Information on cancers of urologic organs such as the bladder, prostate, kidney, penis and testis.

Urethral Cancer

Urethral cancer is a rare type of cancer affecting the male or female urethra that comprises approximately 1 to 2 percent of all urological cancers. To date, the number of persons diagnosed with this condition each year has remained stable. Although some people with urethral cancer do not complain of any symptoms, most do. What are these symptoms? How should this malignancy be treated? What is the chance of recovery? The following information should help answer these questions.

What happens under normal conditions?

The urethra is a hollow tube that allows urine to pass from the bladder, the organ that stores urine until ready for release, to the outside of the body. In men the urethra is approximately eight inches long, and passes through the prostate and the penis before it opens to the outside at the end of the penis. In women the urethra is approximately one and a half inches long and opens to the outside just above the vaginal opening.

A layer of cells called epithelium lines the urethra. In both men and women there are several glands located along the length of the urethra. A supportive network of connective tissue, elastic and muscle fibers and blood vessels surrounds the urethra.

What causes urethral cancer?

The exact cause of urethral cancer is not known. However, chronic inflammation and infection have been identified as factors that may increase the risk for developing this condition. Many men with urethral cancer have previously been treated for urethral stricture disease or sexually transmitted diseases (STDs). Many women with urethral cancer have previously been treated for urethral caruncle, urethral diverticulum or chronic urinary tract infection. In both men and women the presence of human papilloma virus (HPV) has been linked to urethral cancer.

What are the symptoms of urethral cancer?

In its early stages, there are usually few symptoms associated with urethral cancer. As the cancer grows, some patients may notice a lump or growth on the urethra. Others may notice pain or bleeding that accompanies urination. If the tumor grows so that it narrows the diameter of the urethra, patients may have difficulty urinating.

How is urethral cancer diagnosed?

The diagnostic investigation begins with a thorough medical history and physical examination. The urologist will ask the patient about medical conditions that may be associated with urethral cancer, such as urethral stricture, STDs, bladder cancer, urethral caruncle, urethral diverticulum and urinary tract infection. The urologist will examine the urethra, feeling for any abnormalities.

An important diagnostic instrument that the urologist will use is the cystoscope, which is a thin, lighted scope that allows the urologist to view the inside of the urethra. Cystourethroscopy is most commonly performed as an office procedure under local anesthesia. If the urologist observes any abnormalities, the patient will require a biopsy.

A tissue biopsy is essential to diagnose urethral cancer. It is difficult to perform this procedure under local anesthesia, so the patient is usually scheduled to return for biopsy. Under general anesthesia or regional anesthesia, the urologist will biopsy any suspicious areas identified. Certain patients may also require a biopsy technique that involves passing a needle through the skin or vagina into the urethral growth. The biopsy tissue is then sent to the pathologist for examination under a microscope to confirm the diagnosis. Before the patient awakens from anesthesia, the urologist will perform a thorough examination to determine the local extent of the tumor.

Once urethral cancer is found, the extent of disease is categorized (i.e. staged) based on how deeply the tumor has penetrated the tissues surrounding the urethra (Table 1). More tests will be performed to find out if cancer cells have spread to other parts of the body. A CT scan of the abdomen and pelvis may be performed in order to examine the lymph nodes that collect drainage from the urethra. An MRI may be performed in order to examine the local extent of the tumor. A chest X-ray is usually obtained to ensure that the tumor has not spread to the lungs, and select patients may require a bone scan to look for bony metastases. If the urethral cancer is classified as transitional cell carcinoma, the patient will undergo either excretory urography or retrograde pyelography to image the lining of the kidney and ureter to ensure there are no other sites of cancer.

How is urethral cancer treated?

