Background

Question 1

What is the estimated annual incidence of urethral cancer in the United States?

Answer 1

∼500 cases/yr of urethral cancer in the United States. It is a rare but aggressive cancer.

Question 2

What is the epidemiology of urethral cancer?

Answer 2

Urethral cancer is more common in women (4:1 ratio) and more common in African Americans.

Question 3

What are the conditions or exposures associated with urethral cancer?

Answer 3

Exposures associated with urethral cancer include chronic inflammation (STDs, stricture, recurrent urinary tract infections) and HPV infection.

Question 4

Is there an association b/t urethral cancer and other malignancies?

Answer 4

Yes. Urothelial carcinoma of the urethra is often multifocal and is sometimes associated with urothelial cancer in the bladder, ureters or renal pelvis.

Question 5

What is the avg length of the female urethra and its anatomic divisions?

Answer 5

The avg length of the adult female urethra is 4 cm. It is anatomically divided into the distal one-third (ant urethra) and proximal two-thirds (post urethra).

Question 6

In a female, what type of epithelium does the proximal and distal urethra have?

Answer 6

The distal two-thirds of the female urethra has stratified squamous epithelium. The proximal one-third has transitional epithelium.

Question 7

What is the avg length of the male urethra and its anatomic divisions?

Answer 7

The avg length of the adult male urethra is 21 cm. It is divided into the prostatic, bulbomembranous, and penile urethra.

Question 8

In a male, what type of epithelium lines the urethra?

Answer 8

1. Prostatic and bulbomembranous urethra: transitional epithelium (similar to the bladder)
2. Penile urethra: pseudostratified columnar epithelium

Question 9

What is the histologic prevalence of urethral cancers?

Answer 9

SCCs are the most common f/b urothelial carcinoma and adenocarcinoma. In men, most penile and bulbomembranous tumors are SCC. Most prostatic urethral tumors are urothelial.

Question 10

What is the most common site of origin of urethral cancer in men?

Answer 10

In men, urethral cancer occurs most frequently in the bulbomembranous urethra (60%), penile urethra (30%), and prostatic urethra (10%).

Question 11

What is the main pattern of spread in urethral cancer?

Answer 11

The main pattern of spread is direct extension.

Question 12

What is the lymphatic drainage for the urethra?

Answer 12

Generally, the distal 1/3 of the urethra in men and women drains to the inguinal nodes. The proximal 2/3 drain to the pelvic nodes.

Question 13

What portion of urethral cancer pts will be node-positive at Dx?

Answer 13

15%–30% will be node-positive at Dx.

Question 14

Are most clinically apparent nodes pathologically positive in urethral cancer?

Answer 14

Yes. ∼75% of clinically apparent nodes are pathologically positive, unlike in penile cancer where ∼50% of enlarged nodes are pathologically positive.

Question 15

What % of urethral cancer pts have DM at Dx? What are the most common sites of DM?

Answer 15

10% of pts have DM at Dx. The most common sites are the lung, liver, and bone.

Question 16

What are the most common presenting Sx of urethral cancer?

Answer 16

Most women present with irritative voiding Sx or hematuria. In men, Sx are often nonspecific and mimic benign urethral strictures. Men can present with hematuria or obstructive voiding, urethral discharge, or urinary retention.