Urethral Cancer

Dr Png Keng Siang
Dr Png Keng Siang
Senior Consultant Urologist & Robotic Surgeon

What is Urethral Cancer?

Urethral cancer is a rare malignancy that affects the urethra, the tube that carries urine from the bladder to the outside of the body. It can occur in any part of the urethra and is more common in women than in men.

Urethral cancer can be classified based on the type of cells in which the cancer begins. The three main types are:

  • Urothelial carcinoma: Starts in the cells that line the inside of the urethra.
  • Squamous cell carcinoma: Begins in the flat cells lining the urethra, often found nearer to the opening of the urethra in women and the entire urethra in men.
  • Adenocarcinoma: Starts in the glands that secrete mucus in the urethra.

Causes and Risk Factors

Several risk factors have been identified that may increase the likelihood of developing this disease, such as:

Urethral cancer is more commonly diagnosed in individuals over the age of 60.

Chronic irritation of the urethra, which may be caused by infections, catheter use, or certain conditions like sexually transmitted infections (STIs), can lead to increased cancer risk.

Individuals who have had bladder cancer are at a higher risk of developing urethral cancer.

Infection with certain types of human papillomavirus (HPV) has been linked to urethral cancer, particularly squamous cell carcinoma.

Women are more likely to develop urethral cancer than men, possibly due to differences in anatomy and hormonal factors.

Symptoms of Urethral Cancer

The symptoms of urethral cancer may vary depending on the location and size of the tumour. Some individuals may not exhibit any symptoms in the early stages of the disease. As the cancer progresses, the following symptoms may occur:

Blood in the urine

This is one of the most common symptoms and may present as pink, red, or cola-coloured urine.

Weak or interrupted urine flow

The flow of urine may become weaker than usual or may stop and start.

Pain during urination

Discomfort or pain during urination can occur as the tumour grows.

Urethral discharge

An unusual discharge from the urethra that may be bloody or have a foul odour.

A lump or thickening in the perineum or penis

This might be felt as a noticeable thickening or a distinct lump that can be felt through the skin.

Frequent urination

An increased need to urinate more frequently than usual, especially at night.

Pain in the pelvis, hips, or thighs

As the cancer spreads, pain may develop in the surrounding areas.

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Diagnosis

The following steps are typically involved in the diagnosis of urethral cancer:

Physical Examination

A thorough physical examination, including a pelvic examination in women and a genital examination in men, to check for any abnormalities or masses.

Urine Tests

Analysis of urine can help detect blood or abnormal cells that might indicate cancer.

Urethroscopy

A procedure in which a thin tube with a camera is inserted into the urethra to look for abnormal areas and collect tissue samples for biopsy.

Biopsy

The definitive diagnosis of urethral cancer is made by examining a tissue sample under a microscope.

Imaging Tests

These may include ultrasound, computed tomography (CT) scans, magnetic resonance imaging (MRI), and positron emission tomography (PET) scans to evaluate the extent of the cancer.

Staging of Urethral Cancer

Urethral cancer stages range from 0 to IV:

  • Stage 0: Cancer is found only in the cells lining the urethra.
  • Stage I: Cancer has grown through the lining but has not reached the muscle layer of the urethra.
  • Stage II: Cancer has spread to the nearby connective tissue or muscle of the urethra.
  • Stage III: Cancer has spread to the nearby tissues such as the vagina, prostate, or bladder.
  • Stage IV: Cancer has spread to other parts of the body, such as the lymph nodes, lungs, liver, or bones.

Treatment Options

Treatment for urethral cancer depends on several factors, including the type, location, stage of the cancer, and the patient’s overall health. Common treatment options include:

Surgery may involve removing the tumour, part of the urethra, and surrounding tissues. In more advanced cases, removal of the entire urethra may be necessary.

This treatment uses high-energy rays to kill cancer cells. It may be used before surgery to shrink the tumour or after surgery to eliminate any remaining cancer cells. Radiation therapy is also an option for patients who cannot undergo surgery.

Chemotherapy may be used to treat urethral cancer that has spread to other parts of the body. It can be administered either systemically to affect cancer cells throughout the body or locally to target specific areas.

This is a relatively new approach that helps the immune system fight cancer. It may be an option for certain types of urethral cancer depending on the specific characteristics of the tumour.

In cases where a cure is not possible, palliative care becomes important to manage symptoms and improve quality of life.

Dr Png Keng Siang

Dr Png Keng Siang

Senior Consultant Urologist & Robotic Surgeon

Dr Png is a United States fellowship-trained urologist who received his urology specialist board certification from Singapore. He is the first and only urologist in Singapore to be inducted into the Fellow, American College of Surgeons (FACS) after completing a minimally invasive surgery fellowship in the USA at the Indiana University School of Medicine, where he sub-specialised in robotic and laparoscopic surgery for urological cancers.

  • Joint Committee of Specialist Training Site Accreditor, Urology Residency Program
  • President of the Robotic Surgery Society of Singapore
Prior To Private Practice:
  • Director of the Robotic Urological Surgery Fellowship Program, Tan Tock Seng Hospital
  • Director of the National Healthcare Group Urology Residency Program & Adjunct Assistant Professor, NUS Yong Loo Lin School of Medicine
  • Member of the American Urological Association, Endourological Society (USA)
  • Executive Committee of the Singapore Urological Association, 2013 to 2020
Read Full Bio

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    Urethral Cancer

    Frequently Asked
    Questions

    How rare is urethral cancer compared to other types of cancer?

    Urethral cancer is extremely rare, accounting for less than 1% of all cancers. It is significantly less common than cancers like breast, prostate, and lung cancer.

    What are the potential side effects of radiation therapy for urethral cancer?

    Side effects of radiation therapy may include skin irritation at the treatment site, fatigue, urinary irritation, and in some cases, more severe effects such as bladder and rectal damage depending on the radiation dose and area treated.

    Can urethral cancer be prevented?

    While there is no guaranteed way to prevent urethral cancer, reducing risk factors such as avoiding HPV infection and managing chronic urinary conditions might help lower the risk.

    How is quality of life addressed in patients undergoing treatment for urethral cancer?

    Quality of life is an important consideration, with efforts made to manage both the physical and psychological impacts of the disease and its treatment. This may involve support from various healthcare professionals including counsellors and pain management specialists.