Urethral cancer is a rare type of urological cancer that occurs when cancerous cells develop in the tissues of the urethra, the hollow tube that transports urine from the bladder to outside of the body. In the beginning stages, there may be few to no symptoms but as the cancer grows and narrows the width of the urethra, urinary function can be severely hampered. Pain and bleeding may also occur. Treatment options for urethral cancer are available, with surgery being the most common.
Treating Urethral Cancer
There are four standard forms of care used when treating urethral cancer. They include:
Surgery aims to remove all or most of the cancerous cells and is typically the first form of intervention after urethral cancer diagnosis. Depending on the location of the tumor and how far it has spread, one of the following procedures may be performed:
- Electro-resection with fulguration: This surgical approach is used for superficial cancers that have not yet spread to surrounding tissues and involves using a tool that has a small loop on the end that transmits electric current. The current can burn away cancerous cells without the need to make an incision.
- Laser surgery: A laser is used as a cutting tool to remove cancerous cells or a tumor. At the same time the laser's heat seals off blood vessels, thereby minimizing blood loss. Like electro-resection with fulguration, this approach is most often utilized on superficial tumors that have not spread significantly.
- Open excision: This term refers to any technique that involves using a scalpel to make incisions and remove cancerous tissue. Which approach used depends on where the cancer is located (for example, deeper cancers would require open excision) and if the cancer has spread.
- Lymph node dissection: The lymph nodes act as filters for the body's fluids and cells. When cancer spreads to them, their removal is often be required. During this procedure, a incision is made in the skin over the lymph nodes, then they, nearby lymphatic tissue and possibly some underlying soft tissue are cut away and removed.
- Radical penectomy: This procedure--often performed in combination with a lymph node dissection--is performed when the cancer has spread beyond the urethra and deep into a man's erectile tissues. The entire penis is removed, along with portions of the penis that extend into the pelvis. Reconstructive procedures are possible and a new opening for the urethra can be created to allow for proper urine flow.
- Partial penectomy: During a partial penectomy, just the head of the penis is removed. The surgeon attempts to save as much of the penis shaft as possible. This procedure is an option if the cancer affects only a portion of the male urethra and enough tissue can be spared so that a man can still urinate while standing.
- Anterior exenteration: This surgical procedure is recommended when women have a tumor that is fairly deep within the urethra. An incision is made in the lower abdomen so that the bladder, urethra, vagina, and uterus are removed and a special tube called a urinary pouch is created so that urine can flow without the need for the urethra and bladder.
- Cystoprostatectomy: Urethral cancers that extend to the bladder and prostate gland necessitate both a cystectomy and prostatectomy to remove them as well as the seminal vesicles. This is done through incisions made in the abdomen.
- Cystourethrectomy: For invasive cancers that affect the urethra and the bladder, both a cystectomy and urethrectomy may be performed to excise them. This too is done through an abdominal incision.
If the urethra and/or bladder are removed, procedures to re-route the flow of urine--known as urinary diversion--will be required. There are two types:
- Continent: This category is further subdivided into two types--either a surgical opening is brought out of the abdomen or a replacement bladder is created out of a portion of the intestine. The new bladder allows the patient to urinate instinctively, while the surgical opening calls for a tube to be placed into it occasionally so that urine can be drained. Here, no permanent ostomy bag is worn.
- Non-continent: With this type, the ureters are joined to a piece of the intestine, then the intestine is brought to the surface of the abdomen where an opening has been made so that organ can connect to a permanent ostomy bag.
Radiation therapy uses high-energy X-rays or other types of radiation to treat small urethral tumors that have not spread significantly to surrounding tissues. The radiation can be delivered externally, using a machine that aims energy waves directly at the tumor; or delivered internally by using a radioactive substance enclosed in seeds, needles, catheters, or wires that are inserted into or close by the cancer site. This type of therapy is often used in conjunction with surgery and, at times, chemotherapy.
Chemotherapy drugs are medications used to shrink a tumor or limit its ability to metastasize. The medications are given orally or are injected into a vein or muscle. Once they penetrate the bloodstream, the rapidly dividing cancer cells are targeted. It is often used in combination with surgery and, at times, radiation therapy.
In some cases, such as when a tumor is very small or the patient is in poor health, the best treatment is no treatment at all. This approach calls for the condition to only be monitored closely until symptoms appear or change. This may mean that the patient is required to follow up with their physician and have tests conducted on a regular basis.
The chance of recovery relies on the stage and size of the cancer, the patient's overall health, where in the urethra the cancer developed, and whether the cancer is new or has recurred. Detecting and treating urethral cancer in its earliest stages can render positive outcomes. The five-year survival rate for early-stage urethral tumors is 83 percent, while the survival rate for late-stage tumors is 45 percent five years after diagnosis and treatment. Even with aggressive chemotherapy, radiation therapy and surgery, the recurrence rate for this form of cancer is 50 percent.