What is Urethral Cancer?

Female Urinary Tract
Female Urinary Tract
Medical Illustration Copyright © 2015 Nucleus Medical Media, All rights reserved

Male Urinary Tract
Male Urinary Tract
Medical Illustration Copyright © 2015 Nucleus Medical Media, All rights reserved

Urethral cancer is the most rare of all urological cancer. Only 1 or 2 people out of 100 patients with cancer get this type. It is more common in men than women. Some people with urethral cancer don’t have any symptoms, but most do. This information will tell you more about urethral cancer, how it’s diagnosed and treatment options.

What is the Urethra?

The urethra is a hollow tube that lets urine pass from the bladder, the organ that stores urine until ready for release, to the outside of the body. In men the urethra is about 8 inches long, and passes through the prostate to the end of the penis. In women the urethra is about 1.5 inches long, and opens to the outside just above the vaginal opening.



What are the Symptoms of Urethral Cancer?

In the early stages there may not be many symptoms. As the cancer grows, some patients may notice a lump or growth on the urethra. Others may notice pain or bleeding when they urinate. If the tumor narrows or restricts the urethra, you may have trouble voiding, or you may pass blood from the urethra.



What Causes Urethral Cancer?

The exact cause of urethral cancer is not known. But longtime swelling and infection may add to the risk. Many men with urethral cancer have been treated before for urethral stricture disease or sexually transmitted infections. Many women with urethral cancer have been treated before for urethral caruncle (mass), urethral diverticulum (outpouching) or chronic UTI. In both men and women, human papilloma virus (HPV) has been linked to urethral cancer.

Even if you have had your bladder removed for bladder cancer, urethral cancer may still develop. Routine check-ups with your urologist is key to staying healthy. If cancer cells are found, you may need part or all of the urethra removed.



How is Urethral Cancer Diagnosed?

A urologist will do a physical exam and ask you for your health record. He or she will ask you about other health issues that may relate to urethral cancer, such as:

The urologist will then check the urethra, feeling for any abnormalities. They may also take urine, blood and other tests. For example:

Cystoscopy

The urologist may also use a small, lighted tool called a cystoscope to see the inside of the urethra. This is most often done as an outpatient procedure with local anesthesia. If the urologist sees something atypical, you will need a biopsy. For more information on this procedure please visit our Cystoscopy article.

Tissue Biopsy

A tissue biopsy is needed to diagnose urethral cancer. It is not easy to do with local anesthesia, so you will likely be scheduled to return for a biopsy using general anesthesia. The urologist will take tissue samples from any suspicious zones.

Some patients may also need a certain biopsy that involves passing a needle through the skin or vagina into the urethral growth. A tissue sample is then sent to the pathologist to look at under a microscope to confirm the diagnosis. Before you wake up from anesthesia, the urologist will do a thorough exam to learn the extent of the tumor.

If the urologist diagnoses cancer, they may order imaging and other tests to see exactly where and how far the cancer has spread.



What are the Grades and Stages of Urethral Cancer?

If cancer cells are found, your doctor will need to know the tumor stage and grade. Then the health care team can develop a treatment plan.

Grading

The grade tells how fast the tumor can grow and spread. The most common grading systems use 2 main grades:

  • Low-grade tumors grow more slowly. Though they may come back (recur) after treatment, they rarely spread to other parts of the body. The cells of low-grade tumors have only minor differences from normal cells.
  • High-grade tumors grow more quickly. They often recur after treatment and are more likely to spread to other parts of the body. The cells are disorganized and look abnormal.

Staging

Your doctor must learn if the cancer cells have spread. This is called staging. Your doctor wants to find out:

  • If the tumor has entered nearby tissues
  • If the cancer has spread to other parts of the body

In general, a higher stage cancer (4 is the highest) is more serious. The table lists the stages using the TNM (Tumor, Node, Metastasis) system.

