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Female Urethral Cancer

Urethral cancer is a rare malignant tumor of the urethra, which most commonly occurs in women over 70 years (Amin and Young, 1997) (Krieg and Hoffman, 1999) (Rajan et al, 1993).

Epidemiology

Seldom, annual incidence of 1.5 per million population.

Etiology of Urethral Carcinoma

Risk factors include chronic inflammation or infection, diverticula, caruncle, papillomas, adenomas, leukoplakia and bladder cancer.

Pathology of Urethral Carcinoma

Histology:

• Squamous cell carcinoma 60 %
• Transitional cell carcinoma 20 %
• Undifferentiated carcinomas or adenocarcinomas 15 %
• Very rare: melanoma

Metastasis:

Urethral cancer of the distal urethra spreads into the inguinal lymph nodes, tumors of the proximal urethra spread in the pelvic lymph nodes. The lymph node drainage is variable. Hematogenous metastases occur relatively late in squamous cell carcinomas, in contrast to transitional cell cancer.

Tumor stage according to TNM

T:

• Ta: non-invasive papillary carcinoma
• Tis: Anaplastic flat epithelium with low-differentiation, without polarity and without invasion
• T1: infiltration into the subepithelial connective tissue
• T2: infiltration into the periurethral muscles
• T3: infiltration of the anterior vaginal wall and the bladder neck
• T4: infiltration of neighboring organs

N:

• N0: no lymph node metastases
• N1: singular lymph node metastasis (smaller than 2 cm)
• N2: singular lymph node metastasis (size 2–5 cm), or several small lymph node metastases
• N3: lymph node metastases greater than 5 cm

M:

• M0: No distant metastasis
• M1: Distant metastasis

G:

• G1: well differentiated
• G2: moderately differentiated
• G3: poorly to undifferentiated

Signs and Symptoms of Urethral Carcinoma

Urethral bleeding, dysuria, frequency, urinary retention, palpable tumor or induration on pelvic examination.

Diagnostic Work-Up

• Cystoscopy and biopsy/resection of the tumor
• CT or better MRI of the abdomen and pelvis

Treatment of Female Urethral Cancer

Local excision or resection:

Suitable for well-differentiated non-invasive urethral tumors.

Anterior exenteration with complete urethrectomy:

Radical cystectomy with urethrectomy and resection of the anterior vaginal wall are treatment options for invasive tumors. Pelvic lymphadenectomy is done in the same way as in bladder cancer. If an invasive tumor of the distal urethra is present, inguinal lymphadenectomy is also recommended. Only heterotopic urinary diversion is possible. Some authors advocate for adjuvant radiotherapy.

References

Amin und Young 1997 AMIN, M. B. ; YOUNG, R. H.:

Primary carcinomas of the urethra.
In: Semin Diagn Pathol
14 (1997), Nr. 2, S. 147–60

Krieg und Hoffman 1999 KRIEG, R. ; HOFFMAN, R.:

Current management of unusual genitourinary cancers. Part 2: Urethral cancer.
In: Oncology (Williston Park)
13 (1999), Nr. 11, S. 1511–7, 1520; discussion 1523–4

Rajan u.a. 1993 RAJAN, N. ; TUCCI, P. ; MALLOUH, C. ; CHOUDHURY, M.:

Carcinoma in female urethral diverticulum: case reports and review of management.
In: J Urol
150 (1993), Nr. 6, S. 1911–4

  Deutsche Version: Harnröhrenkarzinom der Frau