Urethral Cancer: Symptoms, Diagnosis & Treatment

The history and management of this cancer vary. Therefore, it is difficult to tell which of the currently available treatments would be an appropriate approach. Managing the tumor focuses on individual patient experience. 

Here, you will take a closer look at urethra cancer, its epidemiology, symptoms, diagnosis, and treatment. Including some of the latest statistics that will help you get a better perspective on this particular carcinoma. 

Urethral cancer is a rare condition, often with a survival rate of 31% at 10 years. The annual incidence of PUC (primary urethral carcinoma) is believed to be 1.5/million in women and 4.3/million in men across the United States. Both its treatment and the tumor can impact your urinary and sexual function. 

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Key Facts

  • Urethral carcinoma is an illness in which malignant cells start to form inside the tissues of the urethra. 

  • Having a history of bladder cancer can make you susceptible to urethral cancer. But, an individual who is at risk of developing penile cancer doesn’t mean they will carry a risk of urethral cancer.

  • Conditions such as chronic inflammation of the urethra, sexually transmitted diseases, and a urinary tract infection are possible risk factors for urethral cancer. 

  • The same tests used to examine the bladder and urethra can be used to diagnose urethral carcinoma. 

Urethra – What Is It, Exactly?

The urethra is the tubular path in charge of transporting urine from the bladder to the external perineum opening. While the ureter is a small duct or a tube that links the kidneys and the bladder. Urine moves through the ureter from the kidneys to the bladder. 

Male Urethra

The male urethra is S-shaped with a length of 18cm to 20cm. It has two primary functions, semen passage during ejaculation and proper urination. It consists of:

  • bladder

  • internal sphincter 

  • prostatic urethra

  • Membranous urethra

  • External sphincter

  • Detrusor muscle

  • Bulbar urethra

  • Penile Urethra

The nearest to the bladder is known as the proximal urethra. While the furthest part of the urethra is known as the distal urethra. Then, you also have the narrowest segment known as the external meatus and the bulbomembranous urethra known as the posterior. The anterior is the penile urethra. 

Female Urethra

The female urethra is a lot shorter than its male counterpart. It’s only 4cm long. This urethra is embedded in the vaginal wall and can be found between the vaginal opening and labia. The female urethra starts at the bladder neck towards the outer region of the vaginal opening. 

The urethra connects the bladder to the exterior of the human system. It helps urine leave the body. The urethra is lined with stratified columnar epithelium, which is a rare type of epithelial tissue. This tissue is made up of multiple layers of column-shaped cells. Whereas the distal penile urethra is lined by the squamous epithelium. 

The cancer forms in the cells that line the urethra. In many cases, however, the tumor can spread and affect the reproductive and urinary system. It is not uncommon for these cells to spread to other sections of the human body. 

Types of Urethral Cancer Cells

Urethral cancer is named for the cells that become cancerous (malignant). Urethral cancer is a rare form of urologic cancer found in 1% of patients with carcinoma of the urinary or genital organs

But, to understand the illness, you need to know how it impacts the body. Urologic cancer impacts the urinary tract of both males and females and the reproductive organs in male patients.

Urothelial cancer is the predominant histological type of primary urethral cancer and accounts for 54% to 65% of cases.

It is typically followed by 3 cancer cell types, known as:

  • Squamous cell carcinoma – This is the most prevalent form of urethral cancer. It forms inside the penis, in the lining of the urethra in men, and close to the bladder in women. According to clinical reports, around 90% of male tumors have a squamous cell cancer history. 

  • Adenocarcinoma – This type of carcinoma can be found in the glands that surround the urethra in both women and men. Urethral adenocarcinoma is a rare malignant illness that typically affects the female urethra. Those over the age of 50 are more susceptible to the disease. 

  • Transitional cell carcinoma – This transitional cell cancer begins in a segment of the urethra that passes through the prostate gland in men, and in the spot close to the urethral opening in women. Also known as urothelial carcinoma, this rare illness can be either high or low grade. Because a transitional cell lines multiple parts of the urinary tract system, patients can develop tumors in more places than one. If you have this kind of cancer in your system, it is better to check for tumors in other parts of the urinary tract.

