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Carcinoma of the Urethra - Holland-Frei Cancer Medicine - NCBI Bookshelf
Lynch, Jr, MD. Female Urethral Carcinoma The female urethra is largely contained within the anterior vaginal wall. In the adult it is 2 to 4 cm in length.
Distally, it is lined with stratified squamous epithelium, changing to stratified or pseudostratified columnar epithelium more proximally. At the bladder neck, the mucosa is transitional cell epithelium. The histopathology of female urethral cancer depends upon the tissue of origin. Transitional cell carcinoma and adenocarcinoma are next most common and occur with roughly equal frequency. Unlike penile cancers, tumor grade does not appear to influence either propensity for metastasis or prognosis.
Female urethral cancers occur more often in white women than in black women. The lymphatic drainage of the distal urethra and labia is to the superficial and deep inguinal nodes.
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The proximal urethra drains to the papilloma virus umano of the iliac, obturator, presacral, and para-aortic lymphatic chains. Metastases to distant sites—liver, lung, brain and bone—occur late and are more common with adenocarcinomas.
Roughly half of tumors involve the entire length of urethra at diagnosis. A rare variation of urethral cancer is carcinoma arising in a urethral diverticulum. These tumors are usually squamous carcinomas and are usually located in the distal two thirds of the urethra.
They have been reported more frequently in black women than in white women, and likely arise from remnants of wolffian or mullerian ducts or ectopic cloacal epithelium. Distal urethral or anterior lesions usually present early and are diagnosed while at low stage.
These tumors have been successfully managed with local excision, transurethral resection, partial metastatic cancer last stage symptoms, and fulguration or ablation with either neodymium:YAG or CO2 laser techniques. More proximal lesions present later and at higher stage than distal lesions.
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For superficial tumors, transurethral resection or laser surgery may be appropriate. Inguinal node dissection should be performed in the presence of palpably enlarged nodes, and pelvic node dissection should be performed when proximal involvement of the urethra is identified.
Female Urethral Carcinoma
There does not appear to be any therapeutic advantage to prophylactic node dissection when the inguinal nodes are not enlarged. Radiation Therapy Radiation therapy, administered as both external beam radiation and brachytherapy, has been used for definitive treatment of both localized and advanced tumors.
It has also been used to downsize tumors before definitive surgical intervention.
Chemotherapy and Combined Therapy The rarity of these tumors has precluded much meaningful clinical research in chemotherapeutic treatment, or in chemotherapy combined with radiation or surgery. Combination chemotherapy in conjunction with radiation and surgery has produced promising outcomes in squamous carcinomas of the head and neck, anus, and penis, and may be expected to demonstrate similar benefit in squamous cancers of the urethra. However, multinational, multiinstitutional trials are required to provide clinical data to assess the efficacy of any such treatment regimens.
Prognosis Long-term survival is related to the stage of the tumor at the time of diagnosis and appears to be independent of tumor histology or grade. Patients with tumors of the anterior metastatic cancer last stage symptoms distal urethra had better survival than those with more proximal lesions, apparently because their tumors presented earlier in their clinical course. Beginning distally, the penile urethra is comprised of the meatus and fossa navicularis which is lined with stratified squamous epithelium.
The pendulous urethra extends from the proximal fossa navicularis to the suspensory ligament of the penis, where it then becomes the bulbar urethra between the ligament and the urogenital membrane.
These areas are lined with stratified or pseudostratified columnar epithelium as is the short 1. This contains the metastatic cancer last stage symptoms sphincter which is comprised of striated muscle fibers. The prostatic urethra passes through the prostate and is lined with transitional cell epithelium.
Holland-Frei Cancer Medicine. 6th edition.
The remainder occur predominantly in metastatic cancer last stage symptoms fossa navicularis. Infrequently, transitional cell carcinoma or undifferentiated tumor may predominate at the bladder neck or within the prostatic urethra. Poorly differentiated transitional cell cancers may show some squamous characteristics.
Rarely adenocarcinoma may arise in the glands of Littre or the prostatic utricle. Metastases from distant tumor sites to the penis also occur infrequently. Figure Retrograde urethrogram demonstrating squamous carcinoma of bulbous urethra associated with a stricture. Obstructive symptoms are common in more proximal lesions, while urethral bleeding and palpation of a mass herald more distal lesions Figure In general, the more proximal a tumor, the later in its development and the higher its stage at diagnosis.
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Four-color version of figure on CD-ROM A special case exists in the urethral segment which is retained following cystectomy. These tumors are almost exclusively transitional cell carcinomas. Monitoring of the urethra in this situation and management of these tumors is discussed elsewhere. Lymphatic drainage of the distal male urethra is similar to that of penile tumors.
Tumors of the fossa and pendulous urethra drain to the superficial inguinal lymph nodes, while tumors of the bulbar, membranous, and prostatic urethral segments drain to the iliac, obturator, and presacral node groups. There may be crossover at the prepubic lymphatic plexus. Surgical Management Low-grade, low-stage tumors of the urethra may lend themselves to transurethral resection or laser fulguration, but such lesions are rare.
Excisional biopsy may be feasible, and biopsy prior to laser fulguration is essential to assess histopathology and tumor depth.
Selected lesions of the distal urethra may lend themselves to partial penectomy.
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Tumors must not involve the corpus spongiosum or the corpora cavernosa, and must be amenable to a 2-cm margin. More advanced or more proximal lesions may require a total penectomy with creation of a perineal urethrostomy.
Proximal cancers may necessitate an anterior exenteration with radical cystoprostatourethrectomy and urinary diversion.
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Careful serial palpation of the groins as well as interval pelvic CT evaluations are essential in the follow-up of definitive treatment of a urethral primary. Inguinal node dissection should be performed in the presence of clinically positive groin nodes. This has been curative in many cases. Radiation, Chemotherapy, and Combined Therapy Experience with these modalities is limited, although some success in treating superficial, low-grade lesions with external-beam radiotherapy in both metastatic cancer last stage symptoms and females has been achieved.
Again, the use of these treatment modalities as well as the employment of combined therapy programs requires large, international, multiinstitutional studies to acquire data sufficient for meaningful interpretation.
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Summary Cancers of both the male and the female urethra are quite rare, but the disease may be devastating if not recognized and treated as early as possible. Early surgical or radiotherapeutic intervention may cure these tumors. Advanced disease, at least for the present, tends to carry a grim prognosis. Effective programs of surgery or metastatic cancer last stage symptoms combined with chemotherapy have not been developed, although such programs—based on experience with tumors of similar histopathology in other systems—have the potential for improving outcome.
With improvements in treatment and with increased availability of modern diagnostic techniques, combination chemotherapy, worldwide communications and data transmission, there is hope that multinational, multiinstitutional programs of treatment may provide effective therapy for those suffering from these cancers while expanding our effectiveness in managing them.
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A male patient, years-old, from urban area, presents at clinic in July History: April - he presents at the hospital for laterocervical lymph nodes, surgically removed.