What happens and what types of urethral tumors are there?
The urethra is lined with different types of epithelium, which is why the tumors in it are different. Squamous cell carcinoma is more common in the distal part of the canal, urothelial carcinoma is more common closer to the bladder, and adenocarcinoma can develop from the mucosal glands. The tumor first grows inside the wall, narrowing the lumen, then grows into surrounding tissues and metastasizes to the inguinal and pelvic lymph nodes. In women, the urethra is short, so the tumor spreads beyond it earlier; in men it is more often associated with cicatricial narrowing and prolonged inflammation.
- Squamous cell carcinoma is the most common variant
- Urothelial (transitional cell) carcinoma
- Adenocarcinoma from paraurethral glands
- Melanoma and sarcoma are very rare forms
- Growth into the lumen of the canal or into surrounding tissues
Causes and risk factors
It is rarely possible to name the exact cause, but conditions are known that greatly increase the risk. The main one is chronic damage to the mucous membrane: repeated urethritis, prolonged wearing of a catheter, cicatricial narrowing after injuries and operations. A special role is played by the high-risk human papillomavirus, which causes precancerous changes in the epithelium. Smoking makes its contribution, since carcinogens are excreted in the urine and come into contact with the mucous membrane. In women, chronic inflammation and urethral diverticulum are considered risk factors.
- Urethral strictures and trauma scars
- Chronic urethritis, long-term catheterization
- Human papillomavirus infection
- Urethral diverticulum in women
- Smoking
- Previous bladder cancer
Symptoms you shouldn't miss
At an early stage, complaints are nonspecific and are easily explained by inflammation. The person notices that the stream has become thin and intermittent, there is a feeling of incomplete emptying, a burning sensation, and sometimes drops of blood at the beginning or end of urination. Later, a dense formation along the canal, pain in the perineum, discharge with an unpleasant odor, and in men - swelling of the penis. An alarming sign of a late stage is a fistula through which urine leaks past the canal, and enlarged inguinal lymph nodes.
- Weak, thin, or intermittent stream of urine
- Blood in the urine or urethral discharge
- Frequent painful urges
- A lump or nodule under the mucosa
- Pain in the perineum, swelling of the external genitalia
- Urinary retention
How to make a diagnosis
The examination begins with examination and palpation of the urethra; in women, a vaginal examination. The main method is urethrocystoscopy: the canal is examined from the inside and a piece of tissue is taken for histology, because only this confirms the diagnosis. Additionally, urine is examined for atypical cells. To understand how much the tumor has grown into neighboring structures, an MRI of the pelvis with contrast is done, and to look for metastases, a computed tomography scan of the chest and abdominal cavity is done. Inguinal lymph nodes are assessed by ultrasound and, if necessary, punctured.
- Inspection and palpation of the urethra, perineum, inguinal areas
- Urethrocystoscopy with biopsy is a key method
- Cytological examination of urine
- MRI of the pelvis with contrast
- CT scan of the chest and abdomen
- Ultrasound and puncture of inguinal lymph nodes
Treatment and observation
The treatment plan depends on the location of the tumor, its type and stage, so the decision is made by a consultation with the participation of a urologist, chemotherapy and radiation therapist. For small tumors of the distal urethra, organ-preserving removal is possible; for widespread tumors, more extensive operations with reconstruction of the urinary tract and removal of lymph nodes are possible. Surgery is often combined with radiation therapy and drug treatment. After completion of therapy, regular monitoring is required: examinations, cystoscopy and photographs according to the schedule prescribed by the doctor.
- Organ-preserving tumor excision at an early stage
- Extended operations with reconstruction of the urinary tract
- Removal of inguinal and pelvic lymph nodes according to indications
- Radiation therapy alone or after surgery
- Chemotherapy for advanced disease
- Follow-up examinations and cystoscopy after treatment
