Urethral Cancer

Presentation

  • bulbomembranous urethra is the most common site of male urethral tumor 60%
  • Adenocarcinoma is found int the proximal and distal urethra

Pathways of Spread

  • The incidence of pelvic or inguinal LN in stage II or II cancer is 35% - 50%
  • Nodes are frequently bilateral
  • Clinical LN are almost alway metastatic disease unlike penile cancer.

Pathology

Histology Male Female
SCCA 90% 60%
TCC 15% 20%
Adeno CA 5% 10%
  • Histology does not affect prognosis

Staging

T-stage Structure invaded
Ta Epithelium
T1 Subpithelial connective tissue
T2 Urogenital Diaphragm
T3 Bladder neck
T4 Other adjacent organs

Male

T2 Corpus spongiosum
prostate
T3 Copus cavernosum
beyond prostatic capsule

Female

T3 Anterior vagina

Nodes

  • Regional LN includes Pelvic and inguinal LN

N1: Single node <= 2 cm
N2: multiple or a node > 2 cm

Prognosis

  • distal is associated with lower grade and stage
  • proximal is associated with higher grade and stage

Treatment

Distal low-stage

  • local excision
  • brachytherapy alone 50-60 Gy
  • brachy + EBRT 40-45 Gy

Proximal

  • radical cystourethroectomy or anterior exenteration
  • preoperative chemoradiation (recommended)
  • brachy + EBRT 40-45 Gy
  • EBRT alone not acceptable for large primary tumors
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