Urethral cancers are rare malignancies of the urethra, the tube that carries urine from the bladder to outside of the body. The presentation of urethral cancer varies between men and women, due to differences in their anatomy and physiology.
In men, the urethra is approximately 21cm long, and it runs from the end of the bladder to the urethral opening (opening to the outside of the body in the tip of the penis), carrying both urine and sperm. The most common type of urethral cancers in men are urothelial carcinomas (also known as transitional cell carcinoma – cancer arising from transitional cells that line organs), followed by squamous cell carcinomas (cancer arising from squamous cells that line organs) and adenocarcinomas (cancer arising from mucus-producing glands in organs).
In women, the urethra is approximately 3-4cm long, and it runs from the end of the bladder to the urethral opening. It sits below the clitoris and above the vaginal opening, and carries only urine. The most common type of urethral cancers in women is squamous cell carcinomas, followed by urothelial carcinomas, and adenocarcinomas.
Urethral cancers are more common in men, and is most commonly found over the age of 60. However, anyone can develop this disease.
Treatment
If urethral cancer is detected, it will be staged and graded based on size, metastasis (whether the cancer has spread to other parts of the body) and how the cancer cells look under the microscope. Staging and grading helps your doctors determine the best treatment for you.
Cancers can be staged using the TNM staging system:
- T (tumour) indicates the size and depth of the tumour.
- N (nodes) indicates whether the cancer has spread to nearby lymph nodes.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0-IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissue.
- Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and had not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localised cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also known as localised cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advanced or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Grade I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
- Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testing, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment is dependent on several factors, including sex, location, stage of disease and overall health.
Treatment options for men include:
- Surgery, potentially including:
- Endoscopic resection (removal of cancer only via long tube down the throat (endoscope)).
- Transurethral resection (TUR) (removal of cancer via special tool inserted into the urethra).
- Urethrectomy (partial or total removal of the urethra).
- Penectomy (partial or total removal of the penis).
- Lymphadenectomy (removal of affected lymph nodes).
- Cystourethrectomy (removal of the bladder and urethra).
- Cystoprostatectomy (removal of the bladder and prostate).
- Urinary diversion (creating a new pathway for urine to exit the body when urine flow is blocked).
- Ostomy/urostomy (creating an opening in the abdomen made to redirect urine away from a bladder that isn’t working).
- Radiation therapy.
- Chemotherapy.
- Watch and wait.
- Clinical trials.
- Palliative care.
Treatment options for women include:
- Surgery, potentially including:
- Endoscopic resection (removal of cancer only via long tube down the throat (endoscope)).
- Transurethral resection (TUR) (removal of cancer via special tool inserted into the urethra).
- Urethrectomy (partial or total removal of the urethra).
- Lymphadenectomy (removal of affected lymph nodes).
- Cystourethrectomy (removal of the bladder and urethra).
- Vaginectomy (partial or total removal of the vagina).
- Pelvic exenteration (surgery to remove the urethra, bladder, and vagina).
- Urinary diversion (creating a new pathway for urine to exit the body when urine flow is blocked).
- Ostomy/urostomy (creating an opening in the abdomen made to redirect urine away from a bladder that isn’t working).
- Radiation therapy.
- Chemotherapy.
- Watch and wait.
- Clinical trials.
- Palliative care.
For more information on the treatment options, please refer to the Rare Cancers Australia treatment options page.
Urethral Cancer Treatment and Fertility
Some treatment for urethral cancer may make it difficult to conceive or carry a child. If fertility is important to you, discuss your options with your doctor and a fertility specialist prior to the commencement of treatment.
Risk factors
While the cause of urethral cancer remains unknown, the following factors may increase the risk of developing the disease:
- Having a personal or family history of bladder, ureter and/or renal pelvis cancers.
- Having conditions that cause chronic inflammation in the urethra, including:
- Sexually transmitted diseases (STDs), including human papillomavirus (HPV).
