How Do They Test for Urethral Cancer?

As with any ailment, the doctor first does a physical exam and learns the symptoms from the patient. Non-invasive imaging like X-ray, CT scans or ultrasound can show a urethral cancer, but a cystoscopy (camera scope inserted into the urethra and bladder) may also be helpful.

Urethral cancer is a rare but aggressive cancer that occurs when cells in the urethra grow out of control. It accounts for less than one percent of all genitourinary cancers. 

There are three types of urethral cancer: 

• Squamous cell carcinoma
  • The most common kind of urethral cancer
  • In men it starts in the cells that line the urethra in the penis
  • In women it starts in the part of the urethra near the bladder
• Transitional cell carcinoma
  • In men it starts where the urethra passes through the prostate
  • In women it starts near the urethral opening
• Adenocarcinoma
  • Starts in the glands around the urethra

Symptoms of urethral cancer in men may be vague and nonspecific. When symptoms do occur, they may include: 

• Blood in urine
• Difficulty urinating
• Painful urination 
• Urethral discharge
• Urinary retention 
• Perineal pain
• Genital swelling
• Prolonged erection (priapism)
• Periurethral abscess
• Fistula 

Symptoms of urethral cancer in women may include: 

• Urinary irritation 
• Blood in urine 
• Painful sexual intercourse

Symptoms of urethral cancer in women are often mistaken for a urinary tract infection (UTI), which is a much more common cause of the symptoms.

The cause of urethral cancer is unknown. 

Risk factors associated with urethral cancer include:

• Chronic inflammation
• A history of sexually transmitted infections, urethritis, or urethral stricture (in men)
• Urethral diverticuli (in women)
• Urinary stasis and infection 
• Human papillomavirus (HPV), especially HPV 16
• Lesions of the bladder, ureters, or renal pelvis

Urethral cancer is diagnosed with a patient history and physical examination. Tests used to diagnose urethral cancer include: 

• Cystoscopy
• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI) scan
• X-rays
• Transurethral biopsy of the lesion 
• Blood tests
• Urine tests

Treatment for urethral cancer varies based on the location of the tumor, whether it has spread (metastasized), and the gender of the patient. 

Treatment for urethral cancer may include one or more of the following: 

• Surgery 
  • Removal of the urethra (urethrectomy)
  • May also include removal of parts of the penis or vagina, depending on whether the cancer has spread
    • If this is the case, reconstructive surgery may also be performed 
  • Removal of any affected lymph nodes (lymphadenectomy)
• Radiation therapy 
• Chemotherapy
  • Neoadjuvant chemotherapy: administered before surgery
  • Adjuvant chemotherapy: administered after surgery
    • For urothelial carcinoma
      • Cisplatin, gemcitabine, and ifosfamide (CGI)
      • Ifosfamide, paclitaxel, and cisplatin (ITP)
      • Methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC)
    • For squamous cell carcinoma: CGI or ITP 
    • For adenocarcinoma: gemcitabine, fluorouracil, leucovorin, and cisplatin
• Chemoradiotherapy (a combination of chemotherapy and radiotherapy)