Based on a recent SEER analysis of 2,065 male patients with primary urethral cancer, transitional cell carcinoma was the most common illness, comprising 78% of cases. While adenocarcinoma was the least present, only found in 5% of cases. In the majority of patients, urethral cancer spreads quickly to the tissues near the urethra. By the time it gets diagnosed, it would already affect the nearby lymph nodes

Symptoms of Urethral Cancer

Experts are calling it the silent illness and for a good reason. This cancer might not trigger any symptoms. Particularly in its early phases. But, as the tumor expands, so does the risk of symptoms. Here are some of the most typical signs of urethral carcinoma:

  • Bloody urine

  • Bleeding and/or discharge from the urethra

  • Difficulty urinating

  • Constant need to urinate, but without any urine passing through

  • Dribbling, poor flow, or pain when urinating

  • Urinary incontinence (particularly at night)

  • Increased lymph nodes (in the groin)

  • Lump between the anus and the genitals

Male urethral cancer typically causes urinary problems, discharge, and blood in the urine. Do have in mind that these signs could also be caused by other health issues, completely unrelated to carcinoma. If you believe you have this illness, it’s best to consult with a doctor. Your healthcare provider will do a proper diagnosis and let you know whether or not you have this disease. 

Diagnosis 

A urologist will ask about your current health state and possible hereditary illnesses that might be connected to cancer. These health problems include: 

People with Lynch syndrome (hereditary non-polyposis colorectal cancer) can also be susceptible to bladder cancer and urinary tract complications. This may affect their susceptibility to urethral cancer. That’s why it’s crucial to be completely honest about your health during this process. 

The urologist will then do a physical exam to check for any abnormalities that may have affected the urethra. They can ask for blood, urine, and other samples if necessary. Here is a list of each of the diagnostic procedures that can help identify urethra cancer. 

Cystoscopy

Doctors use a cystoscope to view the inside of the urethra. This is a practical, small, and very light tool that will help analyze the organ. It is typically an outpatient procedure done on local anesthesia. If the doctor spots an abnormality, you might have to do a biopsy. 

Tissue Biopsy

A doctor will take a tissue sample from any zones that indicate signs of cancer. This procedure is done under general anesthesia. In the female urethra, it involves the use of a needle that punctures the vagina or skin to reach the urethral tumor growth. 

The sample is then sent to a pathologist, who will then confirm or deny the diagnosis. While the patient is still under the effect of the anesthesia, the doctor will do a final thorough check to see how much the tumor has grown. If there is a risk of malignant cancer, the urologist will suggest additional tests and imaging to analyze the spread. 

Tumor Stage and Grade

If a tumor does affect the body, the urologist must identify its grade and stage, before they can devise a treatment plan. The grade identifies the spread and growth of the malignancy. It shows how fast the cancer is affecting the system. 

There are two main grades of tumors, such as:

  • low grade – If it’s low grade, the odds of cancer spreading into deeper layers of the bladder and other parts is relatively low. The cells of such tumors are slightly different from that of normal cells. Although the tumor can recur post-treatment, the risk is quite low. 

  • high grade – If it’s high grade, it can spread to the surrounding tissues and is more likely to come back after treatment. These cells are completely disorganized and look nothing like normal cells.

Staging, however, can identify whether the malignancy is spreading. The doctor will learn if the cancer is affecting neighboring tissues or other sections of the human body. Overall, the early stages are the easiest to treat. 

The staging groups range from 0 to 4.

Here is how each staging group looks:

  • Stage 0 signifies the body doesn’t have cancer, but it does have abnormal cells with the risk of becoming cancer. 

  • Stage 1 means the cancer is very small and focused in a single area.

  • Stages 2 and 3 imply the malignancy is getting bigger and is growing in the lymph nodes or other tissues.

  • Stage 4 means the cancer has metastasized or affected other regions of the human body. This is a serious and life-threatening health condition. 

Treatment Options

Treatment for urethral cancer varies based on the type and stage of cancer. For example, in case of metastatic urethral cancer, then doctors will suggest chemotherapy. But, if the illness is recurrent, then you may have to do radiation therapy or surgery. 

Chemotherapy

This treatment utilizes adequate drugs to kill the malignant cells. It typically keeps the cells from dividing, growing, and creating more dangerous cells.

When it comes to treating patients with primary urethral carcinoma (PUC), it can be difficult to find the best approach. This is a very rare lesion that typically affects men and African Americans. 

Almost all the information about primary urethral carcinoma treatment derives from single-center and retrospective case series. Because of the rarity of the disease, it has made it incredibly difficult to determine the ideal treatment. To manage primary urethral cancer, doctors can try various options.

Radiation

A high dose of radiation therapy can slow down the growth of cancer or kill abnormal cells. When these cells die, they are broken down inside the body and eventually leave the system. Radiation therapy is a treatment approach that needs plenty of time to work.