There are treatment options for all patients diagnosed with urethral cancer. These options may be divided into three categories: surgery, radiation and chemotherapy. Surgery is the most common treatment for cancer of the urethra. There are several surgical techniques that may be used. The tumor may be removed endoscopically, meaning using an instrument such as a cystoscope or a resectoscope, which does not require a skin incision. Some patients may require conventional surgery to remove the affected area. Certain men with a tumor that involves only part of the urethra closest to the outside of the body (anterior urethra) may require removal of part of the penis that contains the tumor (partial penectomy) or even removal of the entire penis (penectomy). For patients with tumors that involve the part of the urethra that connects to the bladder (posterior urethra) more extensive surgery may be required. In men with this type of tumor the bladder and prostate, as well as the penis, may be removed. In women with this type of tumor surgery to remove the urethra, bladder and part of the vagina may be required. For the men and women undergoing these extensive surgeries lymph nodes in the pelvis are often removed as well. If the urethra is removed, the urologist will construct a new way for the urine to pass from the body, a procedure known as urinary diversion.

Radiation therapy destroys cancer cells with high-energy radiation. Radiation therapy may be used alone or in conjunction with surgery or chemotherapy. Although radiation therapy may allow the patient to retain his or her urethra and surrounding organs, this method of treatment is not without complications.

Chemotherapy kills cancer cells with drugs. Chemotherapy may be used alone in patients with metastatic tumors or in conjunction with surgery or radiation therapy in patients with locally advanced disease. Chemotherapy may kill cancer cells not just at the site of the tumor in the urethra, but also at sites where the tumor might have spread.

What to expect after treatment?

Despite aggressive therapy with chemotherapy, radiation therapy and surgery, recurrence of urethral cancer following treatment is not uncommon. For this reason, patients with this condition require life-long follow-up with a physician. Only with early recognition of recurrence and prompt initiation of appropriate therapy in such cases is prolonged survival possible.

Frequently Asked Questions

What determines if urethral cancer can be treated with local excision vs. a more radical surgical procedure?

In general, urethral cancers that involve the anterior urethra (part of the urethra closest to the outside) are more often successfully treated with local surgery. Tumors that involve the posterior urethra (part of the urethra closest to the bladder) often require more radical surgery to ensure optimal outcome.

What are the chances of urethral cancer coming back following treatment?

The likelihood of urethral cancer recurring following treatment depends on both the stage and location of the initial tumor. For patients with low stage disease, the five-year disease specific survival rate approaches 90 percent; patients with high stage disease have a survival rate of 33 percent. For patients with tumor located in the anterior urethra regardless of stage, the five-year disease specific survival is 60 to 70 percent, whereas for patients with tumor located in the posterior urethra regardless of stage, the five-year survival rate is less than 25 percent.

If my bladder was surgically removed due to bladder cancer, can I still develop urethral cancer?

Yes, patients who undergo cystectomy for bladder cancer may still develop cancer of the urethra. For this reason, it is important for these patients to maintain close follow-up with their urologist. These patients will require periodic cytologic evaluation of urethral washings, and if cancerous cells are found in these washings a urethrectomy may be required.

Table 1 - TNM Staging of Urethral Cancer

Primary Tumor (T)
Tx	Primary tumor cannot be assessed
T0	No evidence of primary tumor
Ta	Noninvasive papillary, polypoid or verrucous carcinoma
Tis	Carcinoma in situ
T1	Tumor invades subepithelial connective tissue
T2	Tumor invades corpus spongiosum, prostate or periurethral muscle
T3	Tumor invades corpus cavernosum, beyond prostatic capsule, anterior vagina or bladder neck
T4	Tumor invades other adjacent organs
Regional Lymph Nodes (N)
Nx	Regional lymph nodes cannot be assessed
N0	No regional lymph node metastasis
N1	Metastases in a single lymph node, 2 cm or less in greatest dimension
N2	Metastases in a single node more than 2 cm in greatest dimension, or in multiple nodes
Distant Metastases (M)
Mx	Distant metastases cannot be assessed
M0	No distant metastases
M1	Distant metastases

