Urethral cancer
Urethral cancer, also known as urethral neoplasm or urethral carcinoma, is a rare form of cancer that originates in the urethra, the tube responsible for transporting urine from the bladder to the outside of the body. The incidence of this cancer is low, with an average rate of approximately 1.69 per million people per year, and it is diagnosed more frequently in Black Americans compared to White Americans, as well as more often in men than in women. Common risk factors include a history of bladder cancer, chronic urinary tract infections, sexually transmitted infections, cigarette smoking, and being over 60 years old. Symptoms can be vague and may include difficulties with urination, pain, unusual discharge, and blood in urine or semen, which can lead to delayed diagnosis since patients may be asymptomatic for extended periods. Diagnosis often occurs at an advanced stage, complicating treatment options, which typically involve surgery, radiation therapy, and potentially immunotherapy. The prognosis can vary significantly based on the cancer's stage at diagnosis, with noninvasive cases having a higher five-year survival rate compared to advanced cases. Understanding the symptoms and seeking timely medical advice is crucial for improving outcomes in those at risk for this rare cancer.
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Subject Terms
Urethral cancer
ALSO KNOWN AS: Urethral neoplasm, urethral carcinoma
RELATED CONDITIONS: Squamous cell carcinoma of the urethra, transitional cell carcinoma of the urethra, adenocarcinoma of the urethra
DEFINITION: Urethral cancer is a cancer of the urethra, which carries urine from the bladder to the outside of the body. In women, the tube is about 3 to 4 centimeters (cm) in length, whereas in men it is a little over 20 cm in length.
Risk factors: Patients with the disease may have a history of bladder cancer, frequent urinary tract infections, chronic irritation of the urethra, or chronic inflammation of the urethra caused by a sexually transmitted infection. Additional risk factors include a history of cigarette smoking and age older than sixty years. A significant number of individuals with urethral cancer have had a sexually transmitted infection. The human papillomavirus is also associated with urethral cancer.
Etiology and the disease process: The urethral mucosal tissue consists of transitional epithelial cells near the bladder and squamous epithelial cells near the urethral opening. These cell types classify urethral cancer as squamous cell carcinoma (the most common type), transitional cell carcinoma (the second most common), or adenocarcinoma (in which transitional cells undergo metaplasia).
Incidence: Urethral cancer is exceedingly rare. The average incidence rate is 1.69 per a million people per year. In the United States, it is diagnosed twice as often in Black Americans than White Americans and more often in men than in women. Although it has been reported in patients as young as their thirties, most patients are in their sixties or older when they are diagnosed.
Symptoms: Because chronic irritation, inflammation, and infection tend to interfere with the natural reproductive mechanisms of the urethral mucosal cells, these processes usually precede urethral cancer. Patients with urethral cancer may be entirely asymptomatic for up to three years.
Symptoms may include voiding problems such as frequency, diminished stream and straining to void, increased nighttime urination, itching, painful urination, bladder opening obstruction, overflow incontinence, blood in the urine or semen, and malodorous or watery discharge, as well as perineal, pelvic, or penile pain.
Screening and diagnosis: Urethral cancer is difficult to diagnose, in part because it is so rare, and patients generally are reluctant to seek early treatment due to embarrassment. Like most cancers, however, early detection leads to a greater chance of cure. Once urethral cancer develops, it often invades nearby structures (such as the bladder) and thus becomes difficult to treat with traditional surgical and radiation techniques. Urethral cancer might be suspected if patients develop a urethral fistula (an unusual drainage of urine), an occurs, or tissue is present. Most patients are in an advanced stage of the disease when it is diagnosed. Screening may consist of a chest X-ray; a computed tomography (CT) scan of the pelvis and abdomen; (MRI) of the urethra, nearby lymph nodes, and other soft tissue; blood chemistry studies; and a complete blood count.
Urethral cancer is staged based on what part of the urethra is affected and how widespread the cancer is. means the cancer affects parts of the urethra closest to the outside of the body. P occurs in deeper parts of the body, near the bladder. In men, this often means the prostate is affected as well. Most clinicians categorize urethral cancer using the following criteria:
- Stage 0: The urethral lining contains abnormal cells that may become cancerous and spread to nearby normal tissue.
- Stage A: Cancer is present and has spread into the tissue adjacent to the lining of the urethra.
- Stage B: Cancer is present in the muscle surrounding the urethra. In men, nearby tissues in the penis may be affected.
- Stage C: Cancer has spread beyond the tissue surrounding the urethra. In women, cancer may be present in the vagina, the vaginal labia, and nearby muscle; in men, cancer may be present in the penis or nearby muscles.
- Stage D1: Cancer has spread to the nearby in the pelvis and groin.
- Stage D2: Cancer has spread to distant lymph nodes and other organs in the body.
Treatment and therapy: Treatment options depend on a patient’s general health, the stage and location of the cancer, when the diagnosis is made, and whether the cancer has recurred. The most common treatment is surgery; several different types of surgery may be pursued depending on the stage and severity of the cancer. Some patients may receive radiation therapy or to kill any remaining cancer cells. Clinical trials of immune checkpoint inhibitors, including one which led to the approval of nivolumab by the US Food and Drug Administration, have shown promise in treating advanced urethral cancers. Radiosensitizers which make tumors more susceptible to radiation therapy and immunotherapy have also shown promise.
Prognosis, prevention, and outcomes: Prognosis depends on a patient’s general health, the stage and size of the cancer, where in the urethra the cancer first developed, when the diagnosis was made, and whether the cancer has recurred.
In most patients, the cancer is locally advanced when a diagnosis is made, and the prognosis is generally poor. Invasive urethral cancer treated with surgery, radiation, and chemotherapy combined occurs in about 50 percent of patients. The five-year survival rate for patients with noninvasive urethral cancer receiving surgical or radiation therapy is 60 percent or higher. When the cancer has metastasized, the survival rate drops to between 10 and 20 percent.
Bibliography
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