- What Is It
- Grades & Stages
- Bleeding or discharge from the urethra
- Blood in the urine
- Difficulty emptying the bladder
- Difficulty passing urine
- Frequent urination or urge to urinate without passing much urine
- Painful, dribbling, weak, or interrupted flow when urinating
- Painless lump or swelling in the groin
- Swollen lymph nodes in the groin
- Thickness, growth, or lump in the penis or between the genitals and anus (perineum)
- Urinary incontinence (inability to control urine)
These conditions may be caused by urethral cancer or by other medical problems. It is important to see a doctor for a thorough clinical assessment and diagnosis.
What is urethral cancer?
Urethral cancer is a rare urological cancer that starts in the cells that line the urethra. Urethral cancer is rare, accounting for less than 1% of all cancers, and occurs more often in men than in women.
The urethra is a hollow tube that connects the bladder to outside the body:
- In men, the urethra is about 8 inches long and runs from the prostate gland to the tip of the penis, passing via the prostate gland and penis.
- In women, the urethra is about 1.5 inches long and opens to the outside of the body just above the vagina within the labia.
Urethral cancer may not be detected until it is more advanced and is often found in the nearby lymph nodes at the time of diagnosis, making treatment more difficult. Urethral cancer can metastasize to tissues around the urethra, the urinary and reproductive system, and other parts of the body.
What are the different types of urethral cancer?
There are 3 types of urethral cancer, named after the types of cells where the cancer originates:
- Squamous cell carcinoma: Most common type.
- In men, it forms in the part of the urethra within the penis.
- In women, it forms in the thin, flat cells of the urethra present near the bladder.
- Transitional cell carcinoma: Cancer forms near the urethral opening in women and in the part of the urethra that passes through the prostate gland in men.
- Adenocarcinoma: Cancer forms in the glands around the urethra.
What causes urethral cancer?
The exact cause of urethral cancer is unknown. Cancer develops when healthy cells start to grow uncontrollably and form a tumor.
Certain factors may increase the risk of developing urethral cancer. Possible risk factors include:
- History of bladder cancer or other cancers of the urinary tract
- Chronic irritation or inflammation of the urethra due to frequent urinary tract infections or sexually transmitted infections
- Human papillomavirus (HPV) infection, especially HPV type 16
- Certain diseases, such as urethral stricture in men and urethral diverticulum, polyps, or urethral caruncle in women
- Age over 60
How is urethral cancer diagnosed?
- Physical examination and health history review
- Pelvic examination to feel for lumps or abnormal areas.
- Digital rectal exam
- Urine cytology: Urine sample is checked under a microscope for abnormal cells
- Urinalysis: Urine sample is checked for color and contents.
- Blood chemistry studies: Blood samples are checked to measure the amounts of certain substances. An unusual amount can indicate disease.
- Complete blood count: Blood samples are checked for the number of red blood cells, white blood cells, and platelets and hemoglobin levels.
- Imaging tests: May include computed tomography (CT) and magnetic resonance imaging (MRI) scans.
- Cystoscopy: Cystoscope (small tool with a lens and a light) is inserted into the urethra to check for signs of a tumor.
- Ureteroscopy: Ureteroscope is inserted through the urethra into the bladder, ureter, and renal pelvis to check for abnormalities. A small tool may be inserted through the ureteroscope to collect tissue samples.
- Biopsy: Tissue samples are collected from the urethra and viewed under a microscope to confirm the diagnosis of urethral cancer.
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What are the grades and stages of urethral cancer?
After a diagnosis of urethral cancer, more tests may be conducted to determine the spread and stage of cancer.
Grades of urethral cancer
Grades help recognize how quickly the tumor is likely to grow and spread:
- Low-grade cancer: Tumor grows slowly and is unlikely to spread.
- High-grade cancer: Tumor grows rapidly and may spread outside the urethra.
Stages of urethral cancer
The stages of cancer indicate whether the tumor has spread beyond the urethra. The higher the number, the greater the spread:
- Stage 0: Cancer cells are in situ (localized) and in the innermost lining of the urethra.
- Stage I: Cancer cells have grown into layers of tissue below the urethral lining.
- Stage II: Cancer has spread into the deeper muscle layer of the urethra.
- Stage III: Cancer is found in one nearby lymph node or has spread to tissues beyond the urethra.
- Stage IV: Cancer has spread to distant lymph nodes and to organs in other parts of the body.
How is urethral cancer treated?
Treatment options for urethral cancer depend on the type, location, gender, and stage. The purpose of treatment may be to cure, control, or alleviate the condition. They include:
- Surgery: Surgery is the most common method of treatment for urethral cancer. If the urethra is removed, a new way is made for the urine to pass out of the body. This is called urinary diversion.
- Radiation therapy: Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells or prevent them from growing.
- Chemotherapy: Chemotherapy uses anticancer drugs to kill the cancer cells or stop them from multiplying.
- Active surveillance: The patient's condition is closely monitored without administering any treatment until there are changes in test results, which are done regularly.
What is the prognosis of urethral cancer?
The prognosis for urethral cancer is largely based on the patient’s age, overall health condition, location and size of tumor, and stage of cancer when it is diagnosed. The earlier the cancer is diagnosed and treated, the better the outcome.
According to some studies, the 5-year survival rate of urethral cancer is about 46% and the 10-year survival rate is about 31%.
The likelihood of urethral cancer recurring after treatment depends on the stage and location of the initial tumor. The chances of the cancer recurring are lower with low-grade cancer than with high-grade cancer.
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National Cancer Institute. Urethral Cancer Treatment (PDQ®)–Patient Version. https://www.cancer.gov/types/urethral/patient/urethral-treatment-pdq
Lynch DF Jr. Carcinoma of the Urethra. In: Kufe DW, Pollock RE, Weichselbaum RR, et al., eds. Holland-Frei Cancer Medicine, 6th ed. Hamilton (ON): BC Decker; 2003. https://www.ncbi.nlm.nih.gov/books/NBK13861/
Science Direct. Urethral Cancer. https://www.sciencedirect.com/topics/medicine-and-dentistry/urethral-cancer
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