Male+Urethra

Urethral cancer is the only urologic cancer that has higher incidence in women than men. 1 Diagnosed mostly between 55 to 60 years of age and has no correlation to race. The locations of male urethral cancers are: The risks and causes of urethral cancer in males is not definitive. 2 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 sexual intercourse or infection can also be etiologic. || Some signs and symptoms: 3 Some diagnostic workup should include urethroscopy, and cystoscopy. Inguinal lymph nodes should be thoroughly evaluated. Computed tomography is useful in the identification of enlarged lymph nodes in patients with involved inguinal lymph nodes. 4 || Distant metastatic spread is rare. However, the most common site for regional metstatic spread is the inguinal lymph node. 6 Other regional lymph nodes that are at risk for metastasis include: internal illiac, external illiac, and presacral lymph nodes. || For the most part if tumors are not specified by a certain grading system, the most common system is cell differentiation. 7 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: Staging for carcinoma of the Urethra is as follows: 8 || Radiation side effects for patients with urethral cancer include nausea, diarrhea, skin irritation, skin redness, skin soreness, burning during urination, and fatigue. 9 A more serious side effect seen is urethra constriction that can lead to urinary discomfort and difficulties. || - 5 year survival rate following inguinal dissection is between 12% to 66% 10 - 83% survival rate for low staged tumors - 45% survival rate for advanced tumors - Overall 5 year survival rate is 60% - Despite the type of treatment, the recurrence rate for proximal urethral cancer is 50% || Surgery is the most common treatment 11 - Low grade - Advanced tumors Radiation Therapy: Chemotherapy: has no role Active surveillance: following patient in a regular basis without any treatment unless a change is seen in the test results 11 || -Skin: Acute and chronic dermatitis 5500cGy -Rectum: Ulcer, stricture 6000cGy -Bladder: Contracture 6000cGy || > [|http://www.cancer.gov/cancertopics/pdq/treatment/urethral/Patient/page1/AllPages#1]. Accessed June 13, 2013.
 * **Epidemiolgy:** || Kevin
 * 60% within the bulbar and membranous areas.
 * 30-35% in the anterior urethra.
 * 5-10% in the prostatic urethra. ||
 * **Etiology:** || Kevin
 * **Signs & Symptoms:** || Jenn
 * Decrease in urinary system
 * Frequent urination
 * Lump or mass
 * Hematuria
 * Enlarged lymph nodes in the groin region ||
 * **Diagnostic Procedures:** || Jenn
 * **Histology:** || Rachel
 * About 80% of male urethral carcinomas can be classified as squamous cell carcinomas, usually well or moderately differentiated. 5
 * Transitional cell carcinoma, adenocarcinoma, and undifferentiated or mixed carcinomas represent approximately 15%, 5%, and 1%, respectively. ||
 * **Lymph node drainage:** || Rachel
 * The lymph nodes of the penile urethra and the fossa navicularis follow those of the penis to the superficial and deep inguinal lymphatics. 5
 * The lymph nodes of the prostatic and bulbomembranous urethra may follow three routes: Some pass under the pubic symphysis to the external iliac nodes, some go to the obturator and internal iliac nodes, and some end in the presacral lymph nodes.
 * The pelvic or iliac lymphatics are rarely affected in the absence of inguinal lymph node involvement. ||
 * **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:** || Amanuel
 * **Treatments:** || Amanuel
 * <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">Transurethral resection
 * <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">Laser fulguration
 * <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">Partial penectomy
 * <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">Total penectomy with perineal urethrostomy
 * <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">Anterior exentration with radical cytoprostatourethrectomy and urinary diversion
 * <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">Inguinal node dissection if positive groin nodes
 * <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">anterior urethral cancer - treated same as penile cancer
 * <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">bulbomembranous urethra - initial treatment to the groins and pelivs followed by boost to perinial and inguinals
 * <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">prostetic urethra - treated same as prostate cancer
 * **TD 5/5:** || Lindsey
 * Tissue dose associated with 5% injury rate within 5 years ** 12
 * **References:** || # Lenhard RE, Osteen R, Gansler T. The American Cancer Society’s Clinical Oncology. Williston, VT: Blackwell Publishing, Inc; 2001
 * 1) eMedicine. Urethral Cancer. [] . Accessed June 17, 2013.
 * 2) Urethral Cancer Treatment. Available at:
 * 1) Chao KS, Perez CA, Brady LW. //Radiation Oncology Management Decisions//. 3rd . Philadelphia, PA: Lippincott Williams & Wilkins; 2011: 545.
 * 2) Chao K, Perez C, Luther B. Radiation Oncology Management Decisions. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2011: 544-545.
 * 3) Chao K, Perez C, Luther B. //Radiation Oncology Management Decisions//. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2002:481.
 * 4) National Cancer Institute. Available at: []. Accessed on June 21,2013.
 * 5) Chao K, Perez C, Luther B. //Radiation Oncology Management Decisions//. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2011: 545.
 * 6) Side Effects of Radiation Therapy. University of Rochester Medical Center. []. Accessed June 17, 2013.
 * 7) <span style="background-color: #ffffff; color: #ff7100; font-family: Arial,Helvetica,sans-serif; line-height: 1.5;">Lynch DF. Carcinoma of U rethra. []. Accessed June17, 2013.
 * 8) <span style="color: #ff7100; font-family: Arial,Helvetica,sans-serif;">Urethral Cancer Treatment and Management. [|http://emedicine.medscape.com/article/451496-treatment#a25]. Accessed June 17, 2013.
 * 9) Washington CM, Leaver D. //Principles and Practice of Radiation Therapy//. 3rd ed. St. Louis, MO: Mosby Elsevier; 2010: 81. ||

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