Cancer of Urethra and Penis

CANCER OF URETHRA

Primary cancer of the urethra is an uncommon disease. It is the only urologic cancer that occurs more frequently in females than males. Squamous cell carcinoma (SCC) represents the most common histologic type (80%); however, transitional cell carcinoma (15%), adenocarcinoma (5%), and, rarely, melanoma, also occur. Risk factors for the development of this tumor are chronic irritation and infection. Spread is primarily by direct extension to adjacent structures. Despite its tendency to remain localized, this is a disease with a poor prognosis, generally because it is found late in most cases. Lesions of the distal urethra have a better prognosis than more proximal ones. A high index of suspicion is the key to diagnosis.

Cancer of Male Urethra

Urethral carcinoma in the male is associated with chronic inflammation, sexually transmitted disease, and strictures in the bulbomembranous portion of the urethra. Patients present with obstructive symptoms, recurrent strictures, a history of venereal disease, hematuria, or a sensation of a mass in the perineum. Spread is by direct extension to adjacent structures. Primary therapy is surgical excision.

Cancer of Female Urethra

Urethral carcinoma in the female is often found in the setting of urethral diverticula. Bleeding, dysuria, frequency, perineal pain, and dyspareunia are common presenting complaints. Most of these tumors are locally advanced when detected and involve the proximal urethra. Small distal tumors may respond well with radiation or surgical excision alone.

Workup

The diagnosis is made by urethrography, urethroscopy, and repeated biopsy of the involved area. Staging is obtained by bimanual examination, magnetic resonance imaging, and computed tomography scan of the chest, abdomen, and pelvis. In general, anterior or distal urethral tumors drain to the inguinal nodes, whereas posterior tumors drain to the pelvic nodes (i.e., obturator, presacral, and internal and external iliac nodes). Unlike cancer of the penis, clinically enlarged inguinal nodes usually imply metastatic disease and not benign inflammation. TNM staging should be employed.

CANCER OF PENIS

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