Urethral cancer is a rare

cancer Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...

originating from the

urethra The urethra (: urethras or urethrae) is the tube that connects the urinary bladder to the urinary meatus, through which Placentalia, placental mammals Urination, urinate and Ejaculation, ejaculate. The external urethral sphincter is a striated ...

. The disease has been classified by the

TNM staging system The TNM Classification of Malignant Tumors (TNM) is a globally recognised standard for classifying the anatomical extent of the spread of malignant tumours (cancer). It has gained wide international acceptance for many solid tumor cancers, but is ...

and the

World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...

. Symptoms include

blood in the urine Hematuria or haematuria is defined as the presence of blood or red blood cells in the urine. "Gross hematuria" occurs when urine appears red, brown, or tea-colored due to the presence of blood. Hematuria may also be subtle and only detectable with ...

, lump at end of penis, or bloody penile discharge. Diagnosis is established by transurethral biopsy. The most common type is papillary urothelial carcinoma. Risk factors suggested include prolonged irritations of the urethra due to

urinary catheterization In urinary catheterization, a latex, polyurethane, or silicone tube known as a urinary catheter is inserted into the bladder through the urethra to allow urine to drain from the bladder for collection. It may also be used to inject liquids used ...

, chronic inflammation due to infection, radiation, diverticula of the urethra, and urethral strictures.

Signs and symptoms

Symptoms that may be caused by urethral cancer include: * Blood visible in urine. * Bloody urethral discharge. *Weak or interrupted flow of urine. *Urination occurs often, painful urination, inability to pass urine. *A lump or thickness in the perineum or penis. * Enlarged lymph nodes or pain in the groin or vaginal area.

Diagnosis

Diagnosis is established by transurethral biopsy and histological findings. Bladder cystoscopy is performed to detect if there is simultaneous bladder cancer.

Histology

The most common histology seen in primary urethral cancer (a cancer which originates in the urethra, as opposed to cancer cells from elsewhere in the body which

metastasize Metastasis is a pathogenic agent's spreading from an initial or primary site to a different or secondary site within the host's body; the term is typically used when referring to metastasis by a cancerous tumor. The newly pathological sites, ...

to the area) is urothelium, a type of transitional epithelium. Urothelial cell cancers comprise just over half of primary urethral cancers. Roughly another quarter of cases are squamous cell carcinomas, and the majority of the remainder are

adenocarcinomas Adenocarcinoma (; plural adenocarcinomas or adenocarcinomata ; AC) is a type of cancerous tumor that can occur in several parts of the body. It is defined as neoplasia of epithelial tissue that has glandular origin, glandular characteristics, o ...

, which originate from the cells of various secretory glands in and around the urethra. Up to 10% of primary urethral cancers have variant histology types, or have unclear cells of origin.

Staging

The World Health Organization classification of tumours of the urinary system and male genital organs (4th edn) was published in January 2016. Urethral cancer has also been classified by the

Treatment

Surgery is the most common treatment for cancer of the urethra. One of the following types of surgery may be done: Open excision, Electro-resection with flash,

Laser surgery Laser surgery is a type of surgery that cuts tissue using a laser in contrast to using a scalpel. Soft-tissue laser surgery is used in a variety of applications in humans ( general surgery, neurosurgery, ENT, dentistry, orthodontics, and ...

, Cystourethrectomy, Cystoprostatectomy, Anterior body cavity, or Incomplete or basic

penectomy Penectomy is penis removal through surgery, generally for medical or personal reasons. Medical reasons Cancer, for example, sometimes necessitates removal of part or all of the penis. The amount of penis removed depends on the severity of the ...

surgery. Radiation therapy is also an option. However, due to increased rates of complications such as

urethral stricture A urethral stricture is a narrowing of the urethra, the tube connected to the Urinary bladder, bladder that allows urination. The narrowing reduces the flow of urine and makes it more difficult or even painful to empty the bladder. Urethral stric ...

