The�urethra�is the tube that carries urine from the bladder to outside the body. In women, the urethra is about 1� inches long and is just above the vagina. In men, the urethra is about 8 inches long, and goes through the prostate gland and the penis to the outside of the body. In men, the urethra also carries semen.

Urethral cancer�is a rare cancer that occurs more often in women than in men. There are different types of urethral cancer that begin in cells that line the urethra. These cancers are named for the types of cells that become malignant (cancerous):

• Squamous cell carcinoma�is the most common type of urethral cancer. It forms in cells in the part of the urethra near the bladder in women, and in the lining of the urethra in the penis in men.

• Transitional cell carcinoma�forms in the area near the urethral opening in women, and in the part of the urethra that goes through the prostate gland in men.

• Adenocarcinoma�forms in glands near the urethra in both men and women.

Urethral cancer can metastasize (spread) quickly to tissues around the urethra and is often found in nearby lymph nodes by the time it is diagnosed.

Urethral cancer is staged according to which part of the urethra is affected. Treatment is also based on this grouping.

Urethral cancer is staged and treated based on the part of the urethra that is affected and how deeply the tumor has spread into tissue around the urethra. Urethral cancer can be described as anterior or posterior.

Anterior urethral cancer

In anterior urethral cancer, the tumors are not deep and they affect the part of the urethra that is closest to the outside of the body.

Posterior urethral cancer

In posterior urethral cancer, the tumors are deep and affect the part of the urethra closest to the bladder. In women, the entire urethra may be affected. In men, the prostate gland may be affected.

The following stages are also used to describe urethral cancer:

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the inside lining of the urethra. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage A

In stage A, cancer has formed and spread into the layer of tissue beneath the lining of the urethra.

Stage B

In stage B, cancer is found in the muscle around the urethra. In men, the penile tissue surrounding the urethra may be affected.

Stage C

In stage C, cancer has spread beyond the tissue surrounding the urethra, and:

• In women, may be found in the vagina, vaginal lips, or nearby muscle;

• In men, may be found in the penis or in nearby muscle.

Stage D

Stage D is divided into stage D1 and stage D2, based on where the cancer has spread.

• In stage D1, cancer has spread to nearby lymph nodes in the pelvis and groin.

• In stage D2, cancer has spread to distant lymph nodes or to other organs in the body, such as the lungs, liver, and bone.

Urethral cancer may be associated with invasive�bladder cancer.

A small number of patients who have bladder cancer are also diagnosed with cancer of the urethra, or will develop it in the future.

Recurrent Urethral Cancer

Recurrent urethral cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the urethra or in other parts of the body.

Treatment

Treatment for urethral cancer depends on the stage and location of the disease, and the patient's age, sex, and overall health. Options include chemotherapy, radiation, and surgery. Because urethral cancer is often invasive, surgery is the primary method of treatment. Chemotherapy and radiation are often used as adjuvant therapies.

Surgery

Surgical treatment options depend on the stage and location of the cancer. Surgery is usually performed under general anesthesia. Early urethral cancer is treated using�fulguration�(destruction of cancer cells using high-frequency electric current) and laser therapy (destruction of cancer cells using a narrow beam of intense light).

Procedures performed for advanced cases include the following:

• Removal of the bladder and urethra (cystourethrectomy)
• Removal of part of the penis (partial penectomy)
• Removal of the penis, urethra, and penile root (radical penectomy)
• Removal of the bladder and prostate (cystoprostatectomy)
• Removal of cancerous lymph nodes (lymph node dissection)
• Removal of the bladder, urethra, and vagina (anterior exenteration)

If partial penectomy, radical penectomy, or anterior exenteration is required, additional surgical procedures are performed to reconstruct the reproductive organs. If the bladder and urethra are removed, a urinary diversion is performed to allow for the passage of urine.

Complications of surgery include the following:

• Adverse reaction to anesthesia
• Bowel obstruction
• Incontinence
• Infection
• Mortality (approximately 1�2% of cases)
• Recurrence (in approximately 50% of cases)
• Tissue death (necrosis)
• Urethral narrowing (stricture) or abnormal passage (fistula)

Radiation

Radiation may be used in conjunction with surgery in advanced urethral cancer, or as primary treatment for early urethral cancer that is noninvasive. Radiation uses high-energy rays from a machine outside the body (called external beam radiation) or surgically implanted radioactive seeds or pellets (called brachytherapy) to destroy cancer cells. External radiation and�brachytherapy�are sometimes used together.

External beam radiation usually involves treatment 5 days a week for approximately 6 weeks. Brachytherapy involves surgical implantation of the seeds, which become inactive over time and remain in place.

Side effects of radiation are caused by the destruction of healthy tissue and include the following:

• Abnormal healing resulting in abnormal passage in the urethra (fistula)
• Burning of the skin (similar to sunburn)
• Diarrhea
• Fatigue
• nflammation of the bladder (cystitis)
• Narrowing of the urethra (stricture; causing urination difficulty)
• Nausea

Chemotherapy

Chemotherapy�involves using drugs to destroy cancer cells. It is a systemic treatment (i.e., destroys cancer cells throughout the body) that is administered orally or intravenously (through a vein; IV). Medications are often used in combination to destroy urethral cancer that has metastasized.

• Radiotherapy
  
• Chemotherapy
  
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