Urethra Cancer
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Cancer of the urethra, a rare type of cancer, is a
disease in which cancer (malignant) cells are found in the urethra. The urethra
is the tube that empties urine from the bladder, the hollow organ in the lower
abdomen that stores urine. In women, the urethra is about 1 1/2 inches long
and opens to the outside of the body above the vagina. In men, the urethra
is about 8 inches long and goes through the prostate gland and then through
the penis to the outside of the body. Cancer of the urethra affects women more
often then men.
There may be no symptoms of early cancer of the urethra.
A doctor should be seen if there is a lump or growth on the urethra, or pain,
bleeding, or other difficulty during urination
If there are symptoms, a doctor will examine the patient
and feel for lumps in the urethra. In men, a thin lighted tube called a cystoscope
may be inserted into the penis so the doctor can see inside the urethra. If
the doctor finds cells or other signs that are not normal, a small piece of
tissue (called a biopsy) may be cut out and looked at under a microscope for
cancer cells.
The chance of recovery (prognosis) and choice of treatment
depend on the stage of the cancer (whether it is just in one area or has spread
to other places) and the patient’s general state of health.
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Once cancer of the urethra is found, more tests will
be done to find out if cancer cells have spread to other parts of the body
(staging). A doctor needs to know the stage of the disease to plan treatment.
For cancer of the urethra, patients are grouped into stages depending on where
the tumor is and whether it has spread to other places. The following stage
groupings are used for cancer of the urethra:
The part of the urethra that is closest to the outside
of the body is called the anterior urethra, and cancers that start here are
called anterior urethral cancers.
The part of the urethra that connects to the bladder
is called the posterior urethra, and cancers that start here are called posterior
urethral cancers. Because the posterior urethra is closer to the bladder and
other tissues, cancers that start here are more likely to grow through the
inner lining of the urethra and affect nearby tissues.
Occasionally, patients who have bladder cancer also
have cancer of the urethra. This is called urethral cancer associated with
invasive bladder cancer.
Recurrent cancer means that the cancer has come
back (recurred) after it has been treated. It may come back in the same place,
or in another part of the body.
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There are treatments for all patients with cancer
of the urethra. Three kinds of treatment are used:
- Surgery (taking out the cancer in an operation).
- Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer
cells).
- Chemotherapy (using drugs to kill cancer cells).
Surgery is the most common treatment of cancer of
the urethra. A doctor may take out the cancer using one of the following operations:
- Electrofulguration uses an electric current to remove the cancer.
The tumor and the area around it are burned away and then removed with a
sharp tool.
- Laser therapy uses a narrow beam of intense light to kill cancer cells.
- Cystourethrectomy removes the bladder and the urethra.
In men, the part of the penis containing the urethra
that has cancer may be removed in an operation called a partial penectomy.
Sometimes the entire penis is removed (penectomy). A patient may need plastic
surgery to make a new penis if all or part of the penis is removed. The bladder
and prostate may also be removed in an operation called cystoprostatectomy.
Lymph nodes in the pelvis may also be removed (lymph node dissection). Lymph
nodes are small bean-shaped structures that are found throughout the body.
They produce and store infection-fighting cells.
In women, surgery to remove the urethra, the bladder,
and the vagina (anterior exenteration) may also be done. Lymph nodes in the
pelvis may be removed (lymph node dissection). Plastic surgery may be needed
to make a new vagina after this operation.
If the urethra is removed, the doctor will need
to make a new way for the urine to pass from the body. This is called urinary
diversion.
If the bladder is removed, the doctor will need
to make a new way for the patient to store and pass urine. There are several
ways to do this. Sometimes the doctor will use part of the small intestine
to make a tube through which urine can pass out of the body through an opening
(stoma) on the outside of the body. This is sometimes called an ostomy or urostomy.
If a patient has an ostomy, a special bag will need to be worn to collect urine.
This special bag, which sticks to the skin around the stoma with a special
glue, can be thrown away after it is used. This bag does not show under clothing,
and most people take care of these bags themselves. The doctor may also use
part of the small intestine to make a new storage pouch (a continent reservoir)
inside the body where the urine can collect. The patient would then need to
use a tube (catheter) to drain the urine through a stoma.
Radiation therapy uses x-rays or other high-energy
rays to kill cancer cells and shrink tumors. Radiation may come from a machine
outside the body (external radiation therapy) or from putting materials that
produce radiation (radioisotopes) through thin plastic tubes (internal radiation
therapy) in the area where cancer cells are found. Radiation may be used alone
or with surgery and/or chemotherapy.
Chemotherapy uses drugs to kill cancer cells. Chemotherapy
may be taken by mouth, or it may be put in the body through a needle in a vein
or muscle. Chemotherapy is called a systemic treatment because the drug enters
the bloodstream, travels through the body and can kill cancer cells outside
the urethra.
Treatment depends on where the cancer is found,
whether it has spread to other areas in the body, and the patient’s sex, age,
and overall health.
Standard treatment may be considered because of
its effectiveness in patients in past studies, or participation in a clinical
trial may be considered. Not all patients are cured with standard therapy and
some standard treatments may have more side effects than are desired. For these
reasons, clinical trials are designed to find better ways to treat cancer patients
and are based on the most up-to-date information. Clinical trials are going
on in many parts of the country for patients with cancer of the urethra.
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For women, treatment may be one of the following:
- Electrofulguration
- Laser therapy
- External and/or internal radiation therapy
- Radiation therapy followed by surgery or surgery alone to remove the urethra
and the organs in the lower pelvis (anterior exenteration), or the tumor
only, if it is small. A new way is made for urine to pass out of the body
(urinary diversion).
For men, treatment may be one of the following:
- Electrofulguration.
- Laser therapy.
- Surgery to remove a part of the penis (partial penectomy).
- Radiation therapy.
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For women, treatment will probably be radiation
therapy followed by surgery or surgery alone to remove the urethra, the organs
in the lower pelvis (anterior exenteration), or the tumor only, if it is small.
Lymph nodes in the pelvis are usually removed (lymph node dissection), and
lymph nodes in the upper thigh may or may not be removed. A new way is made
for urine to pass out of the body (urinary diversion).
For men, treatment will probably be radiation therapy
followed by surgery or surgery alone to remove the bladder and prostate (cystoprostatectomy)
and the penis and urethra (penectomy). Lymph nodes in the pelvis are usually
removed (lymph node dissection), and lymph nodes in the upper thigh may or
may not be removed. A new way is made for urine to pass out of the body (urinary
diversion).
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Because people with bladder cancer sometimes also
have cancer of the urethra, the urethra may be removed at the same time the
bladder is taken out (cystourethrectomy). If the urethra is not removed during
surgery for bladder cancer, the doctor may follow the patient closely so treatment
can be started if cancer of the urethra develops.
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Treatment depends on what treatment the patient
received before. If the patient had surgery, treatment may be radiation therapy
and surgery to remove the cancer. If the patient had radiation therapy, treatment
may be surgery to remove the cancer. Clinical trials are testing chemotherapy
for cancer of the urethra that has spread to other parts of the body.
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Bladder Cancer
