When one needs to pass urine, it is the urethra that carries the urine from the bladder. The urethra goes through the prostate and the penis in men. In women, the tube is shorter and ends just above the opening to the vagina. 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.
There may not be any symptoms at first. Over time, you might notice may become hard to pee. There is a possibility of weak urine flow or sometimes an inability to hold it. It could also result in frequent visits to the bathroom, especially at night. Other symptoms include:
Bleeding from the urethra or blood in the urine
Weak or interrupted flow of urine
Urination occurs often
A lump or thickness in the perineum or penis
Discharge from the urethra
Enlarged lymph nodes in the groin area
Doctors have not been able to clearly identify the causes of urethral cancer however, people over age 60, are have a higher risk of getting urethral cancer. The risk might be higher, if there has been a history of bladder cancer, frequent urinary tract infections, or sexually transmitted diseases that lead to an inflammation of the urethra.
Urethral cancer has been linked to human papillomavirus, especially HPV 16. The HPV vaccine protects against type 16. Doctors recommend it for girls and boys at ages 11 or 12. Females can get the vaccine through age 26 and males through age 21. Some of the other causes of Urethral Cancer are the following:
Having conditions that cause chronic, swollen, reddened part in the urethra
Being a white skinned female
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 the 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 colour 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 performed while the patient is under anaesthesia.
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 anaesthesia.
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.
Different types of treatments are available for patients with urethral cancer. Some treatments are standard, and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer.
Three types of standard treatment are used:
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 tumour 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 lower the risk that the cancer will come back, is called adjuvant 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 radiation therapy is given depends on the type and stage of the cancer being treated.
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 given directly to 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 chemotherapy is given depends on the type and stage of the cancer being treated.
Follow-up tests may be needed
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging. Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.