Kevin 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
Etiology:
Kevin 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 & Symptoms:
Jenn Signs and Symptoms of female urethral caner:4
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 Diagnostic Procedures include:5
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 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.
Grading:
Brandon 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:
Ashley The staging of carcinoma of the urethra is as follows:10
Figure 1. Reprinted from Radiation Oncology Management Decisions.1
Radiation side effects:
Ashley Radiation side effects for patients with urethral cancer include nausea, diarrhea, skin irritation, skin redness, skin soreness, burning during urination, and fatigue. 11A more serious side effect seen is vaginal constriction that can lead to urinary discomfort and difficulties.
Prognosis:
Amanuel The prognosis of urethral cancer in female is12
dependent on the stage of the tumor
independent of the tumor histology
independent of tumor grade
- 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%
Treatments:
Amanuel Surgery is the most common treatment12 - Low stage urethral cancer
Local excision
Transurethral resection
Partial urethectomy
Fulguration or ablation
- High stage local lesion
Total urethectomy
Cytectomy
Anterior exenteration with urinary diversion
Radiation therapy: is an alternative treatment to surgery in low-stage urethral cancer3 - External beam radiation therapy (EBRT)
4500cGy initially followed by a boost to 6500 to 7000cGy
- Brachytherapy: can be given alone or as a boost
When used alone: 5000 to 6000cGy
When used as a boost: 2000 to 2500cGy over 2 to 3 days
Surgery plus radiation therapy: in advanced urethral cancers13 Chemotherapy: in advanced transitional cell tumors Chemo-radiation: in advanced squamous cell carcinoma Active surveillance: following patient in a regular basis without any treatment unless a change is seen in the test results14
TD 5/5:
Lindsey Tissue dose associated with 5% injury rate within 5 years 15 -Skin: Acute and chronic dermatitis 5500cGy -Rectum: Ulcer, stricture 6000cGy -Bladder: Contracture 6000cGy
References:
Chao KS, Perez CA, Brady LW. Radiation Oncology Management Decisions. 3rd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2011: 539.
Lenhard RE, Osteen R, Gansler T. The American Cancer Society’s Clinical Oncology. Williston, VT: Blackwell Publishing, Inc; 2001
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 is12
- dependent on the stage of the tumor
- independent of the tumor histology
- independent of tumor grade
- 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 treatment12
- Low stage urethral cancer
- Local excision
- Transurethral resection
- Partial urethectomy
- Fulguration or ablation
- High stage local lesion- Total urethectomy
- Cytectomy
- Anterior exenteration with urinary diversion
Radiation therapy: is an alternative treatment to surgery in low-stage urethral cancer3- External beam radiation therapy (EBRT)
- 4500cGy initially followed by a boost to 6500 to 7000cGy
- Brachytherapy: can be given alone or as a boost- When used alone: 5000 to 6000cGy
- When used as a boost: 2000 to 2500cGy over 2 to 3 days
Surgery plus radiation therapy: in advanced urethral cancers13Chemotherapy: in advanced transitional cell tumors
Chemo-radiation: in advanced squamous cell carcinoma
Active surveillance: following patient in a regular basis without any treatment unless a change is seen in the test results14
Tissue dose associated with 5% injury rate within 5 years 15
-Skin: Acute and chronic dermatitis 5500cGy
-Rectum: Ulcer, stricture 6000cGy
-Bladder: Contracture 6000cGy
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