- Frequent urinary tract infections (UTIs).
Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Early symptoms
Symptoms often present differently in men and women.
In men, symptoms of urethral cancer may include:
- Urethral strictures, which carries its own set of symptoms:
- Decreased urine stream.
- Feeling like you need to urinate after urinating.
- Difficulty, straining and/or pain while urinating.
- Frequent urination.
- Frequent urinary tract infections (UTIs).
- Blood in urine.
- Dysuria (burning, tingling and/or stinging of the urethra when urinating).
- Unusual discharge.
- Genital swelling.
- Priapism (prolonged penile erection).
- Abscesses in the urethra.
- Fistulas.
- Constipation.
- A lump in the penis.
In women, symptoms of urethral cancer may include:
- Irritative voiding, which carries its own set of symptoms:
- Frequent urination.
- Painful urination.
- Urinary incontinence.
- Blood in urine.
- Pain during or after intercourse.
Not everyone with the symptoms above will have cancer but see your general practitioner (GP) if you are concerned.
Diagnosis/diagnosing
If your doctor suspects you have urethral cancer, they will order a range of diagnostic tests to confirm the diagnosis, and refer you to a specialist for treatment.
Physical examination
Your doctor will collect your overall medical history, as well as your current symptoms. Following this, they may examine your body to check for any abnormalities.
Pelvic examination
The doctor will inspect the abdomen for any swelling or masses, followed by your genitalia. The doctor will then insert two fingers into your vagina while simultaneously pressing on your abdomen with their other hand to feel your uterus and ovaries. Following this, the doctor may use a device called a speculum into your vagina, which will separate the vaginal walls and allow viewing of your vaginal canal and cervix for any visible abnormalities. You many request a family member, friend, or nurse to be present during this exam.
Digital rectal examination (DRE)
A digital rectal examination (DRE) is an exam conducted by a urologist (a doctor specialising in issues pertaining to the kidneys, bladder, prostate, and male reproductive system). In this exam, the doctor will insert a finger (or ‘digit’) into your rectum to feel the back of your prostate. If it feels hard or is an odd shape, further testing may be required.
Imaging tests
The doctor will take images of your body using magnetic resonance imaging (MRI), a computed tomography scan (CT scan), x-ray and/or ultrasound, depending on where it is suspected the cancer is. The doctor may also look at other parts of the body and looks for signs of metastasis.
Blood & Urine tests
Urine and blood tests are used to assess overall health and detect any abnormalities. Some of these tests may include:
- General blood test to assess overall health.
- Full blood count, which measures the levels of red blood cells, white blood cells and platelets.
- Blood chemistry and/or blood hormone studies, which analyse the levels of certain hormones and other substances in the blood.
- Urinalysis.
- Urine cytology.
Ureteroscopy & Biopsy
A ureteroscopy is a surgical procedure that involves inserting a long, flexible tube with a light and small camera (uretoscope) through the urethra into the renal pelvis, bladder, and ureters. You will be given a sedative or anaesthetic throughout the procedure. You will be asked to fast for several hours prior to the procedure. An endoscopy is often done as a day surgery. Your doctor will discuss the risks and any possible complications prior to the procedure.
Once the location(s) of the cancer has been identified, the doctor will perform a biopsy to remove a section of tissue using a needle. The tissue sample will then be analysed for cancer cells.
Prognosis (Certain factors affect the prognosis and treatment options)
While it is not possible to predict the exact course of the disease, your doctor may be able to give you a general idea based on the rate and depth of tumour growth, susceptibility to treatment, age, overall fitness, and medical history. Generally, early-stage urethral cancers have a better prognosis and survival rates. However, if the cancer is advanced and has spread, the prognosis may not be as good and there may be a higher risk of cancer recurrence. It is very important to discuss your individual circumstances with your doctor to better understand your prognosis.
References
Some references are to overseas websites. There may be references to drugs and clinical trials that are not available here in Australia.