Urethral cancer and methods of its treatment

general information

According to the special classification of diseases according to the ICD, the disease is assigned code C68.0, meaning “Urethral neoplasm of a malignant nature.” Urethral cancer is rarely detected in the male half of the population; medicine has noted about six hundred such cases.

Among women, this disease is much more common, and the main reason for the formation of an oncological tumor is considered to be the maturity of the patient’s age at menopause. Doctors have not yet acquired the necessary experience in correctly diagnosing the disease, so the effectiveness of the treatment process today is not yet at the proper level.

Tumor forms

There are four stages of urethral tumors:

1. At the first stage, the neoplasm affects only the upper epithelial layers, the muscle tissue is not damaged, the lymph nodes continue to remain normal, and nearby organs are not in danger.
2. The second degree is characterized by a compaction that has penetrated the muscles of the urethra without damaging the lymph nodes. Metastases have not yet begun.
3. The third stage - painful cells have affected every layer of the organ, affected the lymph nodes, and the first metastases have appeared on the bladder or kidneys.
4. At the fourth stage, cancer cells affect all organs, metastases are found anywhere in the body, the tumor is considered inoperable, and doctors do not give comforting assumptions about survival.

Urethral neoplasms can be extensive, local, and vary in length and width. Cancer of the urethra, according to its forms, is divided into:

• exophytic - a seal appears near the external urethral opening;
• multiple - thickened polyps have completely affected the urethral duct and grow throughout the external genitalia;
• ulcerative - localization occurs on the clitoris, if the tumor is not detected in a timely manner, it will grow into the urethra;
• dense – cancer in this form affects the urethra. This fact poses a great danger and is quite difficult to treat.

Causes of the disease

Urethral tumors of a malignant nature can appear quite rarely. Cancer is in no way associated with the gender of the patient, but is more common in adult women.

The connection between frequent cancer formations due to hereditary causes is being monitored. Despite the fact that the disease gene has not been identified and the disease is not directly transmitted, members of the same family in which the problem was identified are included in the same risk group. In addition, there is a predisposition to the development of benign tumors - leukoplakia or papillomatosis - into cancer.

The reasons explaining the formation of tumors have not yet been determined. Precipitating factors include chronic inflammation that occurs due to infection. During the examination of the patient, it is established that he once suffered from chlamydia, ureaplasmosis, gonorrhea or syphilis.

Other causes include mechanical damage to the tissues of the urethra, tumors in the urethra or prostate, and urethral diverticulosis. Leukoplakia can be considered as a background process.

The histology of neoplasms is determined by the type of tissue from which they are formed. For example, squamous cell carcinoma most often occurs in the lower zone of the urethra, lined with squamous epithelium. The upper urethral zone is characterized by transitional cell neoplasms.

Prerequisites for the occurrence of oncology

The real cause of the appearance of a neoplasm of the urethra is unknown. There are only factors that lead to the transformation of cells into cancerous ones:

• Long-term and indolent infections in the urinary tract;
• Frequently recurring sexually transmitted diseases (gonorrhea, trichomoniasis, etc.);
• Traumatization of the mucous membrane when placing a urinary catheter or other influences;
• Leukoplakia, or keratinization of the mucosal epithelium and the appearance of grayish-white plaques is an optional precancer;
• Cancer pathology of the bladder or prostate in the past;
• Papillomas or diverticula of this area, etc.

Symptoms of the disease in women and men

There are several clinical forms of urethral cancer in women, based on anatomical variants, macroscopic forms, and the level of prevalence of the disease process.

Urethral cancer is manifested by pain and burning in the area of ​​the urethra, not very pleasant symptoms and pain at the time of urination.

During sexual relations, pain is also noted, urinary incontinence may occur in everyday life, and contact bleeding occurs.

When cancer grows in the vagina, the pain in the lower abdomen intensifies, bleeding may occur, and urethro-vaginal fistulas form. But the symptom of gross hematuria indicates that the tumor has affected the bladder.

Taking into account the characteristic complaints, Goiberg M.I divided women with urethral cancer into several groups:

1. The first category includes patients who complain of pain and abnormalities in the emission of urine, accompanied by burning sensations and mild pain in the urethra. This should also include pain in the lumbar region, discomfort and difficulty in passing urine, slight incontinence, pain in the lower abdomen.
2. The second group consisted of patients with problems with urethral bleeding associated with the manifestation or disintegration of tumors.
3. The third group is patients who complain only of tumors in the ureteral canal.
4. The fourth group included women who had never complained about their own health; urethral tumors were detected in them during preventive examinations.

For men, a characteristic feature is that a new formation can affect any part of the urethra. The initial cancer stage is most often located in the bulbar-membranous region. It is somewhat less common in the pendulous zone, and much less common in the prostatic zone. The scaphoid fossa of the ureteric meatus is a rare phenomenon. This is often where melanomas are found.

For men, squamous cell carcinoma is more typical, transitional cell forms are found, and not too often, but adenocarcinomas and melanomas are still diagnosed.

Many experts identify two main forms of urethral cancer in the male half of patients – villous and infiltrating. Urethral cancer can grow into the body of the genital organ and metastasize to the lymph nodes in the groin, pelvic and abdominal areas. Neoplasms of the bulbomembrane region can quickly grow into the tissues located near them, increase pain, and worsen the process of urination.

Symptoms of cancer of the urethra at the first stage of the disease are insignificant, reduced to subtle deviations, which does not allow timely identification of the problem.