Reviewed June, 2004

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Glossary Terms

abdomen:
	Also referred to as the belly. It is the part of the body that contains all of the internal structures between the chest and the pelvis.
anesthesia:
	Loss of sensation in any part of the body induced by a numbing or paralyzing agent. Often used during surgery to put a person to sleep.
anterior:
	At or near the front.
biopsy:
	A procedure in which a tiny piece of a body part (tissue sample), such as the kidney or bladder, is removed (with a needle or during surgery) for examination under a microscope; to determine if cancer or other abnormal cells are present.
bladder:
	The balloon-shaped pouch of thin, flexible muscle in which urine is temporarily stored before being discharged through the urethra.
bladder neck:
	Area of thickened muscle fiber where the bladder joins the urethra. Acting on signals from the brain, bladder neck muscles can either tighten to hold urine in the bladder or relax to allow urine out and into the urethra. These muscles also tighten during ejaculation to prevent backflow of semen into the bladder.
cancer:
	An abnormal growth that can invade nearby structures and spread to other parts of the body and may be a threat to life.
carcinoma:
	Cancer that begins in the skin or in tissues that line or cover body organs.
caruncle:
	Fleshy growth.
chemotherapy:
	Treatment with medications that kill cancer cells or stop them from spreading.
chronic:
	Lasting a long time. Chronic diseases develop slowly. Chronic renal (kidney) failure may develop over many years and lead to end-stage renal (kidney) disease.
corpus spongiosum:
	A column of erectile tissue in the center of the penis and surrounding the urethra. When filled with blood it enlarges and causes the penis to swell and become erect.
CT scan:
	Also known as computerized tomography, computerized axial tomography or CT scan. A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce cross-sectional images of the body. Shows detailed images of any part of the body, including bones, muscles, fat and organs. CT scans are more detailed than general X-rays.
cyst:
	An abnormal sac containing gas, fluid or a semisolid material. Cysts may form in kidneys or other parts of the body.
cystectomy:
	Surgical removal of the bladder.
cystoscope:
	A narrow, tube-like instrument fitted with lenses and a light passed through the urethra to look inside the bladder. The procedure is called cystoscopy (sis-TAW-skuh-pee).
cytologic evaluation:
	Refers to microscopic analysis of cells to evaluate their formation, origin, structure, function, biochemical activities and pathology. This test is commonly used to look for cancers.
diverticulum:
	A pouch or sac in the lining of the mucous membrane of an organ.
endoscopically:
	Using an endoscope, a lighted medical instrument consisting of a long tube inserted into the body, usually through a small incision.
epithelium:
	The outside layer of cells.
excision:
	Surgical cut.
excretory:
	unwanted or undigestable matter.
excretory urography:
	A test to evaluate the kidneys, urinary tract and bladder. Medicine is given through an intravenous line (IV). This medicine moves through the body and is ultimately concentrated in the kidneys. A series of X-rays are taken, and are viewed by the radiologist to evaluate the kidneys, urinary tract and bladder.
gene:
	The basic unit capable of transmitting characteristics from one generation to the next.
general anesthesia:
	Person is put to sleep with muscle relaxation and no pain sensation over the entire body.
gland:
	A mass of cells or an organ that removes substances from the bloodstream and excretes them or secretes them back into the blood with a specific physiological purpose.
HPV:
	Also known as human papilloma virus. One of the most common causes of sexually transmitted disease.
human papilloma virus:
	Also known as HPV. One of the most common causes of sexually transmitted disease.
incision:
	Surgical cut for entering the body to perform an operation.
infection:
	A condition resulting from the presence of bacteria or other microorganisms.
inflammation:
	Swelling, redness, heat and/or pain produced in the area of the body as a result of irritation, injury or infection.
invasive:
	Having or showing a tendency to spread from the point of origin to adjacent tissue, as some cancers do. Involving cutting or puncturing the skin or inserting instruments into the body.
ions:
	Electrically charged atoms.
kidney:
	One of two bean-shaped organs that filter wastes from the blood and discharge these waste products in urine. The kidneys are located near the middle of the back. The kidneys send urine to the bladder through tubes called ureters.
local anesthesia:
	Loss of sensation only in one part of the body induced by application of an anesthetic agent.
lymph:
	Fluid containing white cells. It can transport bacteria, viruses and cancer cells.
lymph nodes:
	Small rounded masses of tissue distributed along the lymphatic system most prominently in the armpit, neck and groin areas. Lymph nodes produce special cells that help fight off foreign agents invading the body. Lymph nodes also act as traps for infectious agents.
