Female Urethra Flashcards
Female Urethra
Primary urethral carcinoma is more common in women.
TRUE or FALSE?
False.
***
Although previous data suggested that urethral cancer was more
common in women than men, a recent Surveillance, Epidemiology, and End
Results (SEER) study reports that primary urethral cancer is more common in
men.1 The ratio of female to male predominance is approximately 1:3.
Female Urethra
Female urethra is divided into anterior(distal) and posterior(proximal) urethra.
The posterior urethra is lined by transitional epithelium, while the anterior urethra is lined by _____.
nonkeratinizing stratified squamous and pseudostratified columnar epithelium.
Female Urethra
Where is the lymphatic drainage of the distal urethra?
inguinal nodes and external iliac.
***
The primary drainage of the posterior or entire urethra is mainly to the obturator
and internal and external iliac nodes.
Female Urethra
Like other transitional cell
carcinoma of the urinary tract, there is a reported correlation between cigarette
smoking and urethral carcinoma.
TRUE or FALSE?
False.
Female Urethra
Most common presenting symptom of female urethral cancer?
Hematuria/spotting
Female Urethra
Lesions in the distal urethra tend to have a better prognosis than lesions in the posterior urethra.
TRUE or FALSE?
True.
Female Urethra
Grigsby and associates demonstrated a worsening prognosis (PFS) with
increased tumor size.
What are the size cut-offs?
<2 cm
2-4
>4 cm
Female Urethra
Patients treated with brachytherapy in addition to EBRT do worse than those treated with EBRT alone.
TRUE or FALSE?
False.
***
Several investigators found that the use of brachytherapy improves local
control. Milosevic et al. reported that patients who were treated with external
beam therapy only were 4.2 times more likely to recur locally independent of
other prognostic factors, compared with those who received brachytherapy as a
component of management.
Similarly, in a study of six patients with locally
advanced urethral carcinoma, Dalbagni et al. noted that high-dose
intraoperative brachytherapy followed by external beam radiation appeared to
improve local control.
Female Urethra
General Management
What are the initial treatment options for stage 0 and I (Ta, Tis, or small T1) lesions at the meatus or in situ distal urethra?
open excision
electroexcision
fulguration
laser (Nd:YAG or C02) coagulation
Female Urethra
General Management
What are the initial treatment options for larger T1, and T2 tumors of the anterior urethra?
surgical resection of the distal third.
interstitial RT +/- EBRT.
Female Urethra
General Management
What are the initial treatment options for
T3,
T4, or
recurrent tumors of the anterior urethra previously treated by excision and RT?
anterior exenteration and urinary diversion
Female Urethra
General Management
For invasive anterior tumors, when is prophylactic ipsilateral irradiation recommended but not dissection?
negative nodes.
dissection for limited inguinal node involvement.
Female Urethra
General Management
What are the treatment options for posterior tumors <2 cm?
radical resection,
definitive RT,
or combined treatment
Female Urethra
General Management
What is the treatment for larger posterior tumors ≥2 cm?
preoperative irradiation, exenterative surgery and urinary diversion, pelvic lymphadenectomy.
Female Urethra
RT dose for implant alone treatment. (LDR)
60 to 70 Gy LDR (6-7 days (0.4 to 0.5 Gy/h)
