Urethral Cancer Treatment (PDQ®)

As a National Cancer Institute (NCI)-designated Comprehensive Cancer Center, a core part of our mission is to educate patients and the community about cancer. The following summary is trusted information from the NCI.

General Information About Urethral Cancer

The urethra is the tube that carries urine from the bladder to outside the body. In women, the urethra is about 1½ inches long and is just above the vagina. In men, the urethra is about 8 inches long, and goes through the prostate gland and the penis to the outside of the body. In men, the urethra also carries semen.

Anatomy of the male urinary system (left) and female urinary system (right) showing the kidneys, ureters, bladder, and urethra. Urine is made in the renal tubules and collects in the renal pelvis of each kidney. The urine flows from the kidneys through the ureters to the bladder. The urine is stored in the bladder until it leaves the body through the urethra.

Urethral cancer is a rare cancer that occurs more often in women than in men. There are different types of urethral cancer that begin in cells that line the urethra. These cancers are named for the types of cells that become malignant (cancerous):

  • Squamous cell carcinoma is the most common type of urethral cancer. It forms in cells in the part of the urethra near the bladder in women, and in the lining of the urethra in the penis in men.
  • Transitional cell carcinoma forms in the area near the urethral opening in women, and in the part of the urethra that goes through the prostate gland in men.
  • Adenocarcinoma forms in glands near the urethra in both men and women.

Urethral cancer can metastasize (spread) quickly to tissues around the urethra and is often found in nearby lymph nodes by the time it is diagnosed.

Risk factors include the following:

These and other symptoms may be caused by urethral cancer. Other conditions may cause the same symptoms. Sometimes early cancer of the urethra does not cause any symptoms at all. A doctor should be consulted if any of the following problems occur:

  • Bleeding from the urethra or blood in the urine.
  • Weak or interrupted ("stop-and-go") flow of urine.
  • Frequent urination.
  • A lump or thickness in the perineum or penis.
  • Discharge from the urethra.
  • Enlarged lymph nodes in the groin area.

The following tests and procedures may be used:

The prognosis (chance of recovery) depends on the following:

  • The stage and size of the cancer (whether it is in only one area or has spread to other areas).
  • Where in the urethra the cancer first formed.
  • The patient's general health.
  • Whether the cancer has just been diagnosed or has recurred (come back).

Treatment options depend on the following:

  • The stage of the cancer and where it is in the urethra.
  • The patient's sex and general health.
  • Whether the cancer has just been diagnosed or has recurred.

Stages of Urethral Cancer

The process used to find out if cancer has spread within the urethra or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following procedures may be used in the staging process:

  • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • CT scan (CAT scan) of the pelvis and abdomen: A procedure that makes a series of detailed pictures of the pelvis and abdomen, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of the urethra, nearby lymph nodes, and other soft tissue and bones in the pelvis. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it.
  • Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:

The three ways that cancer spreads in the body are:

  • Through tissue. Cancer invades the surrounding normal tissue.
  • Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
  • Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

Urethral cancer is staged and treated based on the part of the urethra that is affected and how deeply the tumor has spread into tissue around the urethra. Urethral cancer can be described as anterior or posterior.

In anterior urethral cancer, the tumors are not deep and they affect the part of the urethra that is closest to the outside of the body.

In posterior urethral cancer, the tumors are deep and affect the part of the urethra closest to the bladder. In women, the entire urethra may be affected. In men, the prostate gland may be affected.

In stage 0, abnormal cells are found in the inside lining of the urethra. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

In stage A, cancer has formed and spread into the layer of tissue beneath the lining of the urethra.

In stage B, cancer is found in the muscle around the urethra. In men, the penile tissue surrounding the urethra may be affected.

In stage C, cancer has spread beyond the tissue surrounding the urethra, and:

  • in women, may be found in the vagina, vaginal lips, or nearby muscle;
  • in men, may be found in the penis or in nearby muscle.

Stage D is divided into stage D1 and stage D2, based on where the cancer has spread.

A small number of patients who have bladder cancer are also diagnosed with cancer of the urethra, or will develop it in the future.

Recurrent Urethral Cancer

Recurrent urethral cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the urethra or in other parts of the body.

Treatment Option Overview

Different types of treatments are available for patients with urethral cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Surgery is the most common treatment for cancer of the urethra. One of the following types of surgery may be done:

If the urethra is removed, the surgeon will make a new way for the urine to pass from the body. This is called urinary diversion. If the bladder is removed, the surgeon will make a new way for urine to be stored and passed from the body. The surgeon may use part of the small intestine to make a tube that passes urine through an opening (stoma). This is called an ostomy or urostomy. If a patient has an ostomy, a disposable bag to collect urine is worn under clothing. The surgeon may also use part of the small intestine to make a new storage pouch (continent reservoir) inside the body where the urine can collect. A tube (catheter) is then used to drain the urine through a stoma.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Watchful waiting is closely monitoring a patient's condition without giving any treatment until symptoms appear or change.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Treatment Options for Urethral Cancer

A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.

Anterior Urethral Cancer

Treatment of anterior urethral cancer is different for men and women.

For women, treatment may include the following:

For men, treatment may include the following:

  • Surgery (open excision, electro-resection with fulguration, lymph node dissection, or partial or radical penectomy).
  • Laser surgery.
  • Radiation therapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with anterior urethral cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Posterior Urethral Cancer

Treatment of posterior urethral cancer is different for men and women.

For women, treatment may include the following:

For men, treatment may be radiation therapy followed by surgery (cystoprostatectomy, penectomy, lymph node dissection, and urinary diversion).

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with posterior urethral cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Urethral Cancer Associated with Invasive Bladder Cancer

Treatment of urethral cancer that develops with invasive bladder cancer may include the following:

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with urethral cancer associated with invasive bladder cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Recurrent Urethral Cancer

Treatment of recurrent urethral cancer that comes back near the urethra depends on the type of treatment the patient received before, as follows:

  • Surgery: For patients who were first treated with radiation therapy.
  • Radiation therapy with surgery: For patients who were first treated with surgery alone.

Treatment of recurrent urethral cancer that comes back in distant parts of the body is usually a clinical trial of chemotherapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent urethral cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

To Learn More About Urethral Cancer

For more information from the National Cancer Institute about urethral cancer, see the following:

For general cancer information and other resources from the National Cancer Institute, see the following: