Treatment for urethral cancer depends on the stage and location of the disease, and the patient's age, sex, and overall health. Options include chemotherapy, radiation, and surgery. Because urethral cancer is often invasive, surgery is the primary method of treatment. Chemotherapy and radiation are often used as adjuvant therapies.
Surgery to Treat Urethral Cancer
Surgical treatment options depend on the stage and location of the cancer. Surgery is usually performed under general anesthesia. Early urethral cancer is treated using fulguration (destruction of cancer cells using high-frequency electric current) and laser therapy (destruction of cancer cells using a narrow beam of intense light).
Procedures performed for advanced cases include the following:
- Removal of the bladder and urethra (cystourethrectomy)
- Removal of part of the penis (partial penectomy)
- Removal of the penis, urethra, and penile root (radical penectomy)
- Removal of the bladder and prostate (cystoprostatectomy)
- Removal of cancerous lymph nodes (lymph node dissection)
- Removal of the bladder, urethra, and vagina (anterior exenteration)
If partial penectomy, radical penectomy, or anterior exenteration is required, additional surgical procedures are performed to reconstruct the reproductive organs. If the bladder and urethra are removed, a urinary diversion is performed to allow for the passage of urine.
Complications of surgery include the following:
- Adverse reaction to anesthesia
- Bowel obstruction
- Mortality (approximately 1–2% of cases)
- Recurrence (in approximately 50% of cases)
- Tissue death (necrosis)
- Urethral narrowing (stricture) or abnormal passage (fistula)
Radiation to Treat Urethral Cancer
Radiation may be used in conjunction with surgery in advanced urethral cancer, or as primary treatment for early urethral cancer that is noninvasive. Radiation uses high-energy rays from a machine outside the body (called external beam radiation) or surgically implanted radioactive seeds or pellets (called brachytherapy) to destroy cancer cells. External radiation and brachytherapy are sometimes used together.
External beam radiation usually involves treatment 5 days a week for approximately 6 weeks. Brachytherapy involves surgical implantation of the seeds, which become inactive over time and remain in place.
Side effects of radiation are caused by the destruction of healthy tissue and include the following:
- Abnormal healing resulting in abnormal passage in the urethra (fistula)
- Burning of the skin (similar to sunburn)
- Inflammation of the bladder (cystitis)
- Narrowing of the urethra (stricture; causing urination difficulty)
Chemotherapy to Treat Urethral Cancer
Chemotherapy involves using drugs to destroy cancer cells. It is a systemic treatment (i.e., destroys cancer cells throughout the body) that is administered orally or intravenously (through a vein; IV). Medications are often used in combination to destroy urethral cancer that has metastasized. Commonly used drugs include cisplatin (Platinol®), vincristine (Oncovin®), and methotrexate (Trexall®).
Side effects include the following:
- Anemia (causing fatigue, weakness)
- Nausea and vomiting
- Loss of appetite (anorexia)
- Hair loss (alopecia)
- Mouth sores
- Increased risk for infection
- Shortness of breath
- Excessive bleeding and bruising
Urethral Cancer Prognosis
Five-year survival rates for noninvasive urethral cancer treated surgically or with radiation are approximately 60%. Recurrence rates for invasive urethral cancer treated with surgery, chemotherapy, and radiation combined are higher than 50%. Early diagnosis and treatment offers the best chance for cure.