Urethral cancer is rare and occurs in both sexes; it may be squamous or transitional cell carcinoma or, occasionally, adenocarcinoma.
Most patients are aged ≥ 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 of Urethral Cancer
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 of Urethral Cancer
Cystourethroscopy
Diagnosis is suggested clinically and confirmed by cystourethroscopy and examination under anesthesia (ie, bimanual pelvic examination and possibly vaginal biopsies in females). Biopsy may be required to differentiate urethral carcinoma, prolapse, and caruncle. CT or MRI is used for staging.
Treatment of Urethral Cancer
Usually excision or ablation
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 chemotherapy and 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.
Prognosis for Urethral Cancer
Prognosis depends on the precise location in the urethra and extent of the cancer, particularly depth of invasion. The 5-year survival rates are > 60% for patients with distal tumors and 10 to 20% for patients with proximal tumors. Recurrence rate is >50%.