As follows from statistical data, the more common signs of the disease are a palpable tumor, obstruction of the lower part of the urinary canal, a paraurethral abscess, initial hematuria, accumulation of pus and its discharge from the external opening of the ureteric passage, fistulas in the perineum.

There are other manifestations of the disease associated with pain during an erection and acute retention of urine. When the tumor grows into the perineum, the pain intensifies, lymphatic and blood flows are disrupted, and swelling appears in the scrotum and penis.

There was even a certain sequence of clinical manifestations:

• dysuria occurs;
• signs of pain appear;
• pus accumulates;
• lymph nodes enlarge;
• swelling occurs;
• erections become painful.

What is urethral cancer?

Urinary tract cancer is a harmful malignant tumor of the urethra. A very rare type of cancer (about 1% of all neoplasms in urology). The only urological cancer that is most common among women (despite the ability to affect both sexes).

In such exceptional circumstances, the significant differences in the manifestations of this awe-inspiring disease in men and women are not at all surprising. Women with urethral cancer experience cutting and burning pain during sex and urination. In addition, they suffer from urethral bleeding (urethrorrhagia) and contact bleeding, and urinary incontinence.

In the male body it manifests itself as complicated deurination . The tumor is palpable and easily palpated (felt by touch). A lot of blood appears in the urine, pus is released from the urethra, and erectile dysfunction crowns it all.

Diagnosis of tumors in the urinary canal

Diagnosis begins with a urologist. The doctor checks with the patient all the information, signs, and performs a primary examination. After this, laboratory and instrumental studies are prescribed. A blood test is taken to determine the presence of an inflammatory process.

A urine test provides information on leukocytes and red blood cells. If they are enlarged, it means that inflammation is developing in the body. Blood donated for biochemistry will also indicate deviations from normal values, confirming problems with the urethra and kidneys.

Differential diagnosis is carried out in order to completely exclude the formation of benign neoplasms in the urethra, chronic diseases, and cancer of the male and female reproductive organs.

For instrumental diagnosis, ultrasound, MRI, retrograde urography, CT, urethrocystoscopy, intravenous urography are prescribed. With their help, the doctor can evaluate the parameters and structure of the tissues of the ureteric canals and examine neoplasms.

If a malignant tumor is present, its size and localization point, the spread of metastases, and the level of damage to nearby organs are diagnosed.

Using these studies, it is possible to identify neoplasms in the bladder and kidneys, determine the degree of damage to the lymph nodes and other organs.

When performing retrogranular urography, contrast is used, which is injected into the urethral canal. Distributed along its walls, it helps to examine even minor changes in tissues and the appearance of tumors. Intravenous urography and the use of contrast help the doctor determine the condition of the bladder and urethra and identify pathological changes in them.

How does urethral cancer manifest?

In the early stages of cancer, clinical manifestations are often absent. Consult your doctor if you have the following complaints:

• difficulty starting to urinate
• weak or interrupted urine flow
• frequent urination, especially at night
• urinary incontinence
• urethral discharge
• bleeding from the urethra or blood in the urine
• lump or lump in the perineum or penis
• painless lump or swelling in the perineum

Treatment regimen

At the primary stage of urethral cancer for women, part of the urethra is removed, and the neoplasm is destroyed using a laser or liquid nitrogen. If a neoplasm is detected in the vulva area, the infected urethral area is cut off with a certain number of intact cells.

In the third stage, the ureter, vagina and vulva are removed. If the urinary tract is removed during surgery, the urethra are discharged into the intestines or into the wall of the abdominal cavity.

The treatment process for a malignant tumor for men is prescribed taking into account the stage of development and spread of the disease. The initial stage is removed using electrocoagulation. Cutting off some of the urethral part is performed when tumors appear in the tissues of the ureteral canal. If cells appear in the corpora cavernosa, resection is performed.

General penectomy is performed when tumors have spread to the upper urethral sections. At the same time, the bladder, prostate and testicles are removed.

The process of urination will be carried out through the ureteral fistula created during surgery.

Any operation on a cancerous tumor is accompanied by radiation and chemotherapy. Many urology specialists believe that performing a radiation treatment method without removing the tumor will not bring the desired effect. The prognosis for malignant tumors will be more favorable only after a comprehensive course.

Stages of pathology

Urethral cancer in women and men has the same stages of development:

• T1. In this case, the tumor spreads to the subepithelial connective tissue.
• T2. The malignant process spreads to the corpus spongiosum and prostate (in men).
• T3. The tumor spreads to the prostatic capsule, the anterior wall of the vagina, and affects the neck of the bladder.
• T4. Damage to adjacent organs occurs.
• N1. There is a single metastasis in the lymph node, the diameter of which does not exceed 2 cm.
• N2. One or more metastases are detected in the lymph nodes. Their diameter exceeds 2 cm.
• M0. There are no distant metastases.
• M1. Distant metastases are observed.

The higher the stage, the more severe the symptoms are. The patient has a low chance of cure. He may die within a short time after diagnosis of the disease.

Prevention and prognosis

On average, the five-year survival rate of patients with urethral cancer reaches forty percent. Signs of a favorable prognosis can be early detection of cancer, non-invasive development of tumors, absence of metastasis, and a radical treatment course.

The favorability of prognosis indicators depends on the level of organ damage, how timely the patient sought medical help from specialists, what the individual capabilities of the body are, and the adequacy of the prescribed treatment.

Prevention implies timely treatment of the disease. If minor symptoms appear, you should contact a specialist and regularly go for routine medical examinations. If discomfort occurs, you should not engage in self-treatment. To prevent relapse, it is recommended to monitor the state of your health, examine not only the upper urinary passages, but also check the lower ones.