Urethral cancer

Urethral cancer is a very rare type of cancer, with only a couple of thousand cases ever reported. Diagnosis can be difficult and treatments are sometimes complicated since there just isn’t a lot of opportunity to practice or study it.

Urethral cancer can affect men and women, however this article is specifically for women.

Symptoms of urethral cancer

• Symptoms vary from person to person, and often there are no symptoms at all
• Bladder problems, obstructions, and incontinence
• Perineal pain
• Blood in the urine
• Diminished urine stream, straining to urinate
• Frequent urination, nighttime urination (nocturia)
• Itching
• Painful urination
• Urinary retention
• Discharge – smelly or watery
• Pain in the urethra or nearby structures
• Painful sex
• Swelling
• Nodules in the labia or perineum
• The urge to defecate, but nothing much coming out (tenesmus)
• Recurrent urinary infections
• Lesions

Urethral cancer has been reported to occur in people from ages 13-90, but is most common in the 70s. Those with bladder cancer have an increased risk of urethral cancer, and chronic irritation and infection are possible triggers.

There have been some correlations found in men with a history of previous sexually transmitted infections, and HPV (human papillomavirus) has been implicated in some cases. 

Onset and discovery of cancer may be many years – misdiagnosis is common.

Diagnosis of urethral cancer

Early detection results in the best outcomes. If the cancer is invasive, outcomes are typically poor even after surgery. Most urethral cancers are invasive and get into the tissues around the urethra. By the time a diagnosis is made, the cancer is more advanced and less likely to respond even to aggressive treatment.

It is not typical for urethral cancers to travel to other parts of the body, but it is not impossible and has occurred in less than 15 per cent of cases in women.

Because of how advanced the cancer usually is on discovery, it can be hard to determine whether the cancer started in the bladder or the urethra. The labia, vagina and neck of the bladder may all be invaded.

The frequency of this type of cancer increases with age with the highest rates in people over age 75, and is more common in men (by three times), and more common (double) in those of African descent than Caucasians.

The female urethra is about 4cm long, and is made up of transitional epithelium to squamous epithelium near the exit, which dictates what sort of cancer it is diagnosed as.

These are mucosal cells, making urethral cancer a squamous-cell tumour, transitional-cell (urothelial) carcinoma, or adenocarcinoma secondary to metaplasia.

The Skene’s glands pop out right next to the urethra, made up of pseudostratified and stratified columnar epithelium. These mucosal cells don’t often undergo changes, which is why the cancer is rarer than many other forms.

It is also helpful that the urethral mucosa sheds rapidly, meaning any changes are sloughed off quickly and don’t get a chance to stick around.

Cancers at the exit (distal) end are usually less severe than cancers found deeper inside the urethra, due to the types of cells present in these areas.

When your doctor is checking for urethral cancer, a full genital and rectal examination will be carried out. Any irregularities will be observed. Fistulas, abscesses, masses or nodules may be present.

An MRI and biopsy may be recommended. Classification will be made by your physician.

Treatment of urethral cancer

Typical treatments are surgery, radiotherapy and chemotherapy. Surgery is usually indicated, but depends on the size and location of the tumour, and where it has spread to. It is also dependent on the patient. If the cancer is on the urethral meatus, it can be cut off simply.

Most cancer, at discovery, is very aggressive, and the treatments offered will be heavily tailored to the individual. Some cancers will be regarded as inoperable.

Post-surgery complications can include the development of fistulas, poor wound healing, and abscesses, particularly if the person has poor nutritional status.

Radiotherapy and chemotherapy can be offered as part of treatment, or as palliative care. Radiation can lead to a loss of oxygenation of the surrounding tissue of the urethra, and end up with the same problems as surgery. It is also not always useful in treating advanced-stage cancers.

Chemotherapy agents have specific adverse impacts. The risks and benefits must be carefully discussed with your doctor since it is unlikely that your body will come out the other side with full functioning in this area. This may mean the loss of your bladder, ability to urinate, vaginal function and sexual function.

Outcomes of urethral cancer

Urethral cancer is problematic and outcomes are often very bad, either due to death by cancer or from complications of treatment. However, some people make a full recovery. Surviving this type of cancer doesn’t mean you will get away scot-free by any stretch, so talk very carefully to your doctor about what you can expect from your treatments.

Make sure to ask about sexual function and your vagina, since the therapies involved are all pretty invasive and destructive to nearby tissue. Radiation therapy can cause urethral stricture (narrowed urethra due to scarring or other problems), radiation cystitis/urethritis, irritation to the bowels, fibrosis (thickening of the tissues), infection, bleeding, and sometimes fistulas or secondary cancers.

Complications are sitting at about 20 per cent. Total urinary incontinence can occur after a urethrectomy (removal of the urethra). The area can end up being quite damaged from therapy, and result in dying tissues and infection that further damages the tissue.

Recurrence of tumours is common (50 per cent). Five-year survival rates for urethral cancer that is found at the distal (exit) end are around 83 per cent, and 45 per cent for advanced tumours. Overall, it is about 60 per cent.

The recurrence rate of proximal (closer to the body) is more than 50 per cent despite aggressive therapy.

Speak to your doctor to get the exact situation on your specific situation.