Urethral cancer

Urethral cancer is a rare cancer originating from the urethra.[1] The disease has been classified by the TNM staging system and the World Health Organization.[1][3][4]

This article is about cancer of the urethra. For cancer of the ureter, see Ureteral cancer.

Urethral cancer
Micrograph of a urethral cancer, urothelial cell carcinoma, found on a prostate core biopsy. H&E stain.
SpecialtyOncology Urology
SymptomsBlood in the urine, lump at end of penis,[1] Bloody urethral discharge.[2]

Symptoms include blood in the urine, lump at end of penis,[1] or bloody penile discharge.[2]

Diagnosis is established by transurethral biopsy.[1]

The most common type is papillary urothelial carcinoma.[1][5] Risk factors suggested include prolonged irritations of the urethra due to urinary catheterization, chronic inflammation due to infection, radiation, diverticula of the urethra, and urethral strictures.[1]

Signs and symptoms

Symptoms that may be caused by urethral cancer include:

Diagnosis

Diagnosis is established by transurethral biopsy and histological findings.[1] Bladder cystoscopy is performed to detect if there is simultaneous bladder cancer.[1]

Histology

Types of urethral cancer include the most common type urothelial carcinoma, and others including squamous cell carcinoma, and adenocarcinoma. Melanoma and sarcoma are rare.[1]

Staging

The World Health Organization classification of tumours of the urinary system and male genital organs (4th edn) was published in January 2016.[3] Urethral cancer has also been classified by the TNM staging system.[4]

TNM classification and 2016 WHO grading for primary urethral carcinoma[1][3][4]
T-categoryDescription
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Urethra (male and female)
Ta Noninvasive papillary, polypoid, or verrucous carcinoma
Tis Carcinoma in situ
T1 Tumor invades subepithelial connective tissue
T2 Tumor invades any of the following: corpus spongiosum, prostate, periurethral muscle
T3 Tumor invades any of the following: corpus cavernosum, beyond prostatic capsule, anterior vagina, bladder neck (extraprostatic extension)
T4 Tumor invades other adjacent organs (invasion of the bladder)
Urothelial (transitional cell) carcinoma of the prostate
Tis pu Carcinoma in situ, involvement of prostatic urethra
Tis pd Carcinoma in situ, involvement of prostatic ducts
T1 Tumor invades subepithelial connective tissue (for tumors involving prostatic urethra only)
T2 Tumor invades any of the following: prostatic stroma, corpus spongiosum, periurethral muscle
Ta Noninvasive papillary, polypoid, or verrucous carcinoma
T3 Tumor invades any of the following: corpus cavernosum, beyond prostatic capsule, bladder neck (extraprostatic extension)
T4 Tumor invades other adjacent organs (invasion of the bladder or rectum)
N—regional lymph nodes
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in a single lymph node
N2 Metastasis in multiple lymph nodes
M—Distant Metastasis
M0 No distant metastasis
M1 Distant metastasis

Treatment

Surgery is the most common treatment for cancer of the urethra.[6] One of the following types of surgery may be done: Open excision, Electro-resection with flash, Laser surgery, Cystourethrectomy, Cystoprostatectomy, Anterior body cavity, or Incomplete or basic penectomy surgery.

Radiation therapy has also been used in some cases.[1]

Chemotherapy 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. Commonly used drugs include cisplatin, vincristine, and methotrexate.

Side effects include anemia (causing fatigue, weakness), nausea and vomiting, loss of appetite, hair loss, mouth sores, increased risk for infection, shortness of breath, or excessive bleeding and bruising.[7]

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.[1]

Around half of affected people have locally advanced disease when they first present.[1] 54–65% of cases are of the urothelial carcinoma type.[1]

Prolonged irritations of the urethra due to urinary catheterization, chronic inflammation due to infection, radiation, diverticula of the urethra, and urethral strictures, may increase the risk of primary urethral cancer.[1] Other risk factors include squamous cell carcinoma (SCC) and genital lichen sclerosus.[1]

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.[8] 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.[9]

See also

References
  1. Janisch, Florian; Abufaraj, Mohammad; Fajkovic, Harun; Kimura, Shoji; Iwata, Takehiro; Nyirady, Peter; Rink, Michael; Shariat, Shahrokh F. (1 September 2019). "Current Disease Management of Primary Urethral Carcinoma". European Urology Focus. 5 (5): 722–734. doi:10.1016/j.euf.2019.07.001. ISSN 2405-4569. PMID 31307949.
  2. Kahan, Scott; Miller, Redonda; Smith, Ellen G. (2008). "126. Penile Discharge". Signs and Symptoms. Lippincott Williams & Wilkins. ISBN 978-0-7817-7043-9.
  3. Compérat, Eva; Varinot, Justine (2016). "Immunochemical and molecular assessment of urothelial neoplasms and aspects of the 2016 World Health Organization classification". Histopathology. 69 (5): 717–726. doi:10.1111/his.13025. ISSN 1365-2559. PMID 27353436. S2CID 24816719.
  4. Brierley, James D.; Gospodarowicz, Mary K.; Wittekind, Christian (2017). "Urological Tumours". TNM Classification of Malignant Tumours (8th ed.). John Wiley & Sons. p. 208. ISBN 978-1-119-26354-8.
  5. Ries, LAG; Young, JL; Keel, GE; Eisner, MP; Lin, YD; Horner, M-J, eds. (2007). "Chapter 30: Cancers of Rare Sites". SEER Survival Monograph: Cancer Survival Among Adults: US SEER Program, 1988–2001, Patient and Tumor Characteristics. SEER Program. Vol. NIH Pub. No. 07-6215. Bethesda, MD: National Cancer Institute. pp. 251–262. Archived from the original on 10 October 2013. Retrieved 18 October 2013.
  6. Pagliaro, Lance (28 June 2016). Rare Genitourinary Tumors. Springer. p. 157. ISBN 978-3-319-30046-7.
  7. Urethral Cancer Treatment
  8. Sui W, RoyChoudhury A, Wenske S, Decastro GJ, McKiernan JM, Anderson CB (2017). "Outcomes and Prognostic Factors of Primary Urethral Cancer". Urology. 100: 180–186. PMID 27720774.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  9. Visser O, Adolfsson J, Rossi S, Verne J, Gatta G, Maffezzini M; et al. (2012). "Incidence and survival of rare urogenital cancers in Europe". Eur J Cancer. 48 (4): 456–64. PMID 22119351.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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