Urethral cancer: Treatment - Patient Information [NCI PDQ]

Urethral cancer is a disease in which malignant (cancer) cells form in the tissues of the urethra.

The urethra is the tube that carries urine from the bladder to outside the body. In women, the urethra is about 1½ inches long and is just above the vagina. In men, the urethra is about 8 inches long, and goes through the prostate gland and the penis to the outside of the body. In men, the urethra also carries semen.

Urethral cancer is a rare cancer that occurs more often in women than in men. There are different types of urethral cancer that begin in cells that line the urethra. These cancers are named for the types of cells that become malignant (cancerous):

• Squamous cell carcinoma is the most common type of urethral cancer. It forms in cells in the part of the urethra near the bladder in women, and in the lining of the urethra in the penis in men.
• Transitional cell carcinoma forms in the area near the urethral opening in women, and in the part of the urethra that goes through the prostate gland in men.
• Adenocarcinoma forms in glands near the urethra in both men and women.

Urethral cancer can metastasize (spread) quickly to tissues around the urethra and is often found in nearby lymph nodes by the time it is diagnosed.

Age and a history of bladder cancer can affect the risk of developing urethral cancer.

Risk factors include the following:

• Having a history of bladder cancer.
• Having conditions that cause chronic inflammation in the urethra, including:
  • Sexually transmitted diseases (STDs).
  • Frequent urinary tract infections (UTIs).
• Being 60 or older.
• Being a white female.

Possible signs of urethral cancer include bleeding or trouble with urination.

These and other symptoms may be caused by urethral cancer. Other conditions may cause the same symptoms. Sometimes early cancer of the urethra does not cause any symptoms at all. A doctor should be consulted if any of the following problems occur:

• Bleeding from the urethra or blood in the urine.
• Weak or interrupted ("stop-and-go") flow of urine.
• Frequent urination.
• A lump or thickness in the perineum or penis.
• Discharge from the urethra.
• Enlarged lymph nodes in the groin area.

Tests that examine the urethra and bladder are used to detect (find) and diagnose urethral cancer.

The following tests and procedures may be used:

• Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.
• Laboratory tests: Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time.
• Urine cytology: Examination of urine under a microscope to check for abnormal cells.
• Urinalysis: A test to check the color of urine and its contents, such as sugar, protein, blood, and white blood cells. If white blood cells (a sign of infection) are found, a urine culture is usually done to find out what type of infection it is.
• Digital rectal exam: An exam of the rectum. The doctor or nurse inserts a lubricated, gloved finger into the lower part of the rectum to feel for lumps or anything else that seems unusual. This procedure may be done while the patient is under anesthesia.
• Pelvic exam: An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. The doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and places the other hand over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. A speculum is also inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. This may be done while the patient is under anesthesia.
• Cystoscopy: A procedure to look inside the urethra and bladder to check for abnormal areas. A cystoscope (a thin, lighted tube) is inserted through the urethra into the bladder. Tissue samples may be taken for biopsy.
• Biopsy: The removal of cells or tissues from the urethra, bladder, and, sometimes, the prostate gland, so they can be viewed under a microscope by a pathologist to check for signs of cancer.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) depends on the following:

• The stage and size of the cancer (whether it is in only one area or has spread to other areas).
• Where in the urethra the cancer first formed.
• The patient's general health.
• Whether the cancer has just been diagnosed or has recurred (come back).

Treatment options depend on the following:

• The stage of the cancer and where it is in the urethra.
• The patient's sex and general health.
• Whether the cancer has just been diagnosed or has recurred.

After urethral cancer has been diagnosed, tests are done to find out if cancer cells have spread within the urethra or to other parts of the body.

The process used to find out if cancer has spread within the urethra or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following procedures may be used in the staging process:

• Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• CT scan (CAT scan) of the pelvis and abdomen: A procedure that makes a series of detailed pictures of the pelvis and abdomen, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of the urethra, nearby lymph nodes, and other soft tissue and bones in the pelvis. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it.
• Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
  • The number of red blood cells, white blood cells, and platelets.
  • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
  • The portion of the blood sample made up of red blood cells.

Urethral cancer is staged according to which part of the urethra is affected. Treatment is also based on this grouping.

Urethral cancer is staged and treated based on the part of the urethra that is affected and how deeply the tumor has spread into tissue around the urethra. Urethral cancer can be described as anterior or posterior.

Anterior urethral cancer

In anterior urethral cancer, the tumors are not deep and they affect the part of the urethra that is closest to the outside of the body.

Posterior urethral cancer

In posterior urethral cancer, the tumors are deep and affect the part of the urethra closest to the bladder. In women, the entire urethra may be affected. In men, the prostate gland may be affected.

