Urethral cancer (patient information)

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shanshan Cen, M.D. [2], Vindhya BellamKonda, M.B.B.S [3]

Urethral cancer is a rare cancer that occurs more often in men than in women. There are three types of urethral cancer. Squamous cell carcinoma is the most common type. It forms in the flat cells that line the urethra. Transitional cell carcinoma forms in cells near the urethral opening in women and in the part of the urethra that goes through the prostate gland in men. These cells change shape and stretch as urine passes out of the body. Adenocarcinoma forms in the glands near the urethra. These glands make and release mucus and other fluids.

Urethral cancer can metastasize (spread) quickly to tissues around the urethra and has often spread to nearby lymph nodes by the time it is diagnosed. Signs of urethral cancer include bleeding or trouble urinating.

Signs of urethral cancer include bleeding or trouble with urination.

These and other signs and symptoms may be caused by urethral cancer or by other conditions. There may be no signs or symptoms in the early stages. Check with your doctor if you have any of the following:

• Trouble starting the flow of urine.
• Weak or interrupted (“stop-and-go”) 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.

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Risk factors for urethral cancer include the following:

• Having a history of bladder cancer.
• Having conditions that cause chronic inflammation in the urethra, including:
• Sexually transmitted diseases (STDs), including human papillomavirus (HPV), especially HPV type 16
• Frequent urinary tract infections (UTIs)

Tests that examine the urethra and bladder are used to detect (find) and diagnose urethral cancer.

The following tests and procedures may be used:

• Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
• Pelvic exam : An exam of the vagina, cervix, uterus, fallopian tubes,ovaries, and rectum. A speculum is inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. The doctor or nurse also inserts one or two lubricated, gloved fingers of one hand into the vagina and places the other hand over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.

• Digital rectal exam : An exam of the rectum. The doctor or nurse inserts a lubricated, gloved finger into the lower part 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 : A test 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 : 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): 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. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• Ureteroscopy : A procedure to look inside the ureter and renal pelvis to check for abnormal areas. A ureteroscope is a thin, tube-like instrument with a light and a lens for viewing. The ureteroscope is inserted through the urethra into the bladder, ureter, and renal pelvis. A tool may be inserted through the ureteroscope to take tissue samples to be checked under a microscope for signs of disease.

• Biopsy: 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.

There are different types of treatment for patients with urethral cancer. Four types of standard treatment are used:

• Surgery
• Radiation therapy
• Chemotherapy
• Active surveillance

The prognosis of urethral cancer depends on the following factors:

• Anatomical location
• Size
• Stage
• Depth of invasion

Superficial tumors located in the distal urethra of both the female and male are generally curable. However, deeply invasive lesions are rarely curable by any combination of therapies. In men, the prognosis of tumors in the distal (pendulous) urethra is better than for tumors of the proximal (bulbomembranous) and prostatic urethra, which tend to present at more advanced stages. Likewise, distal urethral tumors tend to occur at earlier stages in women, and they appear to have a better prognosis than proximal tumors.

http://www.cancer.gov/types/urethral/patient/urethral-treatment-pdq

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