Published August 2002
T - Primary Tumour
- TX: Primary tumour cannot be assessed
- T0: No evidence of primary tumour
Urethra (male and female)
- Tis: Carcinoma in situ
- Ta: Non-invasive papillary, polypoid or verrucous carcinoma
- T1: Tumour invades subepithelial connective tissue
- T2: Tumour invades any of the following: corpus spongiosum, prostate, periurethral muscle
- T3: Tumour invades any of the following: corpus cavernosum, beyond prostatic capsule, anterior vagina, bladder neck
- T4: Tumour invades other adjacent organs
N - Regional Lymph Nodes
Regional nodes: inguinal and pelvic irrespective or laterality.
- NX: Regional lymph nodes cannot be assessed
- N0: No regional lymph node metastasis
- N1: Metastasis in a single node 2 cm or less in greatest dimension
- N2: Metastasis in a single node more than 2 cm in greatest dimension, or multiple lymph nodes
M - Distant Metastasis
- MX: Presence of distant metastasis cannot be assessed
- M0: No distant metastasis
- M1: Distant metastasis
- 0a: Ta N0 M0
- Tis N0 M0
- Tis pu N0 M0
- Tis pd N0 M0
- I: T1 N0 M0
- II: T2 N0 M0
- T4 N0-1 M0
- Any T N2 M0
- Any T Any N M1
Investigations for Staging
- History and physical examination
- Urinalysis and culture
For extent of local disease
- CT scan if necessary
To exclude proximal disease
- Cystoscopy +/- retrogrades
For disseminated screen
- Bone scan with suggestive symptoms
- CT to evaluate nodes
Primary carcinoma of the urethra developing in a patient who has neither a concomitant nor antecedent history of bladder cancer is rare. The malignancy commonly involves the entire urethra, although may be limited to the distal urethra and the series in the literature are small. Treatment must be individualized and referral for multi-disciplinary review is recommended.
In series using surgery or radiation therapy alone, the results have been disappointing, leading to recommendations of preoperative radiation and surgery in select patients with stage T2 or greater lesions.
Stage 0, I Anterior Urethra
- Interstitial brachytherapy
- Well differentiated tumours of the distal third may be managed by surgical excision.
External beam radiation to draining lymphatics plus boost or local brachytherapy to tumour.
Stage II, III
- Preoperative radiation to primary tumour and draining lymphatics followed by radical cysto-urethrectomy at six to eight weeks
- Radical radiation therapy using external beam to primary tumour and draining lymphatics with boost to local tumour volume; surgical salvage for recurrence.
Palliative therapy as indicated.
Following the completion of treatment, all patients need to be monitored for potential recurrence of cancer and complications of therapy. This is needed both for management of the individual patient (where early detection would improve outcome), and to permit periodic review and improvement of current treatment policy.
Follow up will be primarily by the urologist and will include urethrocystoscopy where relevant:
- Year 1 = q 3 months
- Year 2 = q 4 months
- Year 3-4 = q 6 months
- Year 5+ =annually
Often it is felt appropriate to share follow up with the family doctor (and/or the urologist), in which case it is important for the patient to be clear who is responsible for certain aspects of the disease, e.g. symptom control by the family doctor, with advice from the BC Cancer Agency at the doctor's request.
Notification is requested in the event of any of the following:
- Local recurrence at the primary site (particularly in patients with clinically localized disease treated with surgery and/or radiotherapy)
- Metastasis at regional or distant sites
- Complications of therapy, especially if acute requiring hospitalization, or chronic and symptomatic
- Death with primary cause, and whether cancer or treatment contributed
The event, date, and evidence where appropriate should be sent to the Agency chart where it will come to the attention of the oncologist, and will be available for periodic review by the tumour group. This information is requested annually for patients no longer followed at the BC Cancer Agency.