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Urethral
cancer is rare and occurs in both sexes; it may be squamous or transitional
cell carcinoma or, occasionally, adenocarcinoma.
Most patients are age ≥ 50. Certain strains of human papillomavirus have been implicated in certain cases. Urethral tumors invade adjacent structures early and thus tend to be advanced when diagnosed. External groin or pelvic (obturator) lymph nodes are usually the first sites of metastasis.
Symptoms and Signs
Most women present with hematuria and obstructive voiding symptoms or urinary retention. Most have a history of urinary frequency or urethral syndrome (hypersensitivity of the pelvic floor muscles). Most men present with symptoms of urethral stricture; only a few present with hematuria or a bloody discharge. Sometimes if the tumor is advanced, a mass is felt.
Diagnosis
Diagnosis is suggested clinically and confirmed by cystourethroscopy. Biopsy may be required to differentiate urethral carcinoma, prolapse, and caruncle. CT or MRI is used for staging.
Prognosis
Prognosis depends on the precise location in the urethra and extent of the cancer, particularly depth of invasion. The 5-yr survival rates are > 60% for patients with distal tumors and 10 to 20% for patients with proximal tumors. Recurrence rate is > 50%.
Treatment
For superficial or minimally invasive distal tumors in the anterior urethra, treatment is with surgical excision, radiation therapy (interstitial or a combination of interstitial and external beam), fulguration, or laser ablation. Larger and more deeply invasive anterior tumors and proximal tumors in the posterior urethra require multimodal therapy with radical surgery and urinary diversion, usually in combination with radiation therapy. Surgery includes bilateral pelvic and sometimes inguinal lymph node dissection, often with removal of part of the symphysis pubis and inferior pubic rami. The value of chemotherapy, which is sometimes used, has not been established.
Last full review/revision December 2007 by David A. Swanson, MD
Content last modified December 2007
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