The following tests and procedures may be used to diagnose urethral cancer:
Factors Affecting Prognosis and Treatment Options
- Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Laboratory tests: Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time.
- Urine cytology: Examination of urine under a microscope to check for abnormal cells.
- Urinalysis: A test to check the color of urine and its contents, such as sugar, protein, blood, and white blood cells. If white blood cells (a sign of infection) are found, a urine culture is usually done to find out what type of infection it is.
- Digital rectal exam: An exam of the rectum. The doctor or nurse inserts a lubricated, gloved finger into the lower part of the rectum to feel for lumps or anything else that seems unusual. This procedure may be done while the patient is under anesthesia.
- Pelvic exam: An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. The doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and places the other hand over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. A speculum is also inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. This may be done while the patient is under anesthesia.
- Cystoscopy: A procedure to look inside the urethra and bladder to check for abnormal areas. A cystoscope (a thin, lighted tube) is inserted through the urethra into the bladder. Tissue samples may be taken for biopsy.
- Biopsy: The removal of cells or tissues from the urethra, bladder, and, sometimes, the prostate gland, so they can be viewed under a microscope by a pathologist to check for signs of cancer.
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 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 number of red blood cells, white blood cells, and platelets.
- The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
- The portion of the blood sample made up of red blood cells.
Cancer spreads in the body through tissue, blood or lymph system. 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.
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.
Anterior Urethral Cancer
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.
Posterior Urethral Cancer
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.
The following stages are also used to describe urethral cancer:
Stage 0 (Carcinoma in Situ)
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.
- In stage D1, cancer has spread to nearby lymph nodes in the pelvis and groin.
- In stage D2, cancer has spread to distant lymph nodes or to other organs in the body, such as the lungs, liver, and bone.
Urethral cancer may be associated with invasive bladder cancer.
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.