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What is cancer of the urethra?
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 prostategland and then through the penis to the outside of the body. Cancer of the urethra affects women more often than 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.
Stages of cancer of the urethra
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:
Anterior urethral cancer
Posterior urethral cancer
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.
Urethral cancer associated with invasive bladder cancer
Recurrent urethral 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.
Treatment Option Overview
How cancer of the urethra is treated
Surgery (taking out the cancer in an operation).
Surgery is the most common treatment of cancer of the urethra. A doctor may take out the cancer using one of the following operations:
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 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 by stage
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. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
Anterior Urethral Cancer
Treatment is different for men and women.
For women, treatment may be one of the following:
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:
Surgery to remove a part of the penis (partial penectomy).
Posterior Urethral Cancer
Treatment is different for men and women.
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).
Urethral Cancer Associated With Invasive Bladder Cancer
Because people with bladdercancer 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.
Recurrent Urethral Cancer
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.
Changes to This Summary (08/19/2005)
Links to the NCI Dictionary of Cancer Terms were added to this summary.
To Learn More
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PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
Before starting treatment, patients may want to think about taking part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.