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 nearby organs (i.e. bladder)

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 smaller

N2

Metastases in a single node 2 to 5 cm, or in multiple nodes (none larger than 5 cm)

N3

Metastases in lymph node larger than 5 cm

Distant Metastases (M)

Mx

Distant metastases cannot be assessed

M0

No distant metastases

M1

Distant metastases

More tests can be done to find out if cancer cells have spread to other parts of the body, such as:

  • CT scan of the abdomen and pelvis: to check the lymph nodes that collect drainage from the urethra
  • MRI: to look at the local extent of the tumor
  • Chest X-ray: to make sure that the tumor has not spread to the lungs
  • Bone scan: may be needed to see if it has spread to your bones.
  • Excretory urography or retrograde pyelography: if the urethral cancer is a certain type called transitional cell carcinoma, this is used to see the lining of the kidney and ureter to make sure there are no other sites of cancer.


How is Urethral Cancer Treated?



Surgery for Treatment for Urethral Cancer

Surgery is the most common treatment for cancer of the urethra. There are many different methods that can be used, depending on whether the cancer is superficial or invasive.

Superficial Cancers
If the tumor has not grown into nearby tissues, it may be removed with a tool such as a cystoscope. The tool is moved into the urethra, and an electrical loop can be used to remove the tumor.

Invasive Tumors
Some patients may need surgery to remove the growth. Most of the time, urethral cancers in the anterior urethra (the part closest to the outside) are treated well with local surgery. Tumors that involve the posterior urethra (the part closest to the bladder) often need more radical surgery to get the best result.

Anterior Urethra in Men

Men with a tumor that involves only this part of the urethra (inside the penis) may need part or the whole penis removed. This depends on where the tumor is and how it can be removed. The goal is to leave enough tissue to allow a man to stand while urinating. If the tumor is growing into the erectile tissues of the penis, the whole penis may need to be removed. In this case, a small hole is made on the underside of the scrotum to allow voiding. This means the patient will sit to urinate.

Posterior Urethra in Men

If the tumor is in this area, the bladder and prostate, part of the bony pelvis, and the penis are at risk. If surgery is needed to remove these organs, a piece of bowel is used to make a pouch. The kidneys can then drain into the pouch.

This pouch can either be incontinent (you will need to wear a stoma bag) or continent (you will need to drain the pouch several times a day with a small catheter). Deciding which type depends on other health issues you have and your preference. For more information on Urinary Diversion please visit our Conditions Page.

Posterior Urethra in Women

With this type of tumor, surgery is needed. Because the female urethra is so short, it is rare to have a tumor small enough and far enough away from the urethral sphincter (the muscle that controls the release of urine) to remove it and still be able urinate normally.

The outermost third (or about 7 mm) of the urethra can be removed without too much trouble. Unfortunately, most women with urethral cancer need more involved surgery. The urethra, bladder and a part of the vagina are often removed. A pouch can be made with bowel for the kidneys to drain into. This pouch would then be used to remove urine from the body.

Lymph Node Removal

The lymph nodes in the pelvis are often removed in both men and women undergoing these surgeries. Some people may have leg swelling. This happens because these nodes usually drain the fluid that seeps out of the blood vessels into the legs. Once these nodes are removed, fluid can build up. If this becomes bothersome, consult your health care provider.



Radiation Therapy for Treatment for Urethral Cancer

Radiation destroys cancer cells. Radiation therapy may be used alone, with surgery, or with chemotherapy. Though it may allow you to keep your urethra and nearby organs, this method has side effects such as:

  • Bladder pain
  • Incontinence
  • Bleeding
  • Rectal (or vaginal in women) pain and bleeding
  • Narrowing of the urethra, causing signs of urine blockage


Chemotherapy for Treatment for Urethral Cancer

These drugs kill cancer cells. Chemotherapy is most often used when the cancer has spread to other organs or parts of the body. It may be offered before surgery or radiation. It can also be used after other treatments to help kill cells outside the zone targeted by the surgery or radiation.

The type of drug used depends on:

  • The risk of the tumor spreading
  • The amount of metastasis (tumors outside the urethra)
  • The specific type of tumor (made of urothelial or squamous cells)

Each chemotherapy drug has side effects. Patients are watched very closely by an oncologist (a doctor who focuses on cancer treatment) to prevent major problems.



