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Urethral cancer

  • Overview

  • Causes and Risk Factors

  • Symptoms

  • Diagnosis

  • Treatment

Καρκίνος Ουρήθρας

Urethral cancer is a rare form of cancer that affects the urethra, the tube that carries urine from the bladder to the outside of the body. This type of cancer is more prevalent in women than in men and tends to occur more frequently in older adults, although it can appear at any age.




Urethral cancer is a relatively rare and complex disease, and the specific causes are not fully understood. However, several risk factors have been identified that can increase the likelihood of developing this type of cancer. Understanding these can help in early detection and potentially reduce the risk of developing urethral cancer. Here are some of the notable causes and risk factors:
1. Chronic Irritation and Infections:
   - Chronic irritation of the urethra, often due to long-term catheter use, recurrent urinary tract infections, or sexually transmitted infections (STIs), can lead to changes in the urethral cells and increase cancer risk.
2. Sexually Transmitted Infections (STIs):
   - Infections, particularly those caused by the human papillomavirus (HPV), are linked to a higher risk of developing several types of cancers, including urethral cancer. HPV is known to cause changes in the cells at the site of infection, which can become cancerous over time.
3. History of Bladder or Other Urothelial Cancers:
   - Individuals who have had bladder cancer or other cancers of the urinary tract are at a higher risk of developing urethral cancer, possibly due to shared risk factors affecting multiple areas of the urinary tract.
4. Age:
   - Urethral cancer is more commonly diagnosed in individuals who are in their 60s and older, indicating that age is a significant risk factor.
5. Gender:
   - Women are more likely to develop urethral cancer than men. This may be due to differences in the anatomy and exposure to risk factors.
6. Previous Pelvic Radiation:
   - Radiation therapy used to treat other pelvic cancers can damage the DNA of cells in the urethra, potentially leading to cancer.
7. Certain Urethral Conditions:
   - People with certain benign (non-cancerous) urethral conditions such as urethral stricture (a narrowing of the urethra) or diverticulum (a pouch or sac opening from the urethra) may be at increased risk.
8. Chemical Exposure:
   - Exposure to certain chemicals, particularly those used in the chemical and textile industries, has been linked to an increased risk of cancer, including cancers of the urinary tract.
These factors do not guarantee that someone will develop urethral cancer, but they do increase the likelihood. Awareness of these risk factors is essential for early detection and prevention strategies. If individuals are aware they are at risk, they can engage in more regular monitoring and early intervention, which are crucial for improving outcomes in cases of urethral cancer.

Causes And Risk Factors of Urethral Cancer


Urethral cancer can manifest through various signs and symptoms, which may vary depending on the location and extent of the tumor. Recognizing these symptoms is crucial for early detection and timely treatment. Here are some of the common signs and symptoms associated with urethral cancer:
1. Blood in the Urine (Hematuria):
   - One of the most common signs of urethral cancer is the presence of blood in the urine, which may appear pink, red, or cola-colored.
2. Painful Urination:
   - Discomfort or pain during urination can be an early sign of urethral cancer.
3. Urinary Retention or Difficulty Urinating:
   - Obstruction caused by a tumor can lead to difficulty starting urination, a weak urine stream, or incomplete emptying of the bladder.
4. Increased Frequency of Urination:
   - Needing to urinate more often than usual, especially at night (nocturia), may be a symptom of urethral cancer.
5. Urethral Discharge:
   - Unusual discharge from the urethra, which may be bloody or purulent, can indicate the presence of a tumor.
6. Presence of a Lump or Thickening in the Perineum or Penis:
   - In men, a palpable lump along the course of the urethra or in the penis can be a sign of urethral cancer. In women, a lump or thickening may be felt in the urethra through the vaginal wall.
7. Enlarged Lymph Nodes in the Groin:
   - Urethral cancer can spread to lymph nodes, causing them to become enlarged and possibly palpable.
8. Swelling in the Legs:
   - Advanced urethral cancer may obstruct lymphatic flow, leading to swelling in the legs.
9. Pain in the Pelvis, Hips, or Thighs:
   - If the cancer spreads to the surrounding tissues or bones, it can cause pain in these areas.
10. Urinary Incontinence:
    - Loss of control over urination can occur if the cancer affects the urinary sphincter or other structures controlling urine flow.
The appearance of any of these symptoms warrants immediate medical attention, especially if they persist or worsen over time. Urethral cancer symptoms can mimic those of more common urinary conditions, so it’s essential for healthcare professionals to consider a comprehensive diagnostic approach to rule out or confirm the presence of cancer. Early diagnosis significantly improves the effectiveness of treatment and the overall prognosis for patients with urethral cancer.

