The
urethra is the structure that carries urine, and in men, semen
from the body. It is located within the penis (organ for
reproduction and urination) in men and in front of the vagina
(passageway to the uterus, birth canal) in women. Urethral
cancer is rare and is often associated with invasive bladder
cancer. It tends to spread (metastasize) to adjacent soft
tissue and is often locally advanced when diagnosed.
Types
Different types of urethral cancer develop within different
types of cells and in different portions of the urethra. In
women, the urethra is lined with transitional cells near the
urethral opening and squamous cells near the bladder. In men,
transitional cells line the upper portion and squamous cells
line the urethra at the base of and within the penis.
Squamous cell carcinoma develops in flat, scaly surface cells
and is the most common type of urethral cancer. Other types
include the following:
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Transitional
cell carcinoma (develops in surface cells of the urethra |
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Adenocarcinoma (develops in glands located near the
urethra) |
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Melanoma
(extremely rare; develops in pigment-producing skin cells)
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Sarcoma
(extremely rare; develops in blood vessels, smooth muscle,
and connective tissue) |
Urethral cancer that is superficial and
located in the anterior portion of the structure (i.e., toward
the urethral opening) often can be treated successfully.
Cancer that develops in the posterior portion of the urethra
(i.e., near the bladder) is usually invasive and rarely
curable. In women, urethral cancer often spreads to the labia,
vagina, and bladder neck. In men, the condition may spread to
the tissues of the penis and perineum, the prostate gland, the
ligament that surrounds the urethra (urogenital diaphragm),
the regional lymph nodes, and the penile and scrotal skin.
Incidence and Prevalence
Urethral cancer is more common in women. It can occur at any
age, but the incidence is highest in patients in their 60s.
In men, 80% of cases are squamous cell carcinomas, most of
which occur in the urethra at the base of the penis. In women,
60% of cases are squamous cell carcinomas.
Signs and Symptoms
Early cancer of the urethra often does not produce symptoms.
As the disease progresses, symptoms include the following:
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Blood in the
urine (hematuria) |
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Diminished
urine stream and straining to void (caused by urethral
stricture) |
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Frequent
urination and increased nighttime urination (nocturia)
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Hardening of
tissue in the perineum, labia, or penis
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Itching
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Incontinence
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Pain during
or after sexual intercourse (dyspareunia)
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Painful
urination (dysuria) |
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Recurrent
urinary tract infections |
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Urethral
discharge and swelling |
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Advanced
cases of urethral cancer may produce swollen lymph nodes
in the groin. |
Diagnosis
Diagnosis of urethral cancer is made by physical examination
and biopsy. The urethra and the bladder are thoroughly
examined using a thin, lighted tube (called a cystoscope) that
is inserted into the urethra. If a suspicious lesion is
located, a small piece of tissue is removed surgically and
examined under a microscope for cancer cells. Biopsy is
performed under local anesthesia, usually in a physician’s
office or an outpatient surgical center.
If the biopsy is positive, imaging tests are performed to
stage the cancer. These tests include x-ray, ultrasound,
computed tomography (CT scan), and magnetic resonance imaging
(MRI scan). MRI is the preferred method to evaluate urethral
cancer.
Treatment
Treatment for urethral cancer depends on the stage and
location of the disease, and the patient’s age, sex, and
overall health. Options include chemotherapy, radiation, and
surgery. Because urethral cancer is often invasive, surgery is
the primary method of treatment. Chemotherapy and radiation
are often used as adjuvant therapies.
Surgery
Surgical treatment options depend on the stage and location of
the cancer. Surgery is usually performed under general
anesthesia. Early urethral cancer is treated using fulguration
(destruction of cancer cells using high-frequency electric
current) and laser therapy (destruction of cancer cells using
a narrow beam of intense light).
Procedures performed for advanced cases include the following:
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Removal of
the bladder and urethra (cystourethrectomy)
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Removal of
part of the penis (partial penectomy)
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Removal of
the penis, urethra, and penile root (radical penectomy)
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Removal of
the bladder and prostate (cystoprostatectomy)
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Removal of
cancerous lymph nodes (lymph node dissection)
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Removal of
the bladder, urethra, and vagina (anterior exenteration)
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If partial penectomy, radical penectomy, or
anterior exenteration is required, additional surgical
procedures are performed to reconstruct the reproductive
organs. If the bladder and urethra are removed, a urinary
diversion is performed to allow for the passage of urine.
Complications of surgery include the following:
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Adverse
reaction to anesthesia |
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Bowel
obstruction |
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Incontinence
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Infection
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Mortality
(approx. 1– 2% of cases) |
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Recurrence
(in approx. 50% of cases) |
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Tissue death
(necrosis) |
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Urethral
narrowing (stricture) or abnormal passage (fistula)
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Radiation
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Radiation may be used in conjunction
with surgery in advanced urethral cancer, or as primary
treatment for early urethral cancer that is noninvasive.
Radiation uses high-energy rays from a machine outside the
body (called external beam radiation) or surgically implanted
radioactive seeds or pellets (called brachytherapy) to destroy
cancer cells. External radiation and brachytherapy
are sometimes used together.
External beam radiation usually involves treatment 5 days a
week for approximately 6 weeks. Brachytherapy involves
surgical implantation of the seeds, which become inactive over
time and remain in place.
Side effects of radiation are caused by the destruction of
healthy tissue and include the following:
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Abnormal
healing resulting in abnormal passage in the urethra
(fistula) |
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Burning of
the skin (similar to sunburn) |
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Diarrhea
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Fatigue
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Inflammation
of the bladder (cystitis) |
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Narrowing of
the urethra (stricture; causing urination difficulty)
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Nausea
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Chemotherapy
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Chemotherapy involves using drugs to destroy
cancer cells. It is a systemic treatment (i.e., destroys
cancer cells throughout the body) that is administered orally
or intravenously (through a vein; IV). Medications are often
used in combination to destroy urethral cancer that has
metastasized. Commonly used drugs include cisplatin (Platinol®),
vincristine (Oncovin®), and methotrexate (Trexall®). Side
effects include the following:
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Anemia
(causing fatigue, weakness) |
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Nausea and
vomiting |
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Loss of
appetite (anorexia) |
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Hair loss
(alopecia) |
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Mouth sores
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Increased
risk for infection |
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Shortness of
breath |
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Excessive
bleeding and bruising |
Prognosis
Five-year survival rates for noninvasive urethral cancer
treated surgically or with radiation are approximately 60%.
Recurrence rates for invasive urethral cancer treated with
surgery, chemotherapy, and radiation combined are higher than
50%. Early diagnosis and treatment offers the best chance for
cure.
Prevention
Urethral cancer cannot be prevented.
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