The following stages are also used to describe urethral cancer:

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the inside lining of the urethra. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage A

In stage A, cancer has formed and spread into the layer of tissue beneath the lining of the urethra.

Stage B

In stage B, cancer is found in the muscle around the urethra. In men, the penile tissue surrounding the urethra may be affected.

Stage C

In stage C, cancer has spread beyond the tissue surrounding the urethra, and:

• in women, may be found in the vagina, vaginal lips, or nearby muscle;
• in men, may be found in the penis or in nearby muscle.

Stage D

Stage D is divided into stage D1 and stage D2, based on where the cancer has spread.

• In stage D1, cancer has spread to nearby lymph nodes in the pelvis and groin.
• In stage D2, cancer has spread to distant lymph nodes or to other organs in the body, such as the lungs, liver, and bone.

Urethral cancer may be associated with invasive bladder cancer.

A small number of patients who have bladder cancer are also diagnosed with cancer of the urethra, or will develop it in the future.

Recurrent urethral cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the urethra or in other parts of the body.

There are different types of treatment for patients with urethral cancer.

Different types of treatments are available for patients with urethral cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Three types of standard treatment are used:

Surgery

Surgery is the most common treatment for cancer of the urethra. One of the following types of surgery may be done:

• Open excision: Removal of the cancer by surgery.
• Electro-resection with fulguration: Surgery to remove the cancer by electric current. A lighted tool with a small wire loop on the end is used to remove the cancer or to burn the tumor away with high-energy electricity.
• Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove or destroy tissue.
• Lymph node dissection: Lymph nodes in the pelvis and groin may be removed.
• Cystourethrectomy: Surgery to remove the bladder and the urethra.
• Cystoprostatectomy: Surgery to remove the bladder and the prostate.
• Anterior exenteration: Surgery to remove the urethra, the bladder, and the vagina. Plastic surgery may be done to rebuild the vagina.
• Partial penectomy: Surgery to remove the part of the penis surrounding the urethra where cancer has spread. Plastic surgery may be done to rebuild the penis.
• Radical penectomy: Surgery to remove the entire penis. Plastic surgery may be done to rebuild the penis.

If the urethra is removed, the surgeon will make a new way for the urine to pass from the body. This is called urinary diversion. If the bladder is removed, the surgeon will make a new way for urine to be stored and passed from the body. The surgeon may use part of the small intestine to make a tube that passes urine through an opening (stoma). This is called an ostomy or urostomy. If a patient has an ostomy, a disposable bag to collect urine is worn under clothing. The surgeon may also use part of the small intestine to make a new storage pouch (continent reservoir) inside the body where the urine can collect. A tube (catheter) is then used to drain the urine through a stoma.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Watchful waiting

Watchful waiting is closely monitoring a patient’s condition without giving any treatment until symptoms appear or change.

New types of treatment are being tested in clinical trials. These include the following:

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Anterior Urethral Cancer

Treatment of anterior urethral cancer is different for men and women.

For women, treatment may include the following:

• Radiation therapy followed by surgery (anterior exenteration and urinary diversion).
• Surgery (open excision, electro-resection with fulguration, lymph node dissection, or anterior exenteration and urinary diversion).
• Laser surgery.
• External and/or internal radiation therapy.

For men, treatment may include the following:

• Surgery (open excision, electro-resection with fulguration, lymph node dissection, or partial or radical penectomy).
• Laser surgery.
• Radiation therapy.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with anterior urethral cancer.

Posterior Urethral Cancer

Treatment of posterior urethral cancer is different for men and women.

For women, treatment may include the following:

• Radiation therapy followed by surgery (anterior exenteration with lymph node dissection and urinary diversion).
• Radiation therapy with or without surgery (other than anterior exenteration and urinary diversion).
• Surgery (other than anterior exenteration and urinary diversion) alone.

For men, treatment may be radiation therapy followed by surgery (cystoprostatectomy, penectomy, lymph node dissection, and urinary diversion).

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with posterior urethral cancer.

Urethral Cancer Associated with Invasive Bladder Cancer

Treatment of urethral cancer that develops with invasive bladder cancer may include the following:

• Surgery (cystourethrectomy or cystoprostatectomy).
• Watchful waiting.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with urethral cancer associated with invasive bladder cancer.

Recurrent Urethral Cancer

Treatment of recurrent urethral cancer that comes back near the urethra depends on the type of treatment the patient received before, as follows:

• Surgery: For patients who were first treated with radiation therapy.
• Radiation therapy with surgery: For patients who were first treated with surgery alone.

Treatment of recurrent urethral cancer that comes back in distant parts of the body is usually a clinical trial of chemotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent urethral cancer.

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made to this summary.

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Date Last Modified: 2007-09-20

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