Urethral cancer

Urethral cancer is a rare disease that develops in the tissues of the urethra, a tube that carries urine out of the body. In men, the urethra is also responsible for passing semen from the body.

How common is urethral cancer?

Although urethral cancer is more common in men than women, the disease affects both genders. Between 2006 and 2010, 419 cases of urethral cancer were entered into the National Cancer Institute's database. Of those, 250 (59.7 percent) affected men, and 169 (40.3 percent) occurred in women.

What causes urethral cancer?

Urethral cancer forms when cells in the urethra start multiplying uncontrollably. Over time, the cancer cells may form a tumor. As they grow, they push into other layers of the urethra, which may spread to the lymph nodes and other organs. Urethral cancer is often in the lymph nodes before it’s detected. The exact causes of urethral cancer are unknown, but some factors are associated with a higher risk for developing it.

Urethral cancer risk factors

Certain risk factors may increase a person’s chances of developing urethral cancer. These risk factors don’t mean cancer will definitely develop, and some people may develop urethral cancer despite not having any of these risk factors.

Unavoidable risk factors for urethral cancer include:

• Being male. Cancers that develop in urothelial cells are more common in men. The male urethra is five times longer than the female urethra, so men have more area for cancer to develop.
• Having had bladder cancer
• Being older

Urethral cancer risk factors that may be avoidable include:

• Infection with the human papillomavirus (HPV) 
• Smoking
• Long-term irritation and inflammation (for example, from a urinary catheter)

Urethral cancer symptoms and signs

Symptoms of urethral cancer vary based on how advanced the cancer is. Often in the early stages, no or few symptoms are present, and if cancer symptoms are present, they are sometimes misdiagnosed as urinary issues or confused with other illnesses. Symptoms may include:

• Difficulty in starting to urinate
• Having to urinate frequently
• A weak urine stream
• Starts and stops in the urinary stream
• Pain or burning during urination

In some cases, urethral cancer isn’t discovered until it has spread (metastasized) outside of the urethra. As the cancer progresses, a person may experience:

• Blood in the urine, which may affect the color of the urine
• Bleeding or discharge from the urethra
• Pain in the pelvic area
• A lump in the pelvic area or groin
• A lump or thickness in the perineum or penis
• Swelling in the legs or feet

Urethral cancer types

There are three types of urethral cancer, each with its own characteristics and treatment options.

Squamous cell carcinoma of the urethra

Squamous cell carcinoma (SCC) is the most common urethral cancer type, according to National Cancer Institute (NCI) statistics. It develops in the thin, flat squamous cells lining the urethra.

Transitional cell carcinoma of the urethra

This type of cancer develops in the cells close to the bladder in female patients. Among males, it typically forms in the section of the urethra that passes through the prostate gland.

Adenocarcinoma of the urethra

Adenocarcinoma is a type of cancer that forms in the glands that line organs. This type of cancer can affect any area of the body, including the urethra.

Diagnosing urethral cancer

If a health care provider thinks a patient may have urethral cancer, they’ll begin by asking about family and personal health history, inquiring about personal risk factors and performing a physical exam or pelvic examination. The care team may then order testing, based on the exam findings, including:

Urine tests to check for cancer cells and white blood cells (a sign of infection). This also allows the care team to analyze the amount of blood, sugar and protein in the urine.

Blood tests to check for signs of cancer or other diseases in the blood. This also helps them evaluate how many of each type of blood cell are present in the body.

Imaging tests, such as a computed tomography (CT) scan or magnetic resonance imaging (MRI), to get a better look at the urethra and surrounding tissues.

Cystoscopy, in which tools are inserted through a cystoscope (a tiny tube with a light and lens), to allow the care team to perform a biopsy. During this process, the care team takes a small sample of tissue for further testing.

Urethral cancer stages

The information discovered during the diagnosis stage will help the care team determine whether a patient has urethral cancer, and if they do, to determine how advanced it is. Doctors use an approach called cancer staging to compare patients with similar cancers, determine their prognosis and gauge how they may react to various treatments.

Doctors use the TNM staging system to determine how advanced urethral cancer is. TNM staging stands for the terms listed below.

T (tumor): This describes the size of the primary tumor.

N (node): This indicates whether the cancer is present in lymph nodes near the primary tumor. Lymph nodes are small, bean-shaped clusters of immune system cells that are crucial to fighting infections and disease. They are usually one of the first sites in the body where cancer spreads.

M (metastasis): This refers to whether the cancer has spread to other areas of the body.

