Overview
Urethral cancer happens when the cells present in the urethra (the tube through which urine is expelled out of the body) start dividing abnormally. It is one of the rare urological cancers, and it is seen both among men and women. However, studies have found that certain types of urethral cancer are more prevalent among women.
Types
Based on the type of cell that they originate from, urethral cancers are categorised into the following types:
- 1. Squamous Cell Carcinoma: It is a common type of urethral cancer. In women, it begins in the urethral cells close to the bladder, and in men, it starts in the urethral lining of the penis.
- 2. Adenocarcinoma: This urethral cancer type begins in the glands present around the urethra.
- 3. Transitional Cell Carcinoma: In men, this cancer type begins in the urethral cells that are present near the urethral opening. In women, on the other hand, it begins in the part of the urethra that is surrounded by the prostate gland.
Usually, urethral cancers are detected in the advanced stages when they demand much complex treatment planning.
Symptoms
Urethral cancer does not have any symptoms in the early stages. However, as the disease progresses, the patient may find it difficult to urinate and lose bladder control. Frequent urination during the nighttime could also be a sign of urethral cancer. Other major symptoms of urethral cancer include:
- Pain while urinating
- Presence of blood in the urine
- Interrupted urine flow
- Frequent urination
- Presence of a lump in the perineum or penis
- Unusual discharge from the urethra
- Lymph nodes present in the groin area begin enlarging
Causes
Although the exact cause of urethral cancer is unknown, researchers have identified a few risk factors. These risk factors can increase one’s chances of developing urethral cancer.
- Age: The risk of getting urethral cancer increases with age.
- Chronic Inflammation: Chronic (long term) inflammation or irritation caused due to various urinary tract infections can increase one’s risk of getting urethral cancers.
- Sexually Transmitted Diseases: Certain sexually transmitted diseases lead to a higher risk of developing urethral cancer. For instance, chronic infection associated with a specific strain of Human Papillomavirus (HPV) leads to an increased risk of urethral cancer.
- History of Bladder Cancer: Those who have received treatment for bladder cancer in the past are also at a higher risk of getting urethral cancer.
- Ethnicity: The incidence of urethral cancer is relatively higher among the population of African-American ethnicity.
Diagnosis
Various testing methods are available for the detection and diagnosis of urethral cancer.
a. Medical History Assessment and Physical Examination: When a patient presents himself/herself with the symptoms of urethral cancer, the doctor evaluates the medical history of the patient, which involves the understanding of the patient’s health habits, past medical conditions and the treatments received, allergies, etc.
During the physical examination, the doctor checks the patient for the physical signs of the disease, such as lumps, lesions, swelling and pain. The physical exams may include a digital rectal exam and pelvic exams, where the entire pelvic region is checked for the signs of urethral cancer.
b. Laboratory Tests: If urethral cancer is suspected, the doctor may recommend a urine test to look for any abnormalities. A cytology analysis of the urine sample can also help in looking out for the presence of abnormal cells. The doctor may also recommend a blood test in order to understand the status of the patient’s overall health.
c. Cystoscopy: This procedure involves inserting a slender, lit tube into the urethra to check the inner lining of the urethra and bladder for the signs of cancer. The doctor may also consider collecting the biopsy sample during this procedure.
d. Biopsy: During the biopsy, a small sample of tissues is collected from the suspected area. This sample is further examined under the microscope for the presence of cancer cells. This test plays a pivotal role in receiving a confirmed diagnosis of the disease.
e. Imaging Tests: To diagnose and stage urethral cancers accurately, the doctor may recommend CT scans, MRI scans and other imaging tests. These tests provide the detailed structure of the tumour along with crucial information like the size of the tumour, exact location, its size, its stage, etc.
These imaging tests may be frequently recommended throughout the treatment course in order to determine the patient’s response to the treatment given.
Treatment
Multiple treatment options are available for the successful management of urethral cancers. The treatments are planned based on various factors like the stage of the disease, its grade, its type, the patient’s age and his/her overall condition.
The treatment plan may contain either one treatment option or a combination of two or more treatment options depending on the severity of the disease.
The commonly recommended treatment approaches for urethral cancer include surgery, chemotherapy and radiation therapy.
a. Active Surveillance: In the case of slow-growing urethral cancers, the doctor may recommend active surveillance, wherein there is no immediate treatment given but the tumour is consistently monitored with regular tests. The treatment may be recommended once the disease starts showing symptoms.
b. Surgery: Surgery is the main line of treatment for urethral cancer, and one or more of the following surgical procedures may be recommended depending on the stage of the disease:
- Open Excision: This procedure removes the tumour with a small portion of healthy tissues surrounding the tumour known as the margin.
