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Urethral cancer, causes, types, diagnosis and treatment of urethral cancer

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  • Scanty clear discharge from the urethra in the initial stage of the disease.
  • Purulent-bloody discharge from the urethra in the later stages.
  • Difficulty urinating, up to its full delay.
  • The presence of a seal in the urethra is often detected by the patient on his own.
  • Pain when urinating.
  • The formation of a cavity with pus near the urethra - in the place where the tumor is located.
  • The formation of fistulas - the channel that connects the urethra with the external environment.
  • Enlarged inguinal lymph nodes (organs of the immune system located under the skin in the inguinal areas).
  • Priapism - a long, persistent, painful erection (enlargement of the penis) that occurs without sexual arousal.
  • Swelling of the genitals and legs.
  • Urethritis (infectious inflammation of the urethra).
  • Sexually transmitted infections.
  • Constriction of the urethra.
  • Frequent change of sexual partners.
  • Unprotected sex.
  • Frequent catheterization of the bladder. Patients several times a day independently introduce rubber tubules into the bladder to discharge urine during urinary retention, which leads to trauma to the urethra and the development of inflammation.

A urologist will help in the treatment of the disease

Diagnostics

  • Analysis of the history of the disease and complaints - when (how long) there were discharges from the urethra, when the patient