Urethral cancer is a rare

cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal bl ...

originating from the

urethra The urethra (from Greek οὐρήθρα – ''ourḗthrā'') is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males. In human females and other primates, the urethra ...

. The disease has been classified by the

TNM staging system The TNM Classification of Malignant Tumors (TNM) is a globally recognised standard for classifying the extent of spread of cancer. It is a classification system of the anatomical extent of tumor cancers. It has gained wide international acceptanc ...

and the

World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of ...

. Symptoms include

blood in the urine Hematuria or haematuria is defined as the presence of blood or red blood cells in the urine. “Gross hematuria” occurs when urine appears red, brown, or tea-colored due to the presence of blood. Hematuria may also be subtle and only detectable ...

, lump at end of penis, or bloody penile discharge. Diagnosis is established by transurethral biopsy. The most common type is papillary

urothelial carcinoma Transitional epithelium also known as urothelium is a type of stratified epithelium. Transitional epithelium is a type of tissue that changes shape in response to stretching (stretchable epithelium). The transitional epithelium usually appears ...

. Risk factors suggested include prolonged irritations of the urethra due to

urinary catheterization In urinary catheterization a latex, polyurethane, or silicone tube known as a urinary catheter is inserted into the bladder through the urethra to allow urine to drain from the bladder for collection. It may also be used to inject liquids used ...

, chronic inflammation due to infection, radiation, diverticula of the urethra, and urethral strictures.

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 Lymphadenopathy or adenopathy is a disease of the lymph nodes, in which they are abnormal in size or consistency. Lymphadenopathy of an inflammatory type (the most common type) is lymphadenitis, producing swollen or enlarged lymph nodes. In cl ...

or pain in the groin or vaginal area.

Diagnosis

Diagnosis is established by transurethral biopsy and histological findings. Bladder cystoscopy is performed to detect if there is simultaneous bladder cancer.

Histology

Types of urethral cancer include the most common type

, and others including

squamous cell carcinoma Squamous-cell carcinomas (SCCs), also known as epidermoid carcinomas, comprise a number of different types of cancer that begin in squamous cells. These cells form on the surface of the skin, on the lining of hollow organs in the body, and on the ...

, and

adenocarcinoma Adenocarcinoma (; plural adenocarcinomas or adenocarcinomata ) (AC) is a type of cancerous tumor that can occur in several parts of the body. It is defined as neoplasia of epithelial tissue that has glandular origin, glandular characteristics, or b ...

. Melanoma and sarcoma are rare.

Staging

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

Treatment

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 Laser surgery is a type of surgery that uses a laser (in contrast to using a scalpel) to cut tissue. Examples include the use of a laser scalpel in otherwise conventional surgery, and soft-tissue laser surgery, in which the laser beam vapo ...

, Cystourethrectomy, Cystoprostatectomy, Anterior body cavity, or Incomplete or basic

penectomy Penectomy is penis removal through surgery, generally for medical or personal reasons. Medical reasons for penectomy Cancer, for example, sometimes necessitates removal of part or all of the penis. The amount of penis removed depends on the ...

surgery. Radiation therapy has also been used in some cases.

Chemotherapy Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs ( chemotherapeutic agents or alkylating agents) as part of a standardized chemotherapy regimen. Chemother ...

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 Metastasis is a pathogenic agent's spread from an initial or primary site to a different or secondary site within the host's body; the term is typically used when referring to metastasis by a cancerous tumor. The newly pathological sites, then, ...

. Commonly used drugs include

cisplatin Cisplatin is a chemotherapy medication used to treat a number of cancers. These include testicular cancer, ovarian cancer, cervical cancer, breast cancer, bladder cancer, head and neck cancer, esophageal cancer, lung cancer, mesothelioma, b ...

vincristine Vincristine, also known as leurocristine and marketed under the brand name Oncovin among others, is a chemotherapy medication used to treat a number of types of cancer. This includes acute lymphocytic leukemia, acute myeloid leukemia, Hodgkin's ...

, and

methotrexate Methotrexate (MTX), formerly known as amethopterin, is a chemotherapy agent and immune-system suppressant. It is used to treat cancer, autoimmune diseases, and ectopic pregnancies. Types of cancers it is used for include breast cancer, le ...

. Side effects include

anemia Anemia or anaemia (British English) is a blood disorder in which the blood has a reduced ability to carry oxygen due to a lower than normal number of red blood cells, or a reduction in the amount of hemoglobin. When anemia comes on slowly, ...

(causing

fatigue Fatigue describes a state of tiredness that does not resolve with rest or sleep. In general usage, fatigue is synonymous with extreme tiredness or exhaustion that normally follows prolonged physical or mental activity. When it does not resolve ...

weakness Weakness is a symptom of a number of different conditions. The causes are many and can be divided into conditions that have true or perceived muscle weakness. True muscle weakness is a primary symptom of a variety of skeletal muscle diseases, i ...

), nausea and vomiting,

loss of appetite Anorexia is a medical term for a loss of appetite. While the term in non-scientific publications is often used interchangeably with anorexia nervosa, many possible causes exist for a loss of appetite, some of which may be harmless, while others i ...

hair loss Hair loss, also known as alopecia or baldness, refers to a loss of hair from part of the head or body. Typically at least the head is involved. The severity of hair loss can vary from a small area to the entire body. Inflammation or scarri ...

, mouth sores, increased risk for infection, shortness of breath, or excessive bleeding and bruising.Urethral Cancer Treatment
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Epidemiology

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. Around half of affected people have locally advanced disease when they first present. 54–65% of cases are of the urothelial carcinoma type. Prolonged irritations of the urethra due to

, 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

(SCC) and genital lichen sclerosus.

Prognosis

A study of the National Cancer Database in the United States assessed cases of primary urethral cancer from 2004 to 2013, finding that median survival was 49 months with 5- and 10-year survival rates estimated at 46% and 31% respectively. A study of the RARECARE project, aimed at investigating rare cancers in Europe, estimated a 5-year relative survival rate of 54% in patients with cancer of the urethra.

References

External links

{{Urologic neoplasia Rare cancers Urological neoplasia Urethra de:Urothelkarzinom