Urethral Cancer: Overview and More - Verywell Health
The urethra is a thin tube through which urine from the bladder leaves the body. The urethra is about 8 inches long and allows for the passage of semen and urine in men. The urethra in women is about 1.5 inches long and only transports urine.
Malignant cells rarely arise in the urethra. In fact, urethral cancer is the rarest form of urological cancer. It accounts for less than 1% of all cancer cases. There is a slightly higher prevalence of urethral cancer in Black Americans and in men compared to women.
This article discusses the symptoms, causes, and treatments of urethral cancer.
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Urethral Cancer Symptoms
In its early stages urethral cancer may present with few, if any, symptoms. By the time symptoms appear the cancer may be in its advanced stages. The following signs and symptoms are associated with urethral cancer:
- Blood in the urine
- Frequent urge to pass urine, especially at night
- Difficulty starting the flow of urine
- Weak or interrupted (stop-and-go) flow of urine
- Inability to hold your urine (incontinence)
- Presence of discharge or bleeding from the urethra
- A painless lump, thickness, or swelling in the groin or penis.
Causes
The exact cause of urethral cancer is unknown but a human papillomavirus (HPV) infection, a history of sexually transmitted infections (STIs), and chronic irritation and inflammation of the urethra are all associated with an increased risk of urethral cancer.
Urethral cancers arise in three different types of cells, including:
- Squamous cells: Squamous cells are the flat cells that line the surface of the urethra. Malignant changes occur most frequently in these cells, making squamous cell carcinoma the most common type of urethral cancer.
- Transitional cells: Transitional cells can be found near the urethral opening in women, and in the part of the urethra that goes through the prostate gland in men. Rarely, these cells may undergo malignant transformation and give rise to urethral cancer.
- Adenocarcinoma: Adenocarcinoma is cancer of the glands that are around the urethra in both men and women. It makes up less than 5% of all urethral cancers.
Urethral cancer is highly aggressive and can quickly spread (metastasize) to local tissues around the urethra and other parts of the body if left untreated. It's important to seek a diagnosis and start treatment as soon as possible.
You may have a higher prevalence of urethral cancer if any of the follow factors apply to you:
Some people fall into groups with a greater prevalence of urethral cancer but never develop it, while others have a low prevalence and end up with urethral cancer.
Decreasing Your Risk
To limit your risk of urethral cancer from HPV, you can:
- Get the HPV vaccine.
- Use protection during intercourse.
- Limit your number of sexual partners.
Diagnosis
A diagnosis of urethral cancer starts with your healthcare provider taking a full medical history and performing a focused urogenital physical exam, including checking the urethra and feeling for any gross abnormalities.
Your healthcare provider—likely a primary care physician or a urologist who specializes in urogential conditions—will also ask you about:
- Your cancer history
- Sexually transmitted infections
- UTIs
- HPV vaccination status
Your healthcare provider will take blood and urine tests. They may also take an MRI (magnetic resonance imaging) or CT (computed tomography) scan of the urethra and the surrounding area to see if they can visualize signs of cancer or cancer spread.
Finally, a tissue biopsy is needed to make an official diagnosis of urethral cancer. A sample can be taken with the use of a thin tube called a catheter or by inserting a needle through the skin or vagina.
This procedure is usually performed by a urologic oncologist. While this procedure may be performed using local anesthesia, some providers prefer to use general anesthesia. Your tissue sample will be analyzed for staging and grading by a pathologist. In cases that are unclear, the diagnosis may be confirmed by cystoscopy, a procedure that allows your provider to visually examine the inside of your urethra.
Treatment
Your treatment plan will be based on the staging of your cancer—whether the cancer is local or spread to other parts of the body. Your urologist, with several specialists that may include an oncologist and a pathologist, will assess the extent and severity of your urethral cancer. This process is known as staging.
The first step in early urethral cancer treatment is almost always to remove the cancerous tissue via surgery. If the cancer has spread locally to the lymph nodes your surgeon may also have to remove this tissue via a procedure known as a lymph node dissection, or regional lymphadenectomy.
Chemotherapy and radiation may be initiated sooner rather than later and will depend on how far the tumor has spread.
Chemotherapy vs. Radiation in Urethral Cancer
Chemotherapy is highly effective at destroying cancerous cells, while radiation is effective at killing any remaining microscopic cancer cells that may be left behind after chemotherapy.
Prognosis
Urethral cancer is a highly aggressive cancer that may spread to other parts of the body quickly. Your prognosis (expected outcome) largely depends on:
- Your overall health
- The precise location of the cancer in the urethra
- The extent and severity of the damage done by the cancer
Prognoses are generally more favorable in those who have localized disease that has not invaded surrounding tissues.
Tumors are usually diagnosed when they are localized, with regional metastases to nodal sites seen in up to 30% of cases in both genders. Distant metastases at initial presentation are rare, occurring in less than 5% of cases, but this is much more frequently observed in those with recurrent disease. Some studies have found that the recurrence rate is as high as 50%.
The typical prognosis for urethral cancer varies from study to study. One major study found that the five-year survival rate of urethral cancer is 46%, and the 10-year survival rate is 31%, while another found that the five-year survival rates are over 60% for patients with distal and 10% to 20% for those with proximal tumors.
Summary
Urethral cancer is a rare cancer of the urethra, a thin tube used to empty urine from the bladder. Urethral cancer is most common in adults older than 60 years old, men, and in Black Americans.
A Word From Verywell
Knowing the subtle signs of urethral cancer can help you to get a timely diagnosis and start treatment as soon as possible.
A supportive network of family and friends makes getting through cancer a bit easier. It's important to remember that you are not alone. Social media and the Internet have made it easier to find and access support groups and other resources. These resources can potentially lessen the weight of your new cancer diagnosis.
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