What is cancer of the urethra?

Cancer of the urethra, a rare type of cancer, is a disease in which cancer (malignant) cells are found in the urethra. The urethra is the tube that empties urine from the bladder, the hollow organ in the lower abdomen that stores urine. In women, the urethra is about 1 1/2 inches long and opens to the outside of the body above the vagina. In men, the urethra is about 8 inches long and goes through the prostate gland and then through the penis to the outside of the body. Cancer of the urethra affects women more often then men.
There may be no symptoms of early cancer of the urethra. A doctor should be seen if there is a lump or growth on the urethra, or pain, bleeding, or other difficulty during urination

If there are symptoms, a doctor will examine the patient and feel for lumps in the urethra. In men, a thin lighted tube called a cystoscope may be inserted into the penis so the doctor can see inside the urethra. If the doctor finds cells or other signs that are not normal, a small piece of tissue (called a biopsy) may be cut out and looked at under a microscope for cancer cells.

The chance of recovery (prognosis) and choice of treatment depend on the stage of the cancer (whether it is just in one area or has spread to other places) and the patient’s general state of health

Stage Explanation

Stages of cancer of the urethra

Once cancer of the urethra is found, more tests will be done to find out if cancer cells have spread to other parts of the body (staging). A doctor needs to know the stage of the disease to plan treatment. For cancer of the urethra, patients are grouped into stages depending on where the tumour is and whether it has spread to other places. The following stage groupings are used for cancer of the urethra:

Anterior urethral cancer

The part of the urethra that is closest to the outside of the body is called the anterior urethra, and cancers that start here are called anterior urethral cancers.

Posterior urethral cancer

The part of the urethra that connects to the bladder is called the posterior urethra, and cancers that start here are called posterior urethral cancers. Because the posterior urethra is closer to the bladder and other tissues, cancers that start here are more likely to grow through the inner lining of the urethra and affect nearby tissues.

Urethral cancer associated with invasive bladder cancer

Occasionally, patients who have bladder cancer also have cancer of the urethra. This is called urethral cancer associated with invasive bladder cancer.

Recurrent urethral cancer

Recurrent cancer means that the cancer has come back (recurred) after it has been treated. It may come back in the same place, or in another part of the body.

Treatment Option Overview

How cancer of the urethra is treated

There are treatments for all patients with cancer of the urethra. Three kinds of treatment are used:

• Surgery (taking out the cancer in an operation).
• Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells)
• Chemotherapy (using drugs to kill cancer cells).

Surgery is the most common treatment of cancer of the urethra. A doctor may take out the cancer using one of the following operations:

• Electrofulguration uses an electric current to remove the cancer. The tumour and the area around it are burned away and then removed with a sharp tool.
   
• Laser therapy uses a narrow beam of intense light to kill cancer cells.
   
• Cystourethrectomy removes the bladder and the urethra.

In men, the part of the penis containing the urethra that has cancer may be removed in an operation called a partial penectomy. Sometimes the entire penis is removed (penectomy). A patient may need plastic surgery to make a new penis if all or part of the penis is removed. The bladder and prostate may also be removed in an operation called cystoprostatectomy. Lymph nodes in the pelvis may also be removed (lymph node dissection). Lymph nodes are small bean-shaped structures that are found throughout the body. They produce and store infection-fighting cells.

In women, surgery to remove the urethra, the bladder, and the vagina (anterior exenteration) may also be done. Lymph nodes in the pelvis may be removed (lymph node dissection). Plastic surgery may be needed to make a new vagina after this operation.

If the urethra is removed, the doctor will need to make a new way for the urine to pass from the body. This is called urinary diversion.

If the bladder is removed, the doctor will need to make a new way for the patient to store and pass urine. There are several ways to do this. Sometimes the doctor will use part of the small intestine to make a tube through which urine can pass out of the body through an opening (stoma) on the outside of the body. This is sometimes called an ostomy or urostomy. If a patient has an ostomy, a special bag will need to be worn to collect urine. This special bag, which sticks to the skin around the stoma with a special glue, can be thrown away after it is used. This bag does not show under clothing, and most people take care of these bags themselves. The doctor may also use part of the small intestine to make a new storage pouch (a continent reservoir) inside the body where the urine can collect. The patient would then need to use a tube (catheter) to drain the urine through a stoma.

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes (internal radiation therapy) in the area where cancer cells are found. Radiation may be used alone or with surgery and/or chemotherapy.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put in the body through a needle in a vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body and can kill cancer cells outside the urethra.

Treatment by stage

Treatment depends on where the cancer is found, whether it has spread to other areas in the body, and the patient’s sex, age, and overall health.

Anterior Urethral Cancer

Treatment is different for men and women.

For women, treatment may be one of the following:

1. Electrofulguration
2. Laser therapy
3. External and/or internal radiation therapy
4. Radiation therapy followed by surgery or surgery alone to remove the urethra and the organs in the lower pelvis (anterior exenteration), or the tumour only, if it is small. A new way is made for urine to pass out of the body (urinary diversion).

For men, treatment may be one of the following:

1. Electrofulguration.
2. Laser therapy.
3. Surgery to remove a part of the penis (partial penectomy).
4. Radiation therapy.

Posterior Urethral Cancer

Treatment is different for men and women.

For women, treatment will probably be radiation therapy followed by surgery or surgery alone to remove the urethra, the organs in the lower pelvis (anterior exenteration), or the tumour only, if it is small. Lymph nodes in the pelvis are usually removed (lymph node dissection), and lymph nodes in the upper thigh may or may not be removed. A new way is made for urine to pass out of the body (urinary diversion).

For men, treatment will probably be radiation therapy followed by surgery or surgery alone to remove the bladder and prostate (cystoprostatectomy) and the penis and urethra (penectomy). Lymph nodes in the pelvis are usually removed (lymph node dissection), and lymph nodes in the upper thigh may or may not be removed. A new way is made for urine to pass out of the body (urinary diversion)

Urethral Cancer Associated With Invasive Bladder Cancer

Because people with bladder cancer sometimes also have cancer of the urethra, the urethra may be removed at the same time the bladder is taken out (cystourethrectomy). If the urethra is not removed during surgery for bladder cancer, the doctor may follow the patient closely so treatment can be started if cancer of the urethra develops.

Recurrent Urethral Cancer

Treatment depends on what treatment the patient received before. If the patient had surgery, treatment may be radiation therapy and surgery to remove the cancer. If the patient had radiation therapy, treatment may be surgery to remove the cancer. Clinical trials are testing chemotherapy for cancer of the urethra that has spread to other parts of the body.

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