General Information / Anatomy / Function / Statistics

• Passage from the bladder to the exterior
• In the female about one to one and a half inches long
• In the male follows a tortuous course for approximately 8 inches
• Rare cancer in both sexes
• In women occurs in early to mid sixties, more common in white women
• In men has been reported in teenagers and also in men over 80 years. Median age 55 to 60 years

Symptoms / Signs

Female

• Urethral or vaginal bleeding
• Urinary frequency, burning, pain, vaginal discharge and painful intercourse may occur
• A protruding mass from the urethra may be seen
• Less commonly there may be a complete blockage

Male

• Similar to urethral inflammatory conditions
• Hematuria
• Bloody or foul-smelling discharge
• Difficulty in urination
• Pain in the groin
• A mass in the perineum

Etiology / Carcinogens / Risks

• Actual cause is unknown
• Infection and chronic irritation may be predisposing factors
• In males venereal disease or frequent urethral dilations may be significant

Diagnosis / Screening / Staging / Grading / Types

• Urinalysis
• Endoscopy of urethra and bladder
• Biopsy
• X-ray of urethra--urethrogram
• CT scan
• Chest X-ray

Staging

• Cancers originating in the distal third are referred to as anterior
• When other portions are involved they are referred to as posterior   
  • Tis  surface change  
  • T1  just below surface  
  • T2  into muscle, prostate, or spongy penile tissue  
  • T3  into vagina, bladder neck, or cavernous penile tissue  
  • T4  more advanced  

Types

• Squamous type accounts for 75 to 80%
• Transitional cell 14 to 16%
• Adenocarcinoma 5 to 7%
• Tumours occur mostly in the bulbous urethra 50%
• Tumours in the penile urethra 36% and the least number are in the prostatic urethra 6%
• Nodal disease involves the groin and deep pelvic nodes

Treatment

Female

• Distal Tis, T1 and T2 cancers include surgery and or radiation therapy
• Stage T3 or proximal tumours may be treated with preoperative radiation therapy to reduce the mass followed by removal of the bladder, urethra, anterior vaginal wall and, if present, the reproductive organs
• Sometimes complete removal of the vagina and vulva may also be necessary
• Five year survival rate for superficial cancers is about 50% and 25% for more extensive cancers

Male

• If the cancer is in the distal part of the penis, part of the penis may have to be removed. Five year survival 60%
• If the cancer is located higher, complete removal of the penis is necessary
• Transurethral resection and cauterization of the area or radiation therapy have been effective in some instances
• Lymph nodes in the groin should be removed if involved
• Extensive bulbomenbranous cancer requires removal of the bladder and penis in most cases with a generally poor outcome
• Combinations of chemotherapy, radiation and occasionally surgery have been attempted with a goal of restoring potency with an artificial erectile implant
• Prostatic urethral cancer is very rare. In half the patients transurethral resection may be performed. Removal of the bladder and urethra followed by radiation therapy is the recommended course

Revised January 1999