The urethra is known in medical terms as the ‘urethra’. Urine flows from the bladder through the urethra. In rare cases, a patient develops cancer in the urethra. A patient with urethral cancer usually experiences bleeding, pain or urinary problems. Like many forms of cancer, early detection of urethral cancer offers the best chance of cure. Once the cancer is discovered, surgery is indicated, possibly in combination with radiotherapy and/or chemotherapy.

• What is the urethra?
• Epidemiology of urethral cancer
• Causes
• Risk factors of condition
• Types of urethral cancer
• Symptoms: Urinary problems, bleeding and pain
• Diagnosis and examinations

• Late diagnosis
• Detecting cancer
• Determine cancer stage
• Location of cancer

• Therapy
• Prognosis

What is the urethra?

The urethra is a hollow tube that allows urine to flow from the bladder to the outside of the body. In women, the urethra is about 2.5 centimeters long and is located just above the vagina. In men, the urethra is longer (8 centimeters) and passes through the prostate gland and penis to the outside of the body. In men, the urethra also carries sperm.

Epidemiology of urethral cancer

Urethral cancer is a rare form of cancer that occurs more often in men than in women. The incidence of urethral cancer is 4.3 per million in men and 1.5 per million in women. However, the incidence increases with age. Primary urethral cancer (cancer of the urethra that also starts there) is twice as common in African Americans than in people with a white skin color. Urethral cancer occurs in adolescents, adults and the elderly. Most patients diagnosed are between seventy and eighty years old.

Causes

Urethral cancer is a disease in which malignant cells (cancer cells) form in the tissues of the urethra. The cells grow abnormally and uncontrollably in this area. It is not known as of October 2020 why this happens.

Risk factors of condition

Some risk factors are known for urethral cancer:

• Bladder cancer: A history of bladder cancer increases the risk of urethral cancer. Sometimes bladder cancer and/or prostate cancer appear at the same time as urethral cancer.
• the ingestion of arsenic
• frequent urinary tract infections
• sexually transmitted infections (STDs), including the human papillomavirus (HPV), especially HPV type 16.

Types of urethral cancer

There are several types of urethral cancer that start in cells lining the urethra. These cancers are named after the types of cells that become malignant (cancer). Squamous cell carcinoma is most common; the cells form in the part of the urethra near the bladder in women and in the lining of the urethra in the penis in men. A transitional cell carcinoma forms in the area near the urethral opening in women, and in the part of the urethra that passes through the prostate in men. There is also an adenocarcinoma that forms in the glands around the urethra in both men and women.Various urinary problems occur / Source: Frolicsomepl, Pixabay

Symptoms: Urinary problems, bleeding and pain

In the early stages of the cancer, the patient may have no symptoms. Other symptoms usually appear insidiously and include:

• a lump or growth in the perineum or penis / a painless lump or swelling in the groin
• a purulent (purulent); foul-smelling or watery discharge from the urethra
• a swelling
• hemospermia (blood in the semen)
• perineal (around the anus) pain, suprapubic pain (pain above the pubic area) or urethral pain
• pain during sexual intercourse
• urinary problems:
  • bleeding from the urethra or blood in the urine (hematuria)
  • a weak or interrupted urine flow
  • frequent urination (pollakisuria), especially at night (nocturia)
  • incontinence
  • problems starting urine flow
  • urinary retention (inability to empty the bladder completely) due to progressive urethral stricture
• priapism (very prolonged and often painful erection of the penis)
• tenesmen (persistent, painful urge to have a bowel movement)

Diagnosis and examinations

Late diagnosis

The interval between the onset of symptoms and diagnosis may be up to three years. The patient often receives a wrong diagnosis or else does not seek medical help. Cancer metastases are often already present in the body.An extensive blood test is necessary / Source: Frolicsomepl, Pixabay

Detecting cancer

The doctor uses several tests to detect urethral cancer after performing a physical examination and going through the patient’s medical history:

• a biopsy (removal of cell or tissue samples from the urethra, bladder and sometimes the prostate gland, which the doctor examines microscopically for signs of cancer)
• a digital rectal examination
• a gynecological examination
• an extensive blood test
• a ureteroscopy (internal examination of the ureter and renal pelvis)
• a urinalysis (a test to check the color of urine and its contents)
• a urine cytology (a laboratory test in which a laboratory technician checks a urine sample under a microscope for the presence of abnormal cells)

Determine cancer stage

After urethral cancer has been diagnosed, the doctor carries out several tests to detect any spread (metastases) of the cancer cells. This also makes it possible to determine the location of the urethral cancer, which is necessary for applying the correct treatment. Urethral cancer may spread quickly to tissues around the urethra and therefore doctors often only make the diagnosis when there is already lymph node metastases (spread of the cancer in the lymph nodes). The following tests can be used to determine the cancer stage:

• a CT scan
• an MRI scan
• an X-ray of the organs and bones in the chest
• a urethrography (a series of X-rays of the urethra)

Location of cancer

Distal urethral cancer With distal urethral cancer, the cancer has not spread deep into the tissue. In women, the part of the urethra closest to the outside of the body is affected. In men, the part of the urethra that is inside the penis is affected.Proximal urethral cancer Proximal urethral cancer affects the part of the urethra that is not part of the distal urethra. In men and women, proximal urethra is usually present deep in the tissue.Recurrent urethral cancer Recurrent urethral cancer refers to cancer that has returned after it has been treated. The cancer then returns to the urethra itself or to other parts of the body.

Therapy

There are different types of treatments for patients with urethral cancer: surgery, radiotherapy and/or chemotherapy and active surveillance. Control and follow-up examinations are often necessary. The treatment of choice is surgery.

Prognosis

The prognosis and treatment options for urethral cancer depend on:

• the patient’s general health
• the first diagnosis of cancer or cancer recurrence
• any metastases via the mucous membranes along the urethra to nearby tissue, to lymph nodes or to other parts of the body.
• the location of the cancer in the urethra
• the gender of the patient (male or female)

Superficial cancerous tumors located in the distal urethra of both men and women are generally curable. However, in deep invasive cancer tumors, the prognosis is worse, even with a combination of therapies.

read more

• Urinary problems (micturition difficulties): Problems with urination
• Cancer pain: Causes & types of pain and types of pain medication
• Dysuria: Pain or burning during urination/urination
• Cancer recurrence (recurrence): Types, risk factors and tips