Urethral Cancer: Symptoms, Stages, Treatment- Surgery, Radiation Therapy, Chemotherapy
Urethral cancer is a type of cancer which originates in the urethral tissues. The urethra is a tube shaped structure which is responsible for transporting urine from the bladder to excrete outside the body. In females, the urethra is located above the vagina and measures around 1.5 inches in length. In males, the urethra travels via the prostate gland and penis and towards externally to the body and it measures around 8 inches in length. Additionally in men, other than urine, the urethra also transports semen.
Urethral cancer is quite rare and is more common in women than men. Urethral cancer has the ability to spread or metastasize very fast to the surrounding tissues and can also be found in the adjacent lymph nodes. Previous history of bladder cancer and its duration has a bearing on the risk of having urethral cancer in the future.
The standard treatment includes surgery, radiation therapy and chemotherapy.
Types of Urethral Cancer
There are many types of urethral cancer and these types are based on the type of urethral cells in which the cancer originates.
- Squamous Cell Carcinoma: This type of urethral cancer is the most common and it occurs in the urethral cells close to the bladder in females. In males, it occurs in urethral lining of the penis.
- Transitional Cell Carcinoma: This type of urethral cancer originates in the region close to the urethral opening in females; and in males it forms in that region of the urethra which passes through the prostate gland.
- Adenocarcinoma: This type of urethral cancer forms in glands which are located close to the urethra in both males, as well as females.
Depending on where the cancer has developed urethral cancer is described as anterior and posterior urethral cancer.
- Anterior Urethral Cancer: In this type, the tumors present are not that deep and are present in that part of the urethra which is closest to the external side of the body.
- Posterior Urethral Cancer: In this type of urethral cancer, the tumors present are quite deep and are present in the urethral region which is nearest to the bladder. In females, the complete urethra may be involved; whereas in males the prostate gland may be involved.
Risk Factors for Urethral Cancer
- Previous history of bladder cancer.
- Conditions like STDs or UTIs which result in chronic inflammation of the urethra.
- Individuals who are over 60 years or more.
Signs and Symptoms of Urethral Cancer
- Hematuria (blood in the urine).
- Urethral bleeding.
- Urethral discharge.
- Weak urine flow or interrupted urine output.
- Increased frequency of urination.
- Presence of a lump or a feeling of thickness in the penis or perineum.
- Increase in the size of lymph nodes present in the groin region.
Investigations for Urethral Cancer
- Physical exam and medical history.
- Blood tests.
- Biopsy, where a tissue sample is taken and sent to lab for testing for cancer cells.
- Urine cytology where the urine is examined under a microscope to look for any abnormal cells.
- Urinalysis to check for the urine's color and its composition, such as protein, sugar, white blood cells and blood.
- Urine culture is done if white blood cells are present in the urine, as their presence indicates an infection.
- Digital rectal exam is done to check for any abnormal lumps.
- Pelvic exam consists of examining the cervix, vagina, uterus, ovaries, fallopian tubes and rectum to assess the shape, size and position of the uterus and ovaries.
- Cystoscopy is a procedure where a thin tube (cystoscope) is passed into the urethra to check the inside of the urethra and bladder for any abnormal regions. A biopsy can be done during this procedure as well.
Staging Tests for Urethral Cancer
After the diagnosis of urethral cancer is confirmed, there are some tests done to find out the stage of the cancer, i.e. if the cancer is confined to the urethra or whether it has metastasized to other parts of the body. Treatment depends on the stage of the cancer. The investigations done to find out the stages of urethral cancer include:
- CT scan of abdomen and pelvis.
- Chest x-ray.
- MRI (Magnetic Resonance Imaging).
- CBC (Complete Blood Count).
- Blood chemistry tests.
Stages of Urethral Cancer
- Stage 0: Also known as carcinoma in situ, this stage is characterized by the presence of abnormal cells in the internal lining of the urethra. These abnormal cells can turn cancerous and metastasize to the adjacent tissues.
- Stage A: In this stage, the cancer has developed and has metastasized into the tissue layer which is present under the urethral lining.
- Stage B: In this stage, cancer has spread to the muscle surrounding the urethra. In males, the penile tissue encircling the urethra can be involved.
- Stage C: In this stage, the cancer has metastasized past the urethral tissue; and in females it has spread to the vagina, vaginal lips and adjacent muscle. In males, cancer has spread to the penis or adjacent muscle.
- Stage D: Depending on the extent of the cancer, this stage is further divided into Stage D1 and Stage D2:
- Stage D1: In this stage, the cancer has metastasized to the adjacent lymph nodes in the groin and pelvic region.
- Stage D2: In this stage the cancer has metastasized to faraway lymph nodes/ organs in the body (bone, liver, lungs).
Treatment for Urethral Cancer
Treatment depends on the stage of the cancer, patient's overall health and his/her treatment preferences. The standard treatment consists of:
Surgery for Urethral Cancer
This is the most often done treatment for urethral cancer. The types of surgical procedures done include:
- Open Excision: Where the cancer is removed surgically.
- Electro-Resection with Fulguration: The cancer is removed surgically using high levels of electric current to burn the tumor or to kill the cancerous cells.
- Laser surgery uses laser beam like a knife which makes bloodless incisions to destroy or remove the cancerous tissue.
- Lymph node dissection is a surgical procedure where the lymph nodes present in the groin and pelvic region are removed.
- Cystourethrectomy is a surgical procedure done to remove the urethra and the bladder.
- Cystoprostatectomy is a surgical procedure done in males in which the prostate and the bladder are removed.
- Anterior exenteration is a surgical procedure done to remove the organs present in the pelvic cavity (urethra, bladder, and vagina).
- Partial penectomy is a surgery which is done to remove that part of the penis which surrounds the urethra and is affected by cancer.
- Radical penectomy is a surgical procedure where the entire penis is removed.
Radiation Therapy for Urethral Cancer
Radiation therapy is a treatment which involves the use of high-energy beams, such as x-rays, to destroy cancer cells. The 2 types of radiation therapy are:
- External radiation therapy in which a machine targets high energy beams on specific locations of the body to kill cancer cells.
- Internal radiation therapy, where a radioactive substance is placed into a seed, needle, catheter or a wire which in turn is placed within your body, near to the cancer.
Chemotherapy for Urethral Cancer
Chemotherapy is a treatment which involves the use of medicines or drugs to halt the growth of cancer by destroying the cancer cells or to prevent further division of cancer cells. Chemotherapy can be taken orally or intravenously.
Recurrent Urethral Cancer
Urethral cancer, which comes back (recurs) after complete treatment, is known as recurrent urethral cancer. There is a chance of the cancer coming back in the urethra or in other areas of the body after treatment. For this reason, the patient should continue going for follow up tests after the cancer treatment is completed to catch the cancer if it recurs.