Urethral cancer overview

# Overview
Urethral cancer is a rare type of cancer originating from the urethra. The incidence is approximately 0.43 per 100,000 in the United states for men, and approximately 0.15 per 100,000 for women. Types of urethral cancer include transitional cell carcinoma, squamous cell carcinoma, and adenocarcinoma. It may be caused by an infection of human papillomavirus. Urethra cancer must be differentiated from bladder cancer, cervical cancer, bladder stones, urethral stones, cystitis, neurogenic bladder, and urethritis. Common risk factors in the development of urethral cancer are history of bladder cancer, urinary tract infections, and sexually transmitted diseases. Symptoms of urethral cancer include hematuria, urinary hesitancy, frequent urination, incontinence,  swelling in the groin, and a lump or thickness in the perineum or penis. The prognosis varies with the depth of invasion, anatomical location, size, and stage of the tumor. The predominant therapy for urethral cancer is surgical resection. Adjunctive chemotherapy or radiation therapy may be required.

# Classification
Urethral cancer may be classified according to cell types into 3 subtypes: transitional cell, squamous cell, and adenocarcinoma. It may also be classified into distal urethral cancer, proximal urethral cancer and urethral cancer associated with invasive bladder cancer.

# Causes
Urethral cancer may be caused by an infection of human papillomavirus.

# Differential diagnosis
Urethral cancer must be differentiated from bladder cancer, cervical cancer, bladder stones, ureteral stones, cystitis, neurogenic bladder, and urethritis.

# Epidemiology and Demographics
Urethral cancer is a rare disease that tends to affect African American individuals. The incidence is approximately 0.43 per 100,000 in the United states for men, and approximately 0.15 per 100,000 for women.

# Risk Factors
Common risk factors in the development of urethral cancer are history of bladder cancer, urinary tract infections, and sexually transmitted diseases.

# Prognosis
The prognosis varies with the depth of invasion, anatomical location, size, and stage of the tumor. Superficial tumors located in the distal urethra have the most favorable prognosis.

# Diagnosis

## Staging
The staging of urethral cancer is based on the TNM staging system.

## Diagnostic study of choice
There is no single diagnostic study of choice for diagnosing urethral cancer. Cystourethroscopy is useful to evaluate the extent of the disease. Definitive diagnosis is made with transurethral biopsies.

## History and Symptoms
Symptoms of urethral cancer include hematuria, urinary hesitancy, frequent urination, incontinence,  swelling in the groin, and a lump or thickness in the perineum or penis.

## Physical Examination
Common physical examination findings of urethral cancer include hematuria, urethral discharge, perineal/perigenital edema or mass.

## Laboratory Findings
Laboratory findings consistent with the diagnosis of urethral cancer include abnormal cells in urine cytology and hematuria.

## Electrocardiogram
There are no electrocardiogram findings associated with urethral cancer.

## X-ray
There are no x-ray findings associated with urethral cancer.

## Ultrasound
There are no echocardiography/ultrasound findings associated with urethral cancer.

## CT scan
Abdomen and pelvis CT scan may be helpful in the diagnosis of urethral cancer. Findings on CT scan include extravesical extension to lymph nodes, the liver or other structures around the bladder, nodal involvement in the pelvisor retroperitoneum, visceral, pulmonary, or osseous metastasis.

## MRI
Abdominal and pelvic MRI may be helpful in the diagnosis of urethral cancer. MRI may be superior to CT scan to detect superficial and multiple tumors, extraurethral tumor extension, and surrounding organ invasion.

## Other Imaging Findings
Cystoscopy may be helpful for initial diagnosis and staging of urethral cancer. Findings of cystoscopy include Multiple biopsy specimens from various locations and gross extravesical extension, invasion of adjacent organs, or pelvic sidewall involvement.

## Other Diagnostic Studies
Other diagnostic studies for urethral cancer include ureteroscopy and biopsy.

# Treatment

## Medical Therapy
The predominant therapy for urethral cancer is surgical resection. Adjunctive chemotherapy or radiation therapy may be required. The optimal therapy depends on the stage at diagnosis and the anatomic location of the tumor.

## Surgery
Surgery is the mainstay of treatment for urethral cancer. However, it is not recommended among patients with metastatic urethral cancer.

## Primary prevention
There are no primary preventive measures available for urethral cancer.

## Secondary prevention
There are no established measures for the secondary prevention of urethral cancer.