, urinary incontinence,

stenosis Stenosis () is the abnormal narrowing of a blood vessel or other tubular organ or structure such as foramina and canals. It is also sometimes called a stricture (as in urethral stricture). ''Stricture'' as a term is usually used when narrowing ...

of the urethra, non-infectious cystitis, and other disorders of the pelvic region, surgery is preferred over radiation therapy. Chemotherapy and radiation therapy are often used together against cancers which prove resistant to one or the other.

Chemotherapy Chemotherapy (often abbreviated chemo, sometimes CTX and CTx) is the type of cancer treatment that uses one or more anti-cancer drugs (list of chemotherapeutic agents, chemotherapeutic agents or alkylating agents) in a standard chemotherapy re ...

is sometimes used to destroy urethral cancer cells. It is a systemic urethral cancer treatment (i.e., destroys urethral cancer cells throughout the body) that is administered orally or intravenously. Medications are often used in combination to destroy urethral cancer that has metastasized. Commonly used drugs include

cisplatin Cisplatin is a chemical compound with chemical formula, formula ''cis''-. It is a coordination complex of platinum that is used as a chemotherapy medication used to treat a number of cancers. These include testicular cancer, ovarian cancer, c ...

vincristine Vincristine, also known as leurocristine and sold under the brand name Oncovin among others, is a chemotherapy medication used to treat a number of types of cancer. This includes acute lymphocytic leukemia, acute myeloid leukemia, Hodgkin lym ...

, and

methotrexate Methotrexate, formerly known as amethopterin, is a chemotherapy agent and immunosuppressive drug, immune-system suppressant. It is used to treat cancer, autoimmune diseases, and ectopic pregnancy, ectopic pregnancies. Types of cancers it is u ...

. Side effects include

anemia Anemia (also spelt anaemia in British English) is a blood disorder in which the blood has a reduced ability to carry oxygen. This can be due to a lower than normal number of red blood cells, a reduction in the amount of hemoglobin availabl ...

(causing

fatigue Fatigue is a state of tiredness (which is not sleepiness), exhaustion or loss of energy. It is a signs and symptoms, symptom of any of various diseases; it is not a disease in itself. Fatigue (in the medical sense) is sometimes associated wit ...

weakness Weakness is a symptom of many different medical conditions. The causes are many and can be divided into conditions that have true or perceived muscle weakness. True muscle weakness is a primary symptom of a variety of skeletal muscle diseases, ...

), nausea and vomiting,

loss of appetite Anorexia is a medical term for a loss of appetite. While the term outside of the scientific literature is often used interchangeably with anorexia nervosa, many possible causes exist for a loss of appetite, some of which may be harmless, while o ...

hair loss Hair loss, also known as alopecia or baldness, refers to a loss of hair from part of the head or body. Typically at least the head is involved. The severity of hair loss can vary from a small area to the entire body. Inflammation or scarring ...

, mouth sores, increased risk for infection, shortness of breath, or excessive bleeding and bruising.Urethral Cancer Treatment
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Epidemiology

Primary urethral cancer is rare and contributes to less than 1% of all cancers. It is three times more common in men than women and its incidence rises after the age of 75. Around half of affected people have locally advanced disease when they first present. 54–65% of cases are of the urothelial carcinoma type. Prolonged irritations of the urethra due to

, chronic inflammation due to infection, radiation, diverticula of the urethra, and urethral strictures, may increase the risk of primary urethral cancer. Other risk factors include

squamous cell carcinoma Squamous-cell carcinoma (SCC), also known as epidermoid carcinoma, comprises a number of different types of cancer that begin in squamous cells. These cells form on the surface of the skin, on the lining of hollow organs in the body, and on the ...

(SCC) and genital lichen sclerosus.

Prognosis

A study of the National Cancer Database in the United States assessed cases of primary urethral cancer from 2004 to 2013, finding that median survival was 49 months with 5- and 10-year survival rates estimated at 46% and 31% respectively. A study of the RARECARE project, aimed at investigating rare cancers in Europe, estimated a 5-year relative survival rate of 54% in patients with cancer of the urethra.

References

{{Urologic neoplasia Rare cancers Urological neoplasia Urethra de:Urothelkarzinom