Urethra or urethral cancer is an extremely rare form of cancer: only about 0.3 percent of all cancers originate in the urethra or urethra. Most of those affected are over 50 years old. In 2023, it is still unclear why urethral cancer develops. Often the first symptom of urethral cancer is blood in the urine (hematuria). In the further course of the disease, the urethra can become narrowed by the tumor, causing symptoms such as pain when urinating and a weakened urine stream, and later weight loss and night sweats. Once the diagnosis has been confirmed, imaging tests should show whether and to what extent the tumor has spread to the surrounding tissue and lymph nodes. It is also checked whether there are metastases in other organs such as the lungs, liver, brain and bones. The treatment of urethral cancer focuses on removing the tumor through surgery. In addition, radiation and chemotherapy may take place.
- What is urethral cancer?
- Synonyms
- Prevent
- Anatomy and function of the urethra
- Causes and risk factors
- Symptoms of urethral cancer
- Examination and diagnosis
- Treatment of urethral cancer
- TURT and laser treatment
- Operation
- Radiotherapy
- Chemotherapy
- Course of the disease
- Check
- Prognosis
- Prevention
Inside of the urethra or urethra / Source: Michael Reeve, Wikimedia Commons (CC BY-SA-3.0)
What is urethral cancer?
Urethra cancer is a rare form of cancer that affects the urethra or urethra. The causes of urethral cancer are largely unknown in 2023, but it is suspected that there is a link between urethral cancer and frequent inflammation of the lower urinary tract.
Synonyms
Urethra cancer is also known as urethral cancer or urethral carcinoma.
Prevent
Urethra cancer is a rare form of cancer. Women are twice as likely to get the disease as men. Three quarters of all those affected are over 50 years old. Postmenopausal women are the most common group of patients.
Urinary tract / Source: La Gorda/Shutterstock.com
Anatomy and function of the urethra
The urethra, together with the renal pelvis, ureters and bladder, is part of the urinary tract. The urethra (urethra) is a thin tube through which urine is transported from the urinary bladder to the outside. In men, semen also passes through during ejaculation. In men, the urethra runs from the bladder, through the prostate to the glans of the penis. In men, the urethra is roughly 20 cm long. In women, the urethra runs from the bladder (bladder neck) to the vulva. In women, the urethra is 2.5 to 4 cm long.
The anatomical differences result in special characteristics. Men are less likely to get urinary tract infections due to the longer urethra, because bacteria have to travel a greater distance. In women, urethral cancer may be easier to detect or feel from the outside.
Causes and risk factors
The causes of urethral cancer are largely unknown in 2023. However, a link is suspected between the occurrence of this form of cancer and repeated increased strain or irritation of the urethral tissue, for example as a result of frequent or chronic urinary tract infections, sexually transmitted infections (STDs) or frequent urethral injuries (due to certain sexual practices). Because of their increased susceptibility to urinary tract infections, women are likely twice as likely to develop urethral cancer. Another risk factor for the development of urethral cancer is a urethral caruncle, an initially benign tumor of the urethra or urethra that can degenerate over time.
Symptoms of urethral cancer
The first symptom of urethral cancer is usually blood in the urine (hematuria). This may appear visibly as red urine (macroscopic hematuria) or invisible (microscopic hematuria). If the urethra or urethra is narrowed by the tumor, a larger amount of urine remains in the bladder. This in turn can lead to an increased urge to urinate and is also associated with an increased susceptibility to infections. The narrowing of the urethra (urethral stenosis) can also cause pain when urinating and a weakened urine stream. Symptoms after sexual intercourse also occur.
In advanced stages of the disease, weight loss and night sweats may also occur. The involvement of the lymph nodes in the pelvis and groin can lead to lymphatic congestion, which manifests as lymphedema with swollen legs.
Examination and diagnosis
If urethral cancer is suspected, a physical examination by the gynecologist or urologist and a urethraloscopy are performed. A ureteroscopy is an examination in which the doctor inserts a thin hollow tube (the so-called ‘ureteroscope’) through the urethra and bladder into the ureter. A biopsy is used to confirm the diagnosis: the doctor takes a sample of the tumor and examines the tissue under a microscope. In order to determine whether metastases have also formed, the doctor can use an ultrasound examination (ultrasound) to check the lymph nodes of the groin and pelvic area for cancer. The spread of urethral cancer can be determined even more accurately using computed tomography (CT scan) or magnetic resonance imaging (MRI scan).
