Urethral Cancer Diagnosis, Symptoms & Treatment

Urethral cancer facts*

*Urethral cancer facts by John P. Cunha, DO, FACOEP

Urethral cancer is a disease in which malignant (cancer) cells form in the tissues of the urethra, the tube that carries urine from the bladder to outside the body. It is a rare cancer that occurs more often in women than in men.
Squamous cell carcinoma is the most common type of urethral cancer. Other types of urethral cancer include transitional cell carcinoma and adenocarcinoma.
Risk factors for urethral cancer include having a history of bladder cancer, sexually transmitted diseases (STDs), frequent urinary tract infections (UTIs), being 60 or older, and being a white female.
Symptoms of urethral cancer include bleeding from the urethra or blood in the urine, weak or interrupted ("stop-and-go") flow of urine, frequent urination, a lump or thickness in the perineum or penis, discharge from the urethra, and enlarged lymph nodes in the groin area.
Tests to diagnose urethral cancer include blood and urine tests, tissue sample biopsies, pelvic and rectal exams, and cystoscopy.
Treatments for urethral cancer include surgery, radiation therapy, and chemotherapy.
The prognosis depends on the stage and size of the cancer, where in the urethra the cancer first formed, the patient's general health, and whether the cancer has just been diagnosed or has recurred.

Sign of Urethral Cancer

Blood in urine

Hematuria, or blood in the urine, can be either gross (visible) or microscopic (blood cells only visible through a microscope). Gross hematuria can vary widely in appearance, from light pink to deep red with clots. Although the amount of blood in the urine may be different, the types of conditions that can cause the problem are the same, and require the same kind of workup or evaluation.

People with gross hematuria will visit their doctor with this as a primary complaint. People who have microscopic hematuria, on the other hand, will be unaware of a problem and their condition will most commonly be detected as part of a periodic checkup by a primary-care physician.

Learn more about blood in urine »

Urethral cancer is a disease in which malignant (cancer) cells form in the tissues of the urethra.

The urethra is the tube that carries urine from the bladder to outside the body. In women, the urethra is about 1½ inches long and is just above the vagina. In men, the urethra is about 8 inches long, and goes through the prostate gland and the penis to the outside of the body. In men, the urethra also carries semen.

Urethral cancer is a rare cancer that occurs more often in women than in men.

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

These cancers are named for the types of cells that become malignant (cancer):

Squamous cell carcinoma is the most common type of urethral cancer. It forms in 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 glands that are around the urethra in both men and women.

Urethral cancer can metastasize (spread) quickly to tissues around the urethra and is often found in nearby lymph nodes by the time it is diagnosed.

A history of bladder cancer can affect the risk of urethral cancer.

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).

QUESTION

Cancer is the result of the uncontrolled growth of abnormal cells anywhere in the body.
See Answer

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.

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.

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Distal urethral cancer

Treatment of abnormal cells in the mucosa (inside lining of the urethra that have not become cancer, may include surgery to remove the tumor (open excision or transurethral resection), electroresection with fulguration, or laser surgery.

Treatment of distal urethral cancer is different for men and women.

For women, treatment may include the following:

Surgery to remove the tumor (transurethral resection), electroresection and fulguration, or laser surgery for tumors that have not spread deeply into tissue.
Brachytherapy and/or external radiation therapy for tumors that have not spread deeply into tissue.
Surgery to remove the tumor (anterior exenteration) for tumors that have spread deeply into tissue. Sometimes nearby lymph nodes are also removed (lymph node dissection). Radiation therapy may be given before surgery.

For men, treatment may include the following:

Surgery to remove the tumor (transurethral resection), electroresection and fulguration, or laser surgery for tumors that have not spread deeply into tissue.
Surgery to remove part of the penis (partial penectomy) for tumors that are near the tip of the penis. Sometimes nearby lymph nodes are also removed (lymph node dissection).
Surgery to remove part of the urethra for tumors that are in the distal urethra but not at the tip of the penis and have not spread deeply into tissue. Sometimes nearby lymph nodes are also removed (lymph node dissection).
Surgery to remove the penis (radical penectomy) for tumors that have spread deeply into tissue. Sometimes nearby lymph nodes are also removed (lymph node dissection).
Radiation therapy with or without chemotherapy.
Chemotherapy given together with radiation therapy.

Proximal urethral cancer

Treatment of proximal urethral cancer or urethral cancer that affects the entire urethra is different for men and women.

For women, treatment may include the following:

Radiation therapy and/or surgery (open excision, transurethral resection) for tumors that are ¾ of an inch or smaller.
Radiation therapy followed by surgery (anterior exenteration with lymph node dissection and urinary diversion).

For men, treatment may include the following:

Radiation therapy or radiation therapy and chemotherapy, followed by surgery (cystoprostatectomy, penectomy, lymph node dissection, and urinary diversion).

Urethral cancer that forms with invasive bladder cancer

Treatment of urethral cancer that forms at the same time as invasive bladder cancer may include the following:

Surgery (cystourethrectomy in women, or urethrectomy and cystoprostatectomy in men).

If the urethra is not removed during surgery to remove the bladder, treatment may include the following:

Active surveillance. Samples of cells are taken from inside the urethra and checked under a microscope for signs of cancer.

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Metastatic or recurrent urethral cancer

Treatment of urethral cancer that has metastasized (spread to other parts of the body) is usually chemotherapy.

Treatment of recurrent urethral cancer may include one or more of the following:

Surgery to remove the tumor. Sometimes nearby lymph nodes are also removed (lymph node dissection).
Radiation therapy.