Urethral Cancer: Symptoms, Diagnosis, and Treatment

The urethra is a hollow tube that allows urine to pass from the bladder to outside the body. In men, the urethra is about 20 cm long and extends from the prostate to the tip of the penis.

In women, the urethra is about 4 cm long and opens to the outside just above the vaginal opening. Urethral cancer is the rarest type of urinary tract cancer.

It accounts for only about 1 or 2 out of every 100 urinary tract cancers. This cancer is more common in men than in women.

Symptoms of urethral cancer

In the early stages there may be few symptoms, but as the cancer grows, some patients may notice a lump or swelling on the urethra.

Some people may also have pain or bleeding during urination. If the tumor narrows or blocks the urethra, a person may have difficulty passing urine or blood may come from the urethra.

Causes of urethral cancer

The exact cause of urethral cancer is unknown. However, long-term inflammation and infection may increase the risk of this cancer.

Many men with urethral cancer have a history of treatment for urethral stricture or sexually transmitted infections.

Many women with urethral cancer have a history of a urethral caruncle, urethral diverticulum, or recurrent urinary tract infections.

In both men and women, human papillomavirus, or HPV, is associated with urethral cancer.

Diagnostic methods for urethral cancer

The urologist first reviews the patient's history and medical records. They will also ask about other conditions that may be related to urethral cancer, such as:

• History of urethral stricture

• History of sexually transmitted infections

• History of bladder cancer

• History of urethral caruncle

• History of urethral diverticulum

• History of recurrent urinary tract infections

The urethra is then examined to assess any abnormality or mass. The urologist may also request urine tests, blood tests, and imaging studies.

Cystoscopy

The urethral channel and bladder can be evaluated with endoscopy. If the urologist sees an abnormal area, a tissue sample (biopsy) may be taken from the urethra. The samples are then sent for pathologic review.

If cancer is diagnosed, imaging studies and other tests may be ordered to determine the exact location and extent of spread.

Grading and staging of urethral cancer

Grading indicates how quickly the tumor grows and spreads. The most common grading systems use two main grades:

• Low grade: Low-grade tumors grow more slowly. Although they may recur after treatment, they rarely spread to other parts of the body. The cells in low-grade tumors have only minor differences from normal cells.

• High grade: High-grade tumors grow more quickly. They often recur after treatment and are more likely to spread to other parts of the body. Under the microscope, these cells look irregular and abnormal.

Staging of urethral cancer

If cancer cells are found, the doctor must also stage the tumor.

The urologic surgeon needs to know whether the cancer cells have spread. This is called staging. In general, cancer with a higher stage is more serious; stage 4 is the highest stage.

The following table lists the stages using the TNM system (tumor, lymph nodes, metastasis):

Primary tumor (T)

• Tx : The primary tumor cannot be assessed.

• T0 : There is no evidence of a primary tumor.

• Ta : Noninvasive papillary, polypoid, or wart-like carcinoma.

• Tis : Carcinoma in situ; the cancer cells remain in their original site and have not invaded surrounding tissues.

• T1 : The tumor invades the subepithelial connective tissue beneath the surface layer.

• T2 : The tumor invades the corpus spongiosum, prostate, or muscle around the urethra.

• T3 : The tumor invades the corpus cavernosum, extends beyond the prostatic capsule, or invades the anterior vagina or bladder neck.

• T4 : The tumor invades other nearby organs, such as the bladder.

Regional lymph nodes (N)

• Nx: Regional lymph nodes cannot be assessed.

• N0: There is no metastasis in regional lymph nodes.

• N1: Metastasis in a single lymph node measuring 2 cm or less.

• N2: Metastasis in one lymph node measuring 2 to 5 cm, or in multiple lymph nodes, none larger than 5 cm.

• N3: Metastasis in lymph nodes larger than 5 cm.

Distant metastases (M)

To find out whether cancer cells have spread to other parts of the body, the doctor may order additional tests, such as:

• CT scan of the abdomen and pelvis

To check the lymph nodes that drain the urethra.

• MRI

To assess the local extent of the tumor.

• Chest X-ray

To make sure the tumor has not spread to the lungs.

• Bone scan

This may be needed to check for spread to the bones.

• Excretory urography (IVP)

If the urethral cancer is a specific type called transitional cell carcinoma, this method is used to evaluate the kidneys and ureters and make sure there is no other cancer site in the urinary system.

Types of urethral cancer

Urethral cancer can have different types, each with its own features and treatment methods. Knowing the different types can help with better diagnosis and treatment.

