A rare type of cancer in which malignant cells are found in the urethra (the tube that empties urine from the bladder). It has often spread to nearby soft tissue before it is diagnosed. Although it can occur at any age, it appears most often in patients in their 60s. In men, 80 percent of cases are squamous cell carcinomas, most of which occur in the urethra at the base of the penis.

Symptoms

There may be no symptoms of early cancer of the urethra. If symptoms do appear, they may include the following:

  • • Lump or growth on the urethra
  • • Diminished urine stream
  • • Straining to void
  • • Frequent urination and increased nighttime urination
  • • Hardening of tissue in the perineum or penis
  • • Itching
  • • Incontinence
  • • Pain during or after sexual activity
  • • Painful urination
  • • Urinary tract infections
  • • Urethral discharge and swelling
  • • Swollen lymph nodes in the groin

Types of Urethral Cancer

Different types of urethral cancer develop in different types of cells in different areas of the urethra. In men, transitional cells line the upper portion and squamous cells line the urethra at the base of and within the penis.

Squamous cell carcinoma

Squamous cell carcinoma develops in flat, scaly surface cells and is the most common type of urethral cancer.

Transitional cell carcinoma

Transitional cell carcinoma appears in the surface cells of the urethra.

Adenocarcinoma

Adenocarcinoma develops in glands located near the urethra.

Melanoma

Melanoma is a urethral cancer that is extremely rare; it develops in the pigment-producing skin cells.

Sarcoma

Another extremely rare type of cancer, sarcoma develops in blood vessels, smooth muscle, and connective tissue.

Risk Factors

The cause of urethral cancer is unknown; there are a number of known risk factors, including the following:

  • Bladder cancer: The primary risk factor for urethral cancer is a history of bladder cancer.
  • Human papillomavirus (HPV): Infection with human papillomavirus (HPV) or other sexually transmitted diseases is also a risk factor. HPV is a group of more than 70 viruses that are transmitted sexually and cause genital warts. Two types of HPV are associated with warts that appear on the urethra. Having unprotected sexual intercourse with multiple partners increases the risk for HPV infection.
  • Age: People older than age 60 are at higher risk.
  • Chronic irritation: Irritation of the urethra as a result of sexual intercourse or chronic urinary tract infection (UTI) increases risk.
  • Smoking: Smoking increases the risk of bladder cancer, which is a risk factor for urethral cancer.

Diagnosis

If there are urethral cancer symptoms, a doctor examines the patient to feel for lumps in the urethra. In men, a thin lighted tube called a cysto-scope may be inserted into the penis so the doctor can see inside the urethra. If cells or other signs that are not normal are present, the doctor may perform a biopsy, removing a piece of tissue to check for cancer cells.

Staging

If malignant cells are found, imaging tests are performed to find out whether cancer cells have spread to other parts of the body. These tests include X-ray, ultrasound, computed tomography (CT) scan, and magnetic resonance imaging (MRI). MRI is the preferred method to evaluate urethral cancer.

In cancer of the urethra, patients are grouped into stages, which depend on where the tumor is located and whether it has spread. The following stage groupings are used for cancer of the urethra:

Anterior urethral cancer: The anterior urethra is the part of the urethra that is closest to the outside of the body. Urethral cancer that is superficial and located near the urethral opening often can be treated successfully.

Posterior urethral cancer: The posterior urethra is the part of the urethra that connects to the bladder. Because this area is closer to the bladder, cancers that start here are more likely to grow through the inner lining of the urethra and affect nearby tissues. Cancer that develops here is usually invasive and rarely curable. In men, the condition may spread to the tissues of the penis and perineum, the prostate gland, the ligament that surrounds the urethra, the regional lymph nodes, and the penile and scrotal skin.

Recurrent urethral cancer: The cancer has recurred after it has been treated, either in the same location or in another part of the body.

Urethral Cancer: Treatment

Prognosis

The chance of recovery depends on the stage of the cancer and the patient’s general state of health. The five-year survival rate for noninvasive urethral cancer treated by surgery or radiation therapy is about 60 percent. Recurrence rate for invasive urethral cancer treated with surgery chemotherapy, and radiation therapy combined is higher than 50 percent. Early diagnosis and treatment offer the best chance for cure.

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