Female+Urethra

Female urethral cancer is very rare. There are only 1600 reported cases. 1 Urethral cancer is the only urologic cancer that has higher incidence in women than men. Diagnosed mostly between 55 to 60 years of age and has no correlation to race. The female urethra is short, (2-4 cm) in length and is split in to two sections, anterior (distal) urethra and posterior (proximal) urethra. 2 || The risks and causes of urethral cancer in females is not definitive. People with a history of bladder cancer are at an increased risk of developing urethral cancer. Some sexually transmitted diseases, such as HPV, have been associated with some cases of urethral cancer. Chronic irritations from giving birth, sexual intercourse, or infection can also be etiologic. 3 || Signs and Symptoms of female urethral caner: 4 Diagnostic Procedures include: 5 The lymphatic drainage of the urethral meatus acts much like that of the vulva. 8 The primary drainage sites are: superficial and deep inguinal lymph nodes. The primary drainage for the entire urethra includes: obtruator lymph nodes, as well as the internal and external iliac lymph nodes. These are all sites for common local metastasis. || For the most part if tumors are not specified by a certain grading system, the most common system is cell differentiation. 9 With this system cells are determined how (well or poorly) differentiated they are compared to the normal cells in the surrounding area. Grade 1 usually has a much better prognosis than Grade 4: The staging of carcinoma of the urethra is as follows: 10 || Radiation side effects for patients with urethral cancer include nausea, diarrhea, skin irritation, skin redness, skin soreness, burning during urination, and fatigue. 11 A more serious side effect seen is vaginal constriction that can lead to urinary discomfort and difficulties. || The prognosis of urethral cancer in female is 12 - The overall 5 years survival rate is 32% - Patients with tumor size less than 2cm diameter do better than those with tumor larger than 5cm - Patients with anterior or distal urethra have better survival rate than those with proximal lesions - Overall recurrence rate is between 66% to 100% || Surgery is the most common treatment 12 - Low stage urethral cancer - High stage local lesion Radiation therapy: is an alternative treatment to surgery in low-stage urethral cancer 3 - External beam radiation therapy (EBRT) - Brachytherapy: can be given alone or as a boost Surgery plus radiation therapy: in advanced urethral cancers 13 <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">Chemotherapy: in advanced transitional cell tumors <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">Chemo-radiation: in advanced squamous cell carcinoma <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">Active surveillance: following patient in a regular basis without any treatment unless a change is seen in the test results 14 || -Skin: Acute and chronic dermatitis 5500cGy -Rectum: Ulcer, stricture 6000cGy -Bladder: Contracture 6000cGy ||
 * **Epidemiolgy:** || Kevin
 * **Etiology:** || Kevin
 * **Signs & Symptoms:** || Jenn
 * Weak or interrupted (stop and go) flow of urine
 * Frequent urination
 * A lump or thickness in the perineum
 * Enlarged lymph nodes in the groin area
 * Discharge from the urethra
 * Bleeding from the urethra or blood in urine ||
 * **Diagnostic Procedures:** || Jenn
 * Physical Exam
 * Blood test
 * Urine cytology: examination of the urine under a microscope to check for abnormal cells
 * Urinalysis: a test to check the color of urine and its contents, such as protein, blood, and white blood cells (a sign of infection) are found, a urine culture is usually done to find out what type of infection it is.
 * Pelvic Exam
 * Cystoscopy: a procedure to look inside the urethra and bladder to check for abnormal areas. A cystoscope (a thin, lighted tube) is inserted through the urethra into the bladder. Tissue samples may be taken for biopsy.
 * Computed tomography ||
 * **Histology:** || Rachel
 * Squamous carcinoma is the most common, comprising 50% of all tumors. 6
 * Transitional cell carcinoma and adenocarcinoma are next most common and occur with roughly the same frequency.
 * Mixed tumors, undifferentiated carcinomas, melanoma, cloacogencic carcinoma, and clear cell adenocarcinoma have also been reported. ||
 * **Lymph node drainage:** || Rachel
 * The lymph node drainage of the urethral meatus parallels that of the vulva to the superficial and deep inguinal and external iliac lymphatics. 7
 * The primary lymphatic drainage of the whole urethra is mainly to the obturator and internal and external iliac lymphatics. ||
 * **Metastatic spread:** || Brandon
 * **Grading:** || Brandon
 * GX: Grade cannot be assessed (undetermined grade)
 * G1: Well Differentiated (low grade)
 * G2: Moderately Differentiated (intermediate grade)
 * G3: Poorly Differentiated (high grade)
 * G4: Undifferentiated (high grade) ||
 * **Staging:** || Ashley
 * **Radiation side effects:** || Ashley
 * **Prognosis:** || <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">Amanuel
 * <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">dependent on the stage of the tumor
 * <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">independent of the tumor histology
 * <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">independent of tumor grade
 * **Treatments:** || <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">Amanuel
 * <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">Local excision
 * <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">Transurethral resection
 * <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">Partial urethectomy
 * <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">Fulguration or ablation
 * <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">Total urethectomy
 * <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">Cytectomy
 * <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">Anterior exenteration with urinary diversion
 * <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">4500cGy initially followed by a boost to 6500 to 7000cGy
 * <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">When used alone: 5000 to 6000cGy
 * <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">When used as a boost: 2000 to 2500cGy over 2 to 3 days
 * **TD 5/5:** || Lindsey
 * Tissue dose associated with 5% injury rate within 5 years ** 15
 * **References:** || # <span style="background-color: #ffffff; color: #ff0000; font-family: Arial,sans-serif;">Chao KS, Perez CA, Brady LW. //Radiation Oncology Management Decisions//. 3rd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2011: 539.
 * 1) Lenhard RE, Osteen R, Gansler T. The American Cancer Society’s Clinical Oncology. Williston, VT: Blackwell Publishing, Inc; 2001
 * 2) eMedicine. Urethral Cancer. [] . Accessed June 17, 2013.
 * 3) Medicinenet. Urethral Cancer. Available at: []. Accessed June 13, 2013.
 * 4) Carcinoma of the urethra. Available at: []. Accessed on June 13, 2013.
 * 5) Carcinoma of the Urethra. National Center for Biotechnology Information Website. []. Accessed June 21, 2013.
 * 6) Chao KS, Perez CA, Brady LW. Radiation Oncology Management Decisions. 3rd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2011: 539.
 * 7) Chao K, Perez C, Luther B. //Radiation Oncology Management Decisions//. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2002: 441.
 * 8) National Cancer Institute. Available at: []. Accessed on June 21,2013.
 * 9) Chao KS, Perez CA, Brady LW. //Radiation Oncology Management Decisions//. 3rd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2011: 545.
 * 10) Side Effects of Radiation Therapy. University of Rochester Medical Center. []. Accessed June 17, 2013.
 * 11) <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif; line-height: 1.5;">Lynch DF. Carcinoma of U rethra. []. Accessed June17, 2013.
 * 12) <span style="color: #ff7100; font-family: arial,helvetica,sans-serif; line-height: 1.5;">Krieg R, Hoffman R. Current Management of Unusual Genitourinary Cancers. []. Accessed June 17, 2013.
 * 13) National Cancer Institute. Urethral Cancer treatment. []. Accessed June 17, 2013.
 * 14) Washington CM, Leaver D. //Principles and Practice of Radiation Therapy//. 3rd ed. St. Louis, MO: Mosby Elsevier; 2010: 81. ||

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