Of benign tumors, papillomas, polyps, paraurethral cysts are most common. Clinical symptoms appear when the tumors reach large sizes or when inflammation is attached. The diagnosis is made on the basis of the results of urethroscopy (with mandatory cystoscopy), surgical treatment.
Urethral cancer is rare, accounting for 0.2-1% of all malignant tumors of the genitourinary system, women get sick more often than men, 60-70% of tumors are localized in the proximal urethra. In women, transitional cell cancer is more common, in men – squamous. Urethral cancer is characterized by a local distribution of the process with a tendency to infiltrative growth and lymphogenous metastasis with damage to the inguinal and iliac lymph nodes.
TNM classification of urethral cancer
T – pT – primary tumor
Tx – insufficient data to evaluate the primary tumor MOT – primary tumor not determined
Ta – non-invasive papillary, polypoid or warty carcinoma
pre – invasive carcinoma T1 – the tumor spreads to the subepithelial connective tissue
T2 – the tumor spreads to the spongy body of the penis , prostate gland or periurethral muscle
TK – the tumor extends to the cavernous body, beyond the capsule of the prostate gland, to the front wall of the vagina, the neck of the bladder
T 4 – the tumor spreads to other neighboring organs N – pN – regional lymph nodes
Nx – insufficient data to assess the status of regional nymphatic nodes
N0 – no signs of metastases to regional lymph nodes
N1 – metastases in one regional lymph node no more than 2 cm
N2 – metastasis one lymph node more than 2 cm or multiple metastases in the lymph nodes M – distant metastases
Mx – insufficient data to determine distant metastases
Defense – no signs of distant metastasis M1 – are distanced nye metastases G – histopathologic grading
Gx – degree of differentiation may be evaluated high-grade tumor G1- G2 – moderately differentiated tumor G3-4 – poorly differentiated or undifferentiated tumor
grouping of steps Step 0a – TaNOMO Step Ois – TisNOMO Step I -T1N0M0 Stage II -T2N0M0 Stage III – TIN 1 MO, T2N1M0, T3N0, N1M0 Stage IV – T4N0, N1 MO, any TN2M0, any T, any M1
Clinic for urethral cancer
The clinical picture of urethral cancer can be manifested by the presence of a palpable tumor, serous or blood-purulent discharge, urination disorders (urinary retention in men, urinary incontinence in women), pain in the perineum, enlarged inguinal lymph nodes.
Diagnosis of urethral cancer
The diagnosis is made on the basis of instrumental examination data (urethrocystoscopy, ultrasound tomography, ureterography) with mandatory morphological verification of the process.
Urethral Cancer Treatment
Surgical, radiation or combined methods are used.
In the treatment of cancer of the urethra in women with TI stage sizes up to 1 ow, surgical treatment (excision, tumor coagulation, circular resection) or radiation therapy (brachytherapy or remote) is used, SOD – 60 Gy. In case of cancer of the distal urethra of the T1 stage up to 4 cm in size, combined (interstitial and remote) radiation therapy can be used; for cancer of the proximal T1 of up to 4 cm in size, the combined method is preferred (radiation therapy followed by surgery). At stages T2-T4, preoperative radiation or chemoradiotherapy is indicated followed by surgery, the volume of which is determined by the localization and prevalence of the process (urethroectomy, removal of the anterior wall of the vagina, resection of the bladder neck, cysturectectomy, extirpation of the uterus with appendages, resection of the pubic bones).
In the treatment of urethral cancer in men of stage T1, organ-preserving operations (resection, transurethral resection) are possible. At stages T2-T4, a combined treatment is indicated, including preoperative radiation (SOD 40-60 Gy) or chemoradiotherapy (MVAC, 5-fluorouracil and cisplatin) therapy followed by surgery (amputation of the penis in the presence of the hanging part of the urethra, prostaturotectomy or cystoprostaturopectomy with penis for proximal cancer). Iliac or inguinal lymphadenectomy is performed in the presence of enlarged lymph nodes. The 5-year survival rate of patients with urethral cancer in stages T1-T2 is 80%, in stages T2-T4 it does not exceed 20-30%.