- Electro-resection with Fulguration: During this procedure, pulses of electric current are sent through a specialised tool to burn the cancer cells.
- Laser Surgery: During laser surgery, high-energy laser beams (narrow and intense beams of light) are used to destroy cancer cells.
- Lymph Node Dissection: This surgical procedure involves the removal of lymph nodes present in the groin and pelvic region.
- Cystourethrectomy: This procedure is performed to remove the urethra along with the bladder.
- Cystoprostatectomy: This surgical procedure involves the removal of the bladder, perivesical fat, peritoneal covering, prostate gland, vasa deferentia and seminal vesicles. At times, the entire urethra may also be removed during this procedure.
- Anterior Pelvic Exenteration: This procedure is recommended for women diagnosed with urethral cancer that is aggressive and has spread to the nearby lymph nodes. This surgical procedure removes the urethra, bladder, vagina, cervix, uterus and the lower portion of the ureters. This procedure may be followed by the reconstruction of the vagina.
- Penectomy: Among male urethral cancer patients, the doctor may recommend the removal of a portion (partial penectomy) or the entire (radical penectomy) penis. Reconstructive surgery may be performed after this procedure to reconstruct the penis.
If the urethra and bladder are removed, the following surgical procedures may be recommended for storing and passing urine:
- Urinary Diversion: This procedure creates a new path for urine to exit the body when the urethra has been removed.
- Urostomy (Ostomy): During this procedure, a small portion of the small intestine is used to create a new path for urine to be stored and expelled, along with an external urine collection bag.
- Continent Reservoir: This procedure is performed if the bladder is removed completely. The bladder is replaced by a storage pouch made from the small intestine, which is emptied through an opening.
c. Radiation Therapy: Radiation therapy uses intense energy X-rays and other types of radiation beams to destroy the cancer cells. Radiation therapy is one of the common treatment options recommended for urethral cancer. Radiation therapy for urethral cancer may be delivered in two ways – external and internal. During external beam radiation therapy, the radiation beams are delivered from an external source. During internal radiation therapy, the radiation source is placed inside the body – either very close to the tumour or inside the tumour. Radiation therapy may be used in combination with other treatment approaches to increase the overall effectiveness of the treatment.
d. Chemotherapy: Chemotherapy may be administered before the surgery (neoadjuvant) in order to shrink the tumour or after the surgery (adjuvant) to destroy the residual cancer cells. Chemotherapy may be administered orally, intravenously or intramuscularly. As a systemic therapy, chemotherapy destroys cancer cells throughout the body. It may be administered in combination with other treatment approaches to improve the patient’s treatment response.
Frequently Asked Questions
1. Are urethral cancers treatable?
Urethral cancers can be treated with positive clinical outcomes. The advancements in the field of cancer medicine are now allowing specialists to even treat advanced-stage urethral cancers with good survival rates.
However, the early diagnosis changes a lot of things. Be it any cancer, it needs to be detected in the early stages for it to be treated successfully. It is of paramount importance to keep an eye on the symptoms and consult a doctor if any symptoms last for more than two weeks.
2. Do urethral cancers spread quickly?
Yes, usually, urethral cancers can spread quickly. In the majority of the cases, by the time of diagnosis, urethral cancers would have spread to the nearby lymph nodes.
However, some urethral cancers can be slow-growing, and this depends on the grade of the tumour. For more information on the tumour grade and the appropriate treatment, patients should talk to their doctor.
3. Can urethral cancer come back?
In some cases, urethral cancers do come back. However, if they are detected early, they can be treated successfully.
In order to reduce the relapse risk, patients must keep follow-up appointments without fail. This not only helps in reducing the risk of recurrences but also in catching the recurrences in their early stages.
4. Can I prevent urethral cancers?
As this is a rare cancer type, researchers are still finding out the best possible ways to bring down the risk of this cancer.
- Pay Attention to Urinary Tract Infections: Chronic UTIs can lead to urethral cancers. If you are suffering from urinary tract infections, do not leave them untreated. Get them treated and pay extra attention to personal hygiene.
- Healthy Sexual Practices: Healthy sexual practices can help you prevent a broad spectrum of sexually transmitted diseases, which are associated with increased risk of urethral cancers.
If you have a family history of urethral cancer, talk to your doctor to learn the best practices to reduce the risk of this disease.