Primary urethral cancer is rare, occurring in elderly patients; 4 times more common in women.
Risk Factors
Urethral stricture and sexually transmitted disease implicated. Direct spread from tumour in the bladder or prostate is more common.
Pathology And Staging
75% are squamous cell carcinoma (SCC), occurring in the anterior urethra; 15% are TCC, occurring in the posterior/prostatic urethra; 8% are adenocarcinoma; the remainder include sarcoma and melanoma.
Urethral cancer metastasizes to pelvic lymph nodes from the posterior urethra and to the inguinal nodes from the anterior urethra in 50% of patients.
Diagnosis
Cysto-urethroscopy, biopsy, and bimanual examination under anesthesia will obtain a diagnosis and local clinical staging. Chest radiography and abdomino-pelvic CT scan will enable distant staging.
Treatment
For localized anterior urethral cancer, radical surgery or radiotherapy are a couple options. Results are better with anterior urethral disease. Male patients would require perineal urethrostomy. Post-operative incontinence due to disruption of the external sphincter mechanism is minimal unless the bladder neck is involved, but the patient would need to sit to void.
For posterior/prostatic urethral cancer, cystoprostatourethrectomy should be considered for fit men, while anterior pelvic exenteration (exicision of the pelvic lymph nodes, bladder, urethra, uterus, ovaries and part of the vagina) should be considered for women.
In the absence of distant metastases, inguinal lymphadenectomy is performed if nodes are palpable, since 80% contain metastatic tumour.
For locally advanced disease, a combination of preoperative radiotherapy and surgery is recommended.
For metastatic disease, chemotheraphy is the only option.
