Most patients are aged ≥ 50. Certain strains of human papillomavirus Human Papillomavirus (HPV) Infection Human papillomavirus (HPV) infects epithelial cells. Most of the > 100 subtypes infect cutaneous epithelium and cause skin warts; some types infect mucosal epithelium and cause anogenital warts... read more have been implicated in certain cases. Urethral tumors invade adjacent structures early and thus tend to be advanced when diagnosed. External groin or pelvic (obturator) lymph nodes are usually the first sites of metastasis.
Symptoms and Signs of Urethral Cancer
Most women present with hematuria and obstructive voiding symptoms or urinary retention Urinary Retention Urinary retention is incomplete emptying of the bladder or cessation of urination. Urinary retention may be Acute Chronic Causes include impaired bladder contractility, bladder outlet obstruction... read more . Most have a history of urinary frequency Urinary Frequency Urinary frequency is the need to urinate many times during the day, at night (nocturia), or both but in normal or less-than-normal volumes. Frequency may be accompanied by a sensation of an... read more or urethral syndrome (hypersensitivity of the pelvic floor muscles). Most men present with symptoms of urethral stricture Urethral Stricture Urethral stricture is scarring that obstructs the anterior urethral lumen. Urethral stricture can be Congenital Acquired Anything that damages the urethral epithelium or corpus spongiosum can... read more ; only a few present with hematuria or a bloody discharge. Sometimes if the tumor is advanced, a mass is felt.
Diagnosis of Urethral Cancer
Diagnosis is suggested clinically and confirmed by cystourethroscopy and examination under anesthesia (ie, bimanual pelvic examination and possibly vaginal biopsies in females). Biopsy may be required to differentiate urethral carcinoma, prolapse, and caruncle. CT Computed Tomography Imaging tests are often used to evaluate patients with renal and urologic disorders. Abdominal x-rays without radiopaque contrast agents may be done to check for positioning of ureteral stents... read more or MRI Magnetic Resonance Imaging Imaging tests are often used to evaluate patients with renal and urologic disorders. Abdominal x-rays without radiopaque contrast agents may be done to check for positioning of ureteral stents... read more is used for staging.
Treatment of Urethral Cancer
Usually excision or ablation
For superficial or minimally invasive distal tumors in the anterior urethra, treatment is with surgical excision, radiation therapy (interstitial or a combination of interstitial and external beam), fulguration, or laser ablation. Larger and more deeply invasive anterior tumors and proximal tumors in the posterior urethra require multimodal therapy with radical surgery and urinary diversion, usually in combination with chemotherapy and radiation therapy. Surgery includes bilateral pelvic and sometimes inguinal lymph node dissection, often with removal of part of the symphysis pubis and inferior pubic rami.
Prognosis for Urethral Cancer
Prognosis depends on the precise location in the urethra and extent of the cancer, particularly depth of invasion. The 5-year survival rates are > 60% for patients with distal tumors and 10 to 20% for patients with proximal tumors. Recurrence rate is >50%.