The tumor classification of urethral cancer rates the size and depth of the tumor:

• Tis tumors are in situ—flat cancers
• Ta are cancer cells that haven’t moved from the lining
• T1 tumors are usually small and have spread into the connective tissue
• T2 tumors have grown into the muscles of the urethral wall
• T3 and T4 tumors have grown beyond the urethral wall and into the surrounding tissues

The node classification assesses whether cancer has spread to nearby lymph nodes:

• N0 means no cancer in the lymph nodes
• N1, N2 and N3 indicate the number of lymph nodes involved

The metastasis classification evaluates whether cancer has spread to distant organs, such as the lungs or bones:

• M0 means no metastasis
• M1 means metastasis

The stages of urethral cancer range from 0 to 4 based on the TNM classifications. The lower the number, the less advanced the cancer.

Stage 0 urethral cancer

Also called carcinoma in situ, stage 0 urethral cancer hasn’t spread beyond the innermost layer of the urethral lining.

Stage 1 urethral cancer

In this stage, the cancer has grown into the connective tissue beneath the innermost layer of the urethral lining, but hasn’t spread to nearby lymph nodes or distant organs.

Stage 2 urethral cancer

The cancer has grown into the urethral muscle or surrounding tissues, but hasn’t spread to nearby lymph nodes or distant organs.

Stage 3 urethral cancer

The cancer has spread to nearby lymph nodes or structures, such as the:

• Vagina
• Prostate gland
• Urethral glands

Stage 4 urethral cancer

In this stage, often called metastatic urethral cancer, cancer cells have spread to distant organs, such as the:

• Lungs
• Liver
• Bones

Other urethral cancer staging methods

Urethral cancer may also be staged based on its location:

• Distal urethral cancer hasn’t spread deeply into the tissue. Cancer is in the part of the urethra closest to the outside of the body in women or in the penis in men.
• Proximal urethral cancers are in the part of the urethra that’s further inside the body. It has usually spread deeply into tissue when it’s discovered.

Urethral cancer treatment

Treatment options for urethral cancer depend on the stage of the cancer. The most appropriate treatment plan takes into account a person’s:

• Age
• General health
• Personal goals

The main treatment options for urethral cancer include:

Surgery, which is often the primary treatment for urethral cancer

Radiation therapy, which may be used in conjunction with surgery or as the primary treatment for urethral cancer

Chemotherapy, which may be used before or after surgery, or as a primary treatment for advanced urethral cancer

Advanced immunotherapy options, which use the body’s immune system to fight cancer cells

New therapies for urethral cancer are being studied in clinical trials. Health care providers will be able to determine if a clinical trial may be an option.

Even after successful treatment, regular follow-up appointments and monitoring are essential to detect urethral cancer recurrence.

Urethral cancer survival rate

One way people battling cancer can estimate life expectancy is to review the five-year relative survival rate for that type of cancer. A five-year relative survival rate shows the likelihood that a person with a specific type and stage of cancer may live for at least five years after the diagnosis, compared with people who don't have cancer. The rate includes the life expectancy of patients who are still in treatment and those who have finished treatment and have no further evidence of disease.

According to the National Cancer Institute, the five-year relative survival rate for proximal urethral cancer in female patients is about 10 percent to 20 percent. These outcomes may vary based on the tumor size. Five-year relative survival rates for women with small proximal urethral cancer lesions (less than 2 centimeters in diameter) are approximately 60 percent. For lesions larger than 4 centimeters in diameter, the survival rate drops to 13 percent.

For men, the five-year survival rate for proximal urethral cancer is about 15 percent to 20 percent.

Every case of urethral cancer is unique. It’s important to note that survival rates are based on groups of patients and may not accurately predict an individual patient’s prognosis. Because urethral cancer is rare, few patients are available to track, so the survival numbers are estimates based on a small sample.

Urethral cancer diagnosis and treatment options at our Genitourinary Cancer Program

At City of Hope’s Genitourinary Cancer Program, our expert team is committed to providing quality care for patients with urethral cancer.

We offer the latest diagnostic and treatment options, including surgery, chemotherapy and radiation therapy, as well as access to clinical trials. A multidisciplinary team of experts, including urologic oncologists, radiation oncologists, medical oncologists and pathologists, work together to develop a unique plan for each patient.

Our team works closely with each patient to develop a personalized treatment plan that takes into account a patient’s specific needs and goals. We communicate regularly with the patient and each other and adjust the treatment plan as necessary. Our goal is to provide compassionate, comprehensive care that maximizes the chances of a successful outcome and improved quality of life for our patients.