According to research, interstitial brachytherapy paired with external beam therapy in female urethra cancer showed a 5-year disease-free survival rate of 70% to 90%, for tumors in the early stage. While for advanced malignancies, it had a 20% to 30% rate.

Surgery

Surgery can get rid of the tumor. However, if the illness has spread to the lymph nodes, then the doctors will remove that affected area as well. Only a doctor can choose the best type of surgery. The typical procedures for this kind of malignancy include:

Open excision

Known as regular surgical removal of urethral cancer, it is the go-to treatment for managing certain stages of carcinoma. 

Transurethral resection (TUR)

This surgical procedure removes the malignant area. With the help of small surgical tools, doctors can treat the urethra and manage the carcinoma.  

Anterior exenteration

If the tumor has significantly impacted the bladder, vagina, or urethra, the doctors might suggest removing these organs. In certain situations, patients can do reconstructive vaginal surgery to get a new vagina. 

Continent reservoir

If the tumor drastically impairs bladder function, then this surgery can help create a new storage pouch that will replace the bladder. This surgery is only done after the bladder has been removed. 

Cystoprostatectomy

This is the type of surgery that removes the prostate gland and bladder. 

Cystourethrectomy

This surgery removes the urethra and bladder.

Electro Resection paired with fulguration

This surgery uses an electrical current to burn a malignant area affected by ureteral cancer. 

Laser surgery

With the use of laser beam treatment, doctors could destroy or remove the infected area. 

Lymph node dissection

This surgery is often used on the renal pelvis and removes the pelvic nodes. 

Mohs surgery

With this approach, doctors will only remove thin tissue layers affected by urethral cancer. 

Partial penectomy

This surgery removes parts of the penis, which is why patients may need penile reconstructive surgery.

Radical penectomy

This procedure removes the entire penis. In cases such as these, a doctor recommends penile reconstructive surgery. 

Urinary diversion

After the urethra has been surgically removed, this procedure will create a new route for urine to flow and successfully leave the system. 

Urostomy (ostomy)

When a doctor removes your bladder, and there is no way for the body to excrete and store urine, this procedure can help with storage and excretion. 

The success of the surgery depends on the stage of cancer and how serious the health issue is. Regardless of the type of tumor, this disease can affect your sexual and urinary system.

To keep their urethral integrity, many patients choose partial urethrectomy over total urethrectomy. But, research showed a 22% urethral recurrence rate in patients who’ve had a partial urethrectomy with a relatively high post recurrence survival rate.  

Those who want to try a more experimental approach go for clinical trials. There are multiple trials across different regions that accept patients.

Can You Prevent It?

Many people want to know if they can prevent this malignancy. But, because of how rare the illness is, scientists are still looking for the best ways to prevent the disease. Managing the known risks could help. For example, repeated STDs and UTIs can make you susceptible to the tumor. So, the first step should be to focus on your urethra health. 

Doctors are also suggesting excellent hygiene, regular physical activity, a balanced diet, and high fluid intake. Hygiene can help you avoid genital infections, physical activity, diet, and hydration can keep the immune system in tip-top shape. 

But, if you really want to make a difference, it’s crucial to avoid unprotected sex with multiple partners. Since STDs and UTIs can be serious problems, you would have to reduce your exposure as much as possible. 

If you have a history of bladder carcinoma or other serious health complications, it is best to consult with your doctor. They can schedule regular exams and might suggest some preventive strategies. Get a complete medical evaluation with laboratory testing and urine cytology. 

Conclusion 

This cancer is a very rare malignancy. But it can have a significant impact on your urinary and sexual function. Due to its rarity, doctors have yet to find the best treatment alternative. Therefore, they will use several options that might prove helpful, such as radiation and surgery. The stage, severity, and impact of the malignancy will determine the most practical treatment alternative. 

Overall, the tumor can affect females and males differently. Since both sexes have different urethral structures, the illness can influence the system in its own way. But, it is important to point out that both sexes with this cancer can suffer from poor urinary and sexual functions. This type of cancer affects the reproductive organs and urinary tract, which is why it can lead to debilitating symptoms. Although cancer can remain unnoticed during its early phases, the symptoms can become more serious as it grows and spreads.

If you worry about your health and susceptibility to urethral cancer, contact your doctor. So, be open about your medical history and get a proper diagnosis. Because the sooner you spot the illness, the easier it is to manage it. 

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Sources

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