Transitional Cell Carcinoma (TCC)

This cancer starts in the lining cells of the urethra, which can change shape. TCC is the most common type of urethral cancer and usually occurs in the proximal part of the urethra, close to the bladder.

Squamous Cell Carcinoma

This cancer starts in the squamous cells that line the urethra. Squamous cell carcinoma usually develops as a result of chronic infections or long-term inflammation.

Adenocarcinoma

This cancer starts in glandular cells that have grown abnormally in the urethra. Adenocarcinoma is rarer than the other two types and is usually seen in the proximal urethra.

Small Cell Carcinoma

Small cell carcinoma is a rare, aggressive cancer made up of small, round cells. It usually grows quickly and requires intensive treatment.

Melanoma

Melanoma is the rarest type of urethral cancer and starts in pigment-producing cells called melanocytes. It is usually aggressive and requires prompt treatment.

Treatment of urethral cancer

Several treatment options are available for patients with urethral cancer. They fall into three main categories:

• Surgery

• Radiation therapy

• Chemotherapy

• Surgery

Surgery is the most common treatment for urethral cancer. Different methods may be used depending on whether the cancer is superficial or invasive.

Superficial cancers

If the tumor has not invaded surrounding tissues, it may be removed with an instrument called a cystoscope. This instrument is inserted into the urethra, and the tumor is removed using special electrical tools.

Invasive tumors

Some patients may need open surgery to remove the mass. In most cases, cancers in the distal urethra, near the tip of the urethra, are treated well with local surgery. To achieve the best treatment result for tumors involving the posterior urethra, the part closest to the bladder, more extensive surgery is often needed.

Lymph node surgery

If the cancer has spread to the lymph nodes, lymph node removal (lymphadenectomy) may be needed. The doctor may use a CT scan before surgery to evaluate the lymph nodes.

Radiation therapy

High-energy rays are used to destroy cancer cells and shrink tumors. Radiation therapy may be used for advanced cancers or as an additional treatment after surgery.

Chemotherapy

Chemotherapy drugs kill cancer cells. Chemotherapy may be used for advanced cancers or to shrink the tumor before surgery. Chemotherapy may also be given locally, directly into the urethra, or systemically through the bloodstream.

Care after treatment

After treatment, patients should be checked regularly by their doctor to help prevent recurrence and confirm ongoing health. Regular examinations, imaging studies, and other tests help identify any problem early. Paying attention to new signs and symptoms and reporting them to the doctor is very important.
Prevention of urethral cancer

Preventing urethral cancer includes steps that may reduce the risk of this cancer. Although not all risk factors can be controlled, following certain measures may help lower the likelihood of developing the disease:

Healthy lifestyle

• Stopping smoking and alcohol use

Smoking and alcohol use can increase the risk of different cancers, including urethral cancer. Stopping these habits can therefore reduce the likelihood of developing this cancer.

• Personal hygiene

Keeping the genital area clean and preventing chronic infections may help reduce the risk of this cancer.

• Healthy diet

Eating foods rich in vitamins, minerals, and antioxidants may help strengthen the immune system and reduce cancer risk.

Vaccination against HPV

Human papillomavirus (HPV) can be associated with some cancers of the genital area and urinary tract. HPV vaccination can reduce the risk of HPV infections and, as a result, the risk of cancers related to this virus.

Control and treatment of urinary tract infections

Recurrent and chronic urinary tract infections can increase the risk of urethral cancer. Timely treatment of urinary tract infections and prevention of recurrence through hygiene, adequate fluid intake, and careful follow-up of medical treatment can help reduce risk.

Summary

Urethral cancer is a rare cancer that affects the urethra. It is more common in men than in women, and early symptoms may include small lumps or swellings in the urethral area, pain, or bleeding during urination. Accurate diagnosis is made through clinical examination, urine and blood tests, and imaging.

If cancer is diagnosed, tumor grading and staging are performed to determine the extent of spread and the appropriate type of treatment.

Treatment methods include surgery, radiation therapy, and chemotherapy. The choice depends on the extent of spread and the type of tumor. Surgery may include removal of masses and, in more advanced cases, involved lymph nodes.

After treatment, regular care and periodic checkups are necessary to help prevent recurrence.

Prevention of urethral cancer includes a healthy lifestyle, stopping smoking and alcohol use, personal hygiene, a healthy diet, HPV vaccination, and controlling and treating urinary tract infections.

These steps may help lower the risk of this cancer. Paying attention to symptoms and seeing a doctor promptly if any abnormality is noticed is especially important.

Frequently Asked Questions