Urethral Cancer

Urethral cancer is rare and is more common in men than in women. It can metastasize (spread) quickly to tissues around the urethra and has often spread to nearby lymph nodes by the time it is diagnosed.

Types & Stages

There are different types of urethral cancer that begin in cells that line the urethra.

• Squamous cell carcinoma is the most common type of urethral cancer. It forms in the thin, flat cells in the part of the urethra near the bladder in women, and in the lining of the urethra in the penis in men.
   
• Transitional cell carcinoma forms in the area near the urethral opening in women, and in the part of the urethra that goes through the prostate gland in men.
   
• Adenocarcinoma forms in the glands that are around the urethra in both men and women.

Urethral cancer is staged and treated based on the part of the urethra that is affected and how deeply the tumor has spread into tissue around the urethra. Urethral cancer can be described as distal or proximal.

• In distal urethral cancer, the cancer usually hasn’t spread deeply into the tissue. In women, the part of the urethra that is closest to the outside of the body (about a half inch) is affected. In men, the part of the urethra that is in the penis is affected.
   
• Proximal urethral cancer affects the part of the urethra that is not the distal urethra. In women and men, proximal urethral cancer usually has spread deeply into tissue. In men, cancer that forms in the proximal urethra (the part of the urethra that passes through the prostate to the bladder) may occur at the same time as cancer of the bladder and/or prostate. Sometimes this occurs at diagnosis and sometimes it occurs later.

Signs & Symptoms

These and other signs and symptoms may be caused by urethral cancer or by other conditions so check with your doctor if you have any of the following:

• Trouble starting the flow of urine
• Weak or interrupted flow of urine
• Frequent urination, especially at night
• Incontinence
• Discharge from the urethra
• Bleeding from the urethra or blood in the urine
• A lump or thickness in the perineum or penis
• A painless lump or swelling in the groin

Diagnosis

The following tests and procedures may be used after a physical exam:

• Pelvic exam of the vagina, cervix, uterus, fallopian tubes, ovaries and rectum. 
   
• Digital rectal exam of the rectum to feel for lumps or anything else that seems unusual.
   
• Urine cytology, a laboratory test in which a sample of urine is checked under a microscope for abnormal cells.
   
• Urinalysis to check the color of urine and its contents, such as sugar, protein, blood and white blood cells. If white blood cells (a sign of infection) are found, a urine culture is usually done to find out what type of infection it is.
   
• Blood chemistry studies is a procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
   
• Complete blood count (CBC) is a procedure in which a sample of blood is drawn and checked for the following:
   
  • The number of red blood cells, white blood cells and platelets.
  • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
  • The portion of the blood sample made up of red blood cells.
     
• CT scan (CAT scan), a procedure that makes a series of detailed pictures of areas inside the body, such as the pelvis and abdomen, taken from different angles. This procedure is also called computed tomography, computerized tomography or computerized axial tomography.
   
• Biopsy is the removal of cell or tissue samples from the urethra, bladder and, sometimes, the prostate gland. The samples are viewed under a microscope by a pathologist to check for signs of cancer.

Treatment

Surgery to remove the cancer is the most common treatment for cancer of the urethra. One of the following types of surgery may be done:

• Open excision, which is removal of the cancer by surgery.
   
• Transurethral resection (TUR): Surgery to remove the cancer using a special tool inserted into the urethra.
   
• Electroresection with fulguration: Surgery to remove the cancer by electric current. A lighted tool with a small wire loop on the end is used to remove the cancer or to burn the tumor away with high-energy electricity.
   
• Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove or destroy tissue.
   
• Lymph node dissection: Lymph nodes in the pelvis and groin may be removed.
   
• Cystourethrectomy: Surgery to remove the bladder and the urethra.
   
• Cystoprostatectomy: Surgery to remove the bladder and the prostate.
   
• Anterior exenteration: Surgery to remove the urethra, the bladder and the vagina. Plastic surgery may be done to rebuild the vagina.
   
• Partial penectomy: Surgery to remove the part of the penis surrounding the urethra where cancer has spread. Plastic surgery may be done to rebuild the penis.
   
• Radical penectomy: Surgery to remove the entire penis. Plastic surgery may be done to rebuild the penis.

If the urethra is removed, your surgeon will make a new way for the urine to pass from the body. This is called urinary diversion. If the bladder is removed, they will make a new way for urine to be stored and passed from the body. Your surgeon may use part of the small intestine to make a tube that passes urine through an opening (stoma). This is called an ostomy or urostomy. 

If a patient has an ostomy, a disposable bag to collect urine is worn under clothing. Your surgeon may also use part of the small intestine to make a new storage pouch (continent reservoir) inside the body where the urine can collect. A tube (catheter) is then used to drain the urine through a stoma.

Some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. 

Causes & Risk Factors

Risks that can increase the risk of urethral cancer include:

• Increasing age. The risk of ureteral cancer goes up with age. Most people diagnosed with this cancer are 60 and older.
   
• It is more prevalent in men.
   
• Race and ethnicity. In the U.S., Black people have a greater risk of urethral cancer than do people of other races and ethnicities. 
   
• A personal or family history of bladder cancer. 
   
• Having conditions that cause inflammation in your urethra, such as frequent urinary tract infections (UTIs) or a sexually transmitted infection (STI).
   
• Having human papillomavirus (HPV).

Screening

While there isn't a specific screening test for urethral cancer, early detection is crucial. Urethral cancer is typically diagnosed through a combination of physical exams, medical history review, blood and urine tests, imaging studies and potentially biopsies. (See above.)