Diagnosis

In male urethral cancer, diagnosis is established by transurethral biopsy. In women the diagnosis is established in much the same way. Pathologically most tumors are squamous cell carcinomas although transitional cell carcinomas, adenocarcinomas and melanomas may also be seen.

In penile cancer, incisional or excisional biopsy is performed to obtain the diagnosis. Histologically squamous cell is the predominant cell type although melanomas, basal cell carcinomas, lymphomas and metastatic lesions from other primaries have been seen.

Urethral Staging System

• Ta - Non invasive carcinoma
• Tis - Carcinoma in situ
• T1 - Tumor invades connective tissue
• T2 -   Tumor invades prostate, periurethral muscle or the corpus spongiosum
• T3 -  Tumor invades the corpus cavernosum or beyond the prostatic capsule
• T4 -  Tumor invades other adjacent organs
• N0 - No regional lymph node metastasis
• N+ -  Evidence for regional lymph node metastasis (note that there are three subdivisions dependent upon the size and number of lymph nodes involved).
• M0 - No evidence of distant spread of disease
• M+ - Evidence for distant spread of disease

Penile Staging System

• Ta -  Non invasive carcinoma
• T1 - Tumor <2 cm., superficial or exophytic
• T2 - Tumor 2 cm. but <5 cm. or tumor which invades the connective tissue
• T3 - Tumor 5 cm. or invades corpus spongiosum, cavernosum or urethra
• T4 -  Tumor invades other adjacent structures
• N0 -  No regional lymph node metastasis
• N+ - Evidence of lymph node metastasis
• M0 -  No evidence of distant metastasis
• M+ - Evidence of distant metastasis

Treatment

The treatment of male urethral cancer is surgery. The extent of the surgery depends upon the location and stage of the tumor. Radiation is usually reserved for those patients with early stage lesions of the anterior urethra who refuse surgery. Chemotherapy has shown promise in those with metastatic urethral cancer and is being integrated into therapy for those with locally advanced disease.

In female urethral cancer surgery is the primary modality of therapy. However radiation therapy plays a larger role in treatment of this disease than in male cancer. Unfortunately neither of these modalities alone produces an acceptable morbidity rate and low tumor recurrence rate. Due to the inadequacy of these procedures, chemotherapy in conjunction with radiation and/or surgery (a combined modality approach) is being investigated. Long term results of studies are being awaited.

For either male or female urethral cancer, if the patient is willing, and an investigational study is available, participation should be encouraged.

In penile cancer, surgery is used for control of the primary tumor and also to control the inguinal lymph node bearing regions. Radiation therapy to the penis may work best in patients with low stage disease; in these patients if prophylactic or therapeutic lymph node dissection cannot be performed, external beam radiation to the inguinal and pelvic lymph nodes should be considered.

Chemotherapy used in penile cancer is dependent upon the histology of the lesion. For those lesions which appear as transitional cell cancers, bladder cancer chemotherapy agents should be considered. For squamous cell cancer of the penis, there is some suggestion that cytotoxic therapy is beneficial. In those patients with locally advanced disease, combined modality therapy with neoadjuvant chemotherapy should be considered.