|Other names: Primary urethral cancer|
|Micrograph of urethral cancer, urothelial cell carcinoma, found on a prostate core biopsy. H&E stain.|
|Symptoms||Blood in the urine, lump at end of penis, bloody urethral discharge|
|Complications||Urinary retention, priapism|
|Usual onset||73 years|
|Types||Urothelial carcinoma, squamous cell cancer, adenocarcinoma|
|Risk factors||Prolonged urinary catheterization, chronic infection, radiation, diverticula of the urethra, urethral strictures|
|Diagnostic method||Transurethral biopsy|
|Treatment||Surgery, radiation therapy, chemotherapy|
Urethral cancer is cancer originating from the urethra. Symptoms may include blood in the urine, lump at end of penis, pain with sex, or bloody discharge. Complications may include urinary retention and priapism.
Risk factors may include prolonged irritations from urinary catheterization, chronic inflammation due to infection, radiation, diverticula of the urethra, or urethral strictures. The most common types are urothelial carcinoma, squamous cell cancer, and adenocarcinoma. Diagnosis is established by transurethral biopsy. The disease is classified by the TNM staging system and the World Health Organization.
Treatment may include a combination of surgery, radiation therapy, and chemotherapy. Outcomes are often poor with a five-year survival rate of 46%. Urethral cancer is rare, representing less than 1% of cancers. About 4.3 cases occur per million males and 1.5 cases per million females in the United States. The typical age at diagnosis is 73.
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.
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 TNM staging system.
|TX||Primary tumor cannot be assessed|
|T0||No evidence of primary tumor|
|Urethra (male and female)|
|Ta||Noninvasive papillary, polypoid, or verrucous carcinoma|
|Tis||Carcinoma in situ|
|T1||Tumor invades subepithelial connective tissue|
|T2||Tumor invades any of the following: corpus spongiosum, prostate, periurethral muscle|
|T3||Tumor invades any of the following: corpus cavernosum, beyond prostatic capsule, anterior vagina, bladder neck (extraprostatic extension)|
|T4||Tumor invades other adjacent organs (invasion of the bladder)|
|Urothelial (transitional cell) carcinoma of the prostate|
|Tis pu||Carcinoma in situ, involvement of prostatic urethra|
|Tis pd||Carcinoma in situ, involvement of prostatic ducts|
|T1||Tumor invades subepithelial connective tissue (for tumors involving prostatic urethra only)|
|T2||Tumor invades any of the following: prostatic stroma, corpus spongiosum, periurethral muscle|
|Ta||Noninvasive papillary, polypoid, or verrucous carcinoma|
|T3||Tumor invades any of the following: corpus cavernosum, beyond prostatic capsule, bladder neck (extraprostatic extension)|
|T4||Tumor invades other adjacent organs (invasion of the bladder or rectum)|
|N—regional lymph nodes|
|NX||Regional lymph nodes cannot be assessed|
|N0||No regional lymph node metastasis|
|N1||Metastasis in a single lymph node|
|N2||Metastasis in multiple lymph nodes|
|M0||No distant metastasis|
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, cystourethrectomy, cystoprostatectomy, anterior body cavity, or incomplete or basic penectomy surgery.
Radiation therapy has also been used in some cases.
Chemotherapy 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, vincristine, and methotrexate.[clarification needed]
Side effects include anemia (causing fatigue, weakness), nausea and vomiting, loss of appetite, hair loss, mouth sores, increased risk for infection, shortness of breath, or excessive bleeding and bruising.
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.
Prolonged irritations of the urethra due to urinary catheterization, 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 (SCC) and genital lichen sclerosus.
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