Signs and Symptoms of Urethral Cancer

Diagnosing urethral cancer involves several steps and medical tests to confirm the presence of cancer, determine its extent, and identify the specific type of cancer cells involved. The process is critical for developing an effective treatment plan. Here is an outline of the common diagnostic methods used for urethral cancer:
1. Medical History and Physical Examination:
   - The first step involves a thorough review of the patient’s medical history and symptoms, followed by a physical examination. The doctor may check for any visible abnormalities, such as lumps, swelling, or areas of tenderness, particularly around the pelvic area and the groin.
2. Urine Tests:
   - A urinalysis may be conducted to check for blood, abnormal cells, or other signs of disease in the urine.
3. Urethroscopy:
   - This procedure involves inserting a thin, flexible scope into the urethra to visually inspect the urethra and bladder for any abnormalities or growths. Urethroscopy can also help in taking biopsies from suspicious areas.
4. Biopsy:
   - A biopsy is the definitive way to diagnose urethral cancer. During this procedure, a small sample of tissue is removed from the urethra or from any abnormal-appearing areas observed during urethroscopy. The tissue sample is then examined under a microscope by a pathologist to check for cancer cells.
5. Imaging Tests:
   - Various imaging tests can help determine whether the cancer has spread beyond the urethra to other parts of the body. These tests might include:
     - Ultrasound: Often used to view the urinary tract and surrounding organs.
     - Computed Tomography (CT) Scan: Provides detailed cross-sectional images of the body and can show the size and location of urethral tumors, as well as any spread to nearby lymph nodes or organs.
     - Magnetic Resonance Imaging (MRI): Offers detailed images of the soft tissues, including the urethra and its surrounding structures, which is especially useful for assessing the depth and extent of the tumor invasion.
     - Positron Emission Tomography (PET) Scan: Sometimes combined with a CT scan (PET/CT), this test can detect cancer spread and is useful in staging the cancer.
6. Cystoscopy:
   - For further examination of the bladder and urethra, cystoscopy may be performed, where a scope is inserted into the bladder through the urethra.
7. Chest X-ray:
   - To check if cancer has spread to the lungs.
The results from these diagnostic tests help the medical team to stage the cancer, which is crucial for selecting the most appropriate treatment options. The staging of urethral cancer is based on the size of the tumor, its spread to nearby tissues, lymph nodes, and other parts of the body. Early diagnosis is key to effectively managing urethral cancer, as earlier stages of cancer typically have a better prognosis and more treatment options.


Diagnosis of Urethral Cancer

The treatment of urethral cancer depends on various factors including the stage and grade of the cancer, the location of the tumor, the patient's overall health, and whether the cancer has spread. Treatment options typically involve a combination of therapies tailored to the individual patient. Here is an overview of the common treatment modalities for urethral cancer:
1. Surgery:
   - Local Excision: For very early-stage tumors, removing the tumor and a small margin of healthy tissue may be sufficient.
   - Segmental Urethrectomy: Removal of part of the urethra, which may be feasible if the cancer is located in a segment of the urethra that can be removed without significant impact on function.
   - Radical Urethrectomy: Involves removing the entire urethra, and is often necessary for more extensive cancers. In men, this may include removal of the penis and in women, the urethra, part of the vagina, and possibly the bladder.
   - Cystoprostatectomy or Anterior Exenteration: In advanced cases, it may be necessary to remove the bladder and prostate (in men) or the bladder and nearby organs (in women), especially if the cancer has spread to these structures.
2. Radiation Therapy:
   - This can be used as a primary treatment, especially in cases where surgery is not possible, or as an adjunct to surgery to help reduce the risk of recurrence. Radiation therapy can also be palliative, to relieve symptoms in cases of advanced cancer.
3. Chemotherapy:
   - Chemotherapy may be used before surgery (neoadjuvant) to shrink the tumor, or after surgery (adjuvant) to eliminate any remaining cancer cells. It is also the primary treatment for metastatic cancer that has spread beyond the urethra.
4. Immunotherapy:
   - For some types of urethral cancer, particularly those associated with high levels of PD-L1 expression or those that are metastatic, immunotherapy may be an option. This treatment helps to boost the body's immune system to fight the cancer.
5. Targeted Therapy:
   - In cases where the cancer cells exhibit specific genetic mutations, targeted therapy drugs can be used to attack these vulnerabilities.
6. Participation in Clinical Trials:
   - Clinical trials may offer access to new therapies that are not yet widely available but could be beneficial in treating urethral cancer.
7. Palliative Care:
   - Alongside treatments aimed at curing the cancer, palliative care is important to manage symptoms and improve quality of life. This includes pain management, nutritional support, and addressing psychological impacts of cancer treatment.
The choice of treatment is highly individualized and depends on detailed discussions between the patient and their healthcare team, including urologists, oncologists, radiologists, and others involved in cancer care. The goal is to choose a treatment strategy that offers the best chance of a cure or control of the disease while minimizing side effects and preserving the quality of life.


Treatment of Urethral Cancer

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