Treatment of urethral cancer
TURT and laser treatment
If the cancer is discovered at an early stage, you can receive one of these treatments:
- Scraping away the tumor during keyhole surgery. This is called TURT. TURT is an abbreviation and stands for transurethral resection of a tumor.
- Removal of the tumor using laser surgery.
Operation
The most important treatment measure for urethral cancer is surgery. Sometimes it is useful to treat and shrink the tumor in advance with radiation or chemotherapy (neoadjuvant therapy). For smaller tumors without growth into nearby structures, partial or complete removal of the urethra is sufficient. In men, part of the penis may need to be removed. The lost tissue can be restored with the help of plastic surgery. For larger and/or extensive tumors, the urinary bladder may also need to be completely removed. If the urethra and/or bladder are removed, you will receive a urostomy. After surgery, either radiotherapy or combined treatment of radiotherapy and chemotherapy can be performed.
Radiotherapy
Radiotherapy or radiation works by destroying cancer cells. This treatment method is used alone or in combination with chemotherapy for urethral cancer.
Chemotherapy
Chemotherapy aims to kill cancer cells throughout the body using drugs that inhibit cell growth (cytostatics). Cytostatics are especially effective against fast-growing cells, a property that especially applies to cancer cells. It is not possible to cure urethral cancer by simply administering cytostatics. In locally advanced or metastatic tumors, chemotherapy can stop tumor growth for a period of time and prolong survival time. In addition, tumor-related symptoms can be alleviated. In some patients, chemotherapy can significantly reduce the size of the tumor.
To achieve the greatest possible effect against tumor cells and reduce side effects, combinations of cytostatics with different effects are often used. The treatment takes place in several treatment cycles that extend over several weeks. There are longer breaks between the individual cycles. The therapy cycles are usually repeated three to six times. How many cycles are needed depends mainly on how well the treatment is tolerated and how the therapy affects the tumor.
Treatment with cytotoxic drugs also affects normal tissue. This mainly affects the mucous membranes of the stomach and intestines, the blood-forming system in the bone marrow and the hair roots. Possible side effects of chemotherapy include nausea, vomiting, diarrhea, hair loss, increased susceptibility to infections and a tendency to bleed. Some side effects can be prevented or alleviated by accompanying measures or medication. The complaints usually disappear after you stop chemotherapy.
Course of the disease
Urethral cancer tends to spread through the urethral wall to adjacent tissue and possibly to adjacent organs. Lymph node involvement is also observed. With cancer in the upper part of the urethra near the bladder, metastases mainly occur in the pelvic lymph nodes. Cancer in the lower part of the urethra usually metastasizes to the lymph nodes in the groin.
In 50-75% of cases, a tumor also appears in the boss.
In the late stages of the disease, metastases or daughter tumors are often found in the lungs, liver, brain, or bones.
Check
After treatment, regular doctor visits and examinations are essential. These serve to assess the course and to detect relapse or distant metastases at an early stage. Blood tests, ultrasound, chest X-ray and a CT or MRI scan are performed.
Prognosis
Urethra cancer tends to spread as it progresses. The prognosis therefore largely depends on the time of diagnosis: with a small tumor that is detected early, a cure rate of 70 to 80 percent can be expected. The location of the cancer also influences the prognosis: a tumor located close to the opening of the urethra has a more favorable prognosis than that in the upper part of the urethra.
Prevention
So far, there are no known effective measures that can prevent urethral cancer with certainty. Since repeated inflammation and injuries to the urethra and sexually transmitted diseases can play a role in the development of urethral cancer, it is recommended to:
- to have every urethral infection treated adequately
- protect yourself with condoms during intercourse
- Avoid injuries to the urethra by, for example, not inserting objects into it
read more
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- Urethral stricture: symptoms & treatment of urethral stricture
- Urinary complaints in men and women: symptoms and causes
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