malignancy:
	A cancerous growth.
metastases:
	The spread of a cancerous tumor to another part of the body.
metastasis:
	The spreading of a cancerous tumor to another part of the body.
metastatic:
	Cancer that has metastasized, in other words, spread to other parts of the body.
MRI:
	Also referred to a magnetic resonance imaging. A diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body.
pathologist:
	A scientist who is skilled in identifying the cause and progress of diseases by examining tissue and fluid from the body. Especially one who determines the cause of someone's death by conducting an autopsy.
pelvis:
	The bowl-shaped bone that supports the spine and holds up the digestive, urinary, and reproductive organs. The legs connect to the body at the pelvis.
penis:
	The male organ used for urination and sex.
polyp:
	Small, stalk-like growth sticking out from the skin or from a mucous membrane.
posterior:
	Situated at the rear or behind something.
prostate:
	In men, a walnut-shaped gland that surrounds the urethra at the neck of the bladder. The prostate supplies fluid that goes into semen.
prostatic:
	Pertaining to the prostate.
pus:
	The yellowish or greenish fluid that forms at sites of infection.
radiation:
	Also referred to as radiotherapy. X-rays or radioactive substances used in treatment of cancer.
radiation therapy:
	Also referred to as radiotherapy or radiation. X-rays or radioactive substances used in treatment of cancer.
radical:
	Complete removal.
regional anesthesia:
	Loss of sensation in the region of the body produced by application of an anesthetic agent to all nerves supplying that region.
resectoscope:
	A tube-shaped instrument used by the urologist to scoop a tumor from the bladder lining.
retrograde:
	Backwards.
retrograde pyelography:
	Radiographic imaging of the ureters and collecting system of the kidneys by introducing a dye opaque to X-rays by way of urinary catheter.
sexually transmitted diseases:
	Also referred to as STDs. Any of a diverse group of infections caused by biologically dissimilar pathogens and transmitted by sexual contact.
stage:
	Classification of the progress of a disease.
stricture:
	Abnormal narrowing of a body passage.
stricture disease:
	Condition where there is an abnormal narrowing of a body opening.
tissue:
	Group of cells in an organism that are similar in form and function.
transitional cell carcinoma:
	A type of cancer that develops in the lining of the bladder, ureter or renal pelvis.
tumor:
	An abnormal mass of tissue or growth of cells.
ureter:
	One of two tubes that carry urine from the kidneys to the bladder.
urethra:
	In males, this narrow tube carries urine from the bladder to the outside of the body and also serves as the channel through which semen is ejaculated. Extends from the bladder to the tip of the penis. In females, this short, narrow tube carries urine from the bladder to the outside of the body.
urethral:
	Relating to the urethra, the tube tha carries urine from the bladder to outside the body.
urethral diverticulum:
	A sac-like or tubular growth caused by a weakened area in the urethra.
urethral stricture:
	Scarring of tissue that causes narrowing or blockage of the canal leading from the bladder, discharging the urine externally.
urethral stricture disease:
	Scarring and narrowing at one or more points in the urethra and of variable severity.
urethrectomy:
	Excision of a segment or the entire urethra.
urethroscopy:
	Inspection of the urethra with a urethroscope.
urge:
	Strong desire to urinate.
urinary:
	Relating to urine.
urinary diversion:
	A term used when the bladder is removed or the normal structures are being bypassed and an opening is made in the urinary system to divert urine. The flow of urine is diverted through an opening in the abdominal wall.
urinary tract:
	The system that takes wastes from the blood and carries them out of the body in the form of urine. Passageway from the kidneys to the ureters, bladder and urethra.
urinary tract infection:
	Also referred to as UTI. An illness caused by harmful bacteria, viruses or yeast growing in the urinary tract.
urination:
	The passing of urine.
urine:
	Liquid waste product filtered from the blood by the kidneys, stored in the bladder and expelled from the body through the urethra by the act of urinating (voiding). About 96 percent of which is water and the rest waste products.
urologist:
	A doctor who specializes in diseases of the male and female urinary systems and the male reproductive system. Click here to learn more about urologists. Click here to view the brochure in zinio format. (Download the free Zinio reader or the free Acrobat reader.)
vagina:
	The tube in a woman's body that runs beside the urethra and connects the uterus (womb)to the outside of the body. Sometimes called the birth canal. Sexual intercourse, the outflow of blood during menstruation and the birth of a baby all take place through the vagina.

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