Urine is first made by the kidneys and is then carried to the urinary bladder through narrow tubes called the ureters. As you urinate, the muscles in the bladder are made to contract and the urine thus is forced to flow out of the bladder through a different single tube called the urethra, to the outside of the body.
In males, the urethra is anatomically and histologically divided into three parts.
- The Prostatic urethra with transitional cell epithelium,
- The Membranous urethra with transitional cell urothelium,
- Thirdly, the Penile urethra with either pseudostratified or with stratified columnar epithelium.
In females, the urethra is divided into two parts.
- The proximal urethra with transitional and stratified squamous epithelial cells
- The distal urethra with stratified squamous cells only.
What are urethral cancers ?
Urethral Cancers are basically tumours of the Urethra.
How is a urethral cancer caused ?
As in many lower-tract gynaecological tumours, Human Papilloma Virus (HPV) infection plays a role in the aetiology of cancer of the urethra.
What are the types of urethral cancers ?
There are several types of cancer that can initiate in the Urethera.
- Urothelial Carcinoma or Transitional Cell Carcinoma (TCC): Urothelial carcinoma, otherwise known as the transitional cell carcinoma (TCC), is generally the most common cancer of the Urethra. These cancers start in the innermost lining of the urethra, ie. in the transitional cells or the urothelial cells.
- Squamous Cell Carcinoma: This is a far less common variant than the urothelial (transitional cell) cancer. Nearly all squamous cell carcinomas are invasive.
- Adenocarcinoma: This is also a very rare cancer of the bladder. These adenocarcinomas resemble those of the colon. These are also invasive.
- Small Cell Carcinoma: This is extremely rare. They initiate in neuroendocrine cells. These cancers grow rapidly and need to be treated soon with chemotherapy.
- Sarcomas: These include the sarcomas of the muscle cells (rhabdomyosarcomas) of the bladder, but they are rare.
What are the clinical features of urethral cancers ?
In men this cancer is more frequent between the 5th to 6th decades of life. The symptom most commonly seen is difficulty or pain while urinating or dysuria, progressing to blood in the urine or haematuria. In female patients comparable symptoms are seen, though they could be diagnosed later. In advanced cases, enlarged groin nodes may be obvious. Lymph node involvement can be found in half of the patients. Inguinal lymph nodes are palpable.
How are urethral cancers diagnosed ?
- A complete physical examination of the body is mandatory.
- Urinalysis: Checking for blood in the urine or hematuria may point in the direction of a urinary tract infection or cancer. This can be tested by a urinalysis, which is a straight forward test to check for blood in a urine sample. In urine culture, if bacteria are found, it may be an infection, if not, then it may point towards a cancer.
- Urine Cytology: In this test, the doctor looks for cancer cells under a microscope in urine. Urine cytology does find some cancers, by abnormal cytology.
- Urine Tests for Tumour Markers: Several newer tests look for substances in the urine that might indicate bladder cancer. Tumour markers in the urine like bladder tumour-associated antigen (BTA) and carcinoembryonic antigen (CEA) can point towards bladder cancer.
- Imaging Tests: To determine the exact extent of disease, additional tests may need to be performed so doctors can view, assess and judge the cancer and determine how far it has progressed or spread. These tests may include the following such as X- rays, CT Scan, MRI Scan or PET Scans.A urologist can recommend specific radiographic imaging techniques like an intravenous pylegram (IVP) or a CT urogram. In the IVP, dye or contrast media is combined with conventional x-ray technology to assess the urinary tract system for any abnormalities. In the CT urogram, a CT scan with contrast is used to examine the kidneys, ureters, and bladder. This is the recommended procedure nowadays. Today, ultrasound, CT and MRI allow precise definition of the tumour volume with associated local or locoregional extensions.
- Cystoscopy: Cystoscopy is the best method of assessing the condition of the bladder and the urethra. A device called the cystoscope, a long narrow tube, is put into the urethra. This cystoscope is now flexible, making this diagnostic procedure with little or no discomfort. The urologist can look through the cystoscope, and record the abnormal features. A biopsy can also be performed in the cytoscopy.
- Biopsy: Removed tissue examined under a microscope by a pathologist is the only sure-shot way to make a definitive cancer diagnosis.
How are urethral cancers staged ?
Grade and Stage describe the tumour, helping to provide guidance for the urologist in choosing the best treatment option(s). Staging is a careful attempt to find out the exact extent and spread of the cancer. The higher the stage the further the cancer has grown away from its primary site on the Urethra. Grade refers to what the cancer cells look like, and how much they resemble their cell of origin or differentiation. The higher the grade, the more aggressive the tumour is.
How are urethral cancers treated ?
Urethral cancer is highly treatable when found early. Treatment options depend on the type of cancer, staging of the cancer, and its location. There are four types of standard treatment for Urethral cancer:
- Surgery: surgical treatments for Urethral cancer include transurethral resection (complete removal of the tumor and surrounding tissue during an operation).
- Radiation Therapy: A cancer treatment that utilizes high-energy x-rays or basically radiation to eradicate cancer cells. Radiation therapy can be used post surgery to kill any remaining cancer cells.
- Chemotherapy: Another kind of cancer treatment that uses either drugs or chemical substances (hence the name chemotherapy) to kill cancer cells and prevent them from dividing.
- Immunotherapy or Biological Therapy: Immunotherapy works by utilizing your own body’s immune system to fight cancer cells. This treatment is given through your urethra by a small catheter.
What is the care to be taken after the removal of a urethral cancer ?
Metastatic diagnostic workup and monitoring post-treatment has to include imaging and scanning of the limbs, thorax, chest, retroperitoneum, and abdomen with radiography, MRI or CT scans because of the risk of recurrence of Urethral cancer. Adjuvant chemotherapy or radiotherapy may be required in cases wherein excision cannot be done completely.
How to find and reach cancer specialists for urethral cancer treatment ?
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Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