Surgery for Treatment for Urethral Cancer

Surgery is the most common treatment for cancer of the urethra. There are many different methods that can be used, depending on whether the cancer is superficial or invasive.

Superficial Cancers
If the tumor has not grown into nearby tissues, it may be removed with a tool such as a cystoscope. The tool is moved into the urethra, and an electrical loop can be used to remove the tumor.

Invasive Tumors
Some patients may need surgery to remove the growth. Most of the time, urethral cancers in the anterior urethra (the part closest to the outside) are treated well with local surgery. Tumors that involve the posterior urethra (the part closest to the bladder) often need more radical surgery to get the best result.

Anterior Urethra in Men

Men with a tumor that involves only this part of the urethra (inside the penis) may need part or the whole penis removed. This depends on where the tumor is and how it can be removed. The goal is to leave enough tissue to allow a man to stand while urinating. If the tumor is growing into the erectile tissues of the penis, the whole penis may need to be removed. In this case, a small hole is made on the underside of the scrotum to allow voiding. This means the patient will sit to urinate.

Posterior Urethra in Men

If the tumor is in this area, the bladder and prostate, part of the bony pelvis, and the penis are at risk. If surgery is needed to remove these organs, a piece of bowel is used to make a pouch. The kidneys can then drain into the pouch.

This pouch can either be incontinent (you will need to wear a stoma bag) or continent (you will need to drain the pouch several times a day with a small catheter). Deciding which type depends on other health issues you have and your preference. For more information on Urinary Diversion please visit our Conditions Page.

Posterior Urethra in Women

With this type of tumor, surgery is needed. Because the female urethra is so short, it is rare to have a tumor small enough and far enough away from the urethral sphincter (the muscle that controls the release of urine) to remove it and still be able urinate normally.

The outermost third (or about 7 mm) of the urethra can be removed without too much trouble. Unfortunately, most women with urethral cancer need more involved surgery. The urethra, bladder and a part of the vagina are often removed. A pouch can be made with bowel for the kidneys to drain into. This pouch would then be used to remove urine from the body.

Lymph Node Removal

The lymph nodes in the pelvis are often removed in both men and women undergoing these surgeries. Some people may have leg swelling. This happens because these nodes usually drain the fluid that seeps out of the blood vessels into the legs. Once these nodes are removed, fluid can build up. If this becomes bothersome, consult your health care provider.



Radiation Therapy for Treatment for Urethral Cancer

Radiation destroys cancer cells. Radiation therapy may be used alone, with surgery, or with chemotherapy. Though it may allow you to keep your urethra and nearby organs, this method has side effects such as:

  • Bladder pain
  • Incontinence
  • Bleeding
  • Rectal (or vaginal in women) pain and bleeding
  • Narrowing of the urethra, causing signs of urine blockage


Chemotherapy for Treatment for Urethral Cancer

These drugs kill cancer cells. Chemotherapy is most often used when the cancer has spread to other organs or parts of the body. It may be offered before surgery or radiation. It can also be used after other treatments to help kill cells outside the zone targeted by the surgery or radiation.

The type of drug used depends on:

  • The risk of the tumor spreading
  • The amount of metastasis (tumors outside the urethra)
  • The specific type of tumor (made of urothelial or squamous cells)

Each chemotherapy drug has side effects. Patients are watched very closely by an oncologist (a doctor who focuses on cancer treatment) to prevent major problems.



What Can Be Expected after Treatment?

Even after aggressive therapy with chemotherapy, radiation therapy and surgery, urethral cancer may come back. It is important to have lifelong follow-up visits with your health care team. It is important to catch recurrence early, so once or twice per year visits are recommended for:

If you still have your urethra you will need more frequent follow up visits. You are recommended to visit your doctor every 3 months after the procedure for:

Recurrence

The likelihood of urethral cancer coming back after treatment depends on the stage and location of the initial tumor. The chance of cancer returning is lower with low stage disease, and in the anterior urethra.