopyrene.

　　(II) Pathogenesis

　　Squamous cell carcinoma (squamous cell carcinoma, abbreviated as SCC) is also known as epidermoid carcinoma. The carcinoma originates from epidermal keratinocytes and often occurs on the basis of chronic skin diseases and precancerous lesions, such as chronic inflammation, contact with chemical substances, and sunlight damage, and can occur in the mucosa of any part of the body.

　　The pathological and histological changes of scrotal squamous cell carcinoma are similar to those of squamous cell carcinoma in other parts of the body. The tumor is composed of irregular nodules of squamous epithelial cells infiltrating the dermis. The nodules contain cells of different differentiation degrees, but the atypicality may not be obvious under microscopic observation. The diagnosis of carcinoma and the degree of malignancy are mainly determined by the extent of infiltration. According to differentiation and the depth of tissue infiltration, scrotal squamous cell carcinoma is usually divided into grades I to IV. The infiltration of the tumor is mainly in the skin, rarely extending to the contents of the scrotum.

　　About 1/2 to 3/4 of the patients with scrotal cancer have inguinal lymph node swelling at the time of consultation, but most are caused by inflammation. Only less than half are due to cancer metastasis. The time from the discovery of the primary cancer to the appearance of lymph node metastasis is generally 6 to 12 months, and in the late stage, lymph node metastasis can also occur around the iliac vessels.

　　When men suffer from scrotal cancer, they must seek medical treatment in time. Delayed treatment may cause the cancer cells to metastasize, leading to penile cancer or testicular cancer. In addition, it is recommended that patients maintain an optimistic attitude in daily life, which is very beneficial to the treatment of the disease.

　　Scrotal cancer can present as multifocal lesions and can also be accompanied by skin cancer or deep tissue cancer in other parts of the body, such as tongue cancer, prostate cancer, lung cancer, bladder cancer, colon cancer, kidney cancer, and adrenal tumors. These can appear simultaneously with scrotal cancer or sequentially, and it should be considered that they are related to common carcinogenic factors.

　　Scrotal cancer is a common urological disease. When men suffer from this disease, it can seriously affect their health and life. At the same time, this disease is easy to metastasize. If it is not treated in time, it may lead to the joint suffering of patients with penile cancer, testicular cancer, and other types of cancer. Then, what are the symptoms and manifestations of scrotal cancer?

　　Scrotal cancer can present as painless scrotal swellings with warty or papular lesions, which can further present as cauliflower-like, with a hard texture. The growth rate of the tumor varies greatly among individuals, with some showing little change for many years before suddenly increasing in growth rate. Necrosis and ulcers can appear centrally in the tumor, and when infected, pus and blood with an unpleasant odor may be discharged, and local pain may occur. More than 50% of patients with scrotal cancer have swelling of the inguinal lymph nodes at the time of consultation. In the late stage, the tumor can invade the penis and contents of the scrotum, leading to hematogenous metastasis. No significant systemic symptoms are present.

　　The prevention of scrotal cancer lies in improving the working environment, avoiding the invasion of carcinogens, keeping the local area clean, and thus avoiding or reducing the occurrence of scrotal cancer.

　　1. Regular check-ups:Regular checks of the testicles should be carried out early to detect abnormal symptoms of the testicles early and receive treatment in a timely manner.

　　2. Diet habits:Attention should be paid to developing good eating habits, and appropriate, low-fat diet should be adopted.

　　3. Physical exercise:In daily life, it is also necessary to pay attention to physical exercise, strengthen physical fitness and self-resistance, and be able to carry out regular exercise.

　　4. Psychological adjustment:Good psychological adjustment should be made. It is necessary to avoid stress or overwork, to pay attention to learning relaxation techniques, and to do things that are enjoyable.

　　Scrotal cancer is a serious disease. After suffering from scrotal cancer, it often brings great distress to the health of patients. The specific examinations needed for scrotal cancer are as follows:

　　Biopsy

　　Under the microscope, hyperplastic epithelium can be seen breaking through the basement membrane and infiltrating deeply to form irregular fibrous cancer nests. In well-differentiated cancer nests, cells equivalent to the basal layer are arranged on the outer layer of the cancer nests, and the inner layer consists of cells equivalent to the spinous cell layer. Cell bridges can be seen between cells. Keratinized substances can appear centrally in the cancer nests, known as keratin pearls or cancer pearls. In poorly differentiated cancer nests, no keratin pearls are formed, and even cell bridges are absent.

　　Patients with scrotal cancer should pay attention to reasonable nutrition in their diet, try to diversify their food, eat more high-protein, high-vitamin, low-animal-fat, easily digestible foods, fresh fruits and vegetables, avoid spicy and irritating foods, avoid smoking and drinking, avoid high-salt and high-fat foods, avoid drinking strong tea. Avoid staying up late, pay attention to rest, avoid too much emotional fluctuation, and have moderate exercise.

　　Early diagnosis and early treatment of scrotal cancer are very important. Early efforts should be made to achieve surgical resection. The primary lesion needs to be locally resected, and the range should exceed the edge of the scrotum by more than 2cm beyond the tumor, unless the lesion has invaded the contents of the scrotum. Otherwise, it should be preserved as much as possible. Local recurrence after surgery is often caused by incomplete excision, but it may also be new and not recurrent. Lesions with a large and extensive range can also be excised using Mohs chemical surgery, that is, the excised cancer tissue is observed continuously under a microscope until the tumor is completely removed. For those with a wide excision range and difficulty in covering the contents of the scrotum, skin flap transfer and scrotoplasty can be used, and if the contents of the scrotum have been involved, they should be removed together.

　　Since most patients are elderly, prophylactic groin lymph node dissection may not necessarily improve survival rates and is prone to complications such as lower limb lymphatic回流 obstruction, elephantiasis, poor incision healing, etc. Therefore, only when biopsy of enlarged lymph nodes confirms metastasis should ilioinguinal lymph node dissection be performed. The surgery can be performed 2 to 6 weeks after the primary lesion is excised. Routine or adjuvant radiotherapy with deep X-ray may be added after surgery for those with incomplete excision or those who are not suitable for dissection, and chemotherapy may be performed if necessary, but it is often not very sensitive. In the late stage of scrotal cancer with visceral or distant metastasis, palliative adjuvant treatment with radiotherapy and chemotherapy can also be used, such as 60Co irradiation or combined chemotherapy with cisplatin, bleomycin, methotrexate (amethopterin), etc., and local excision can also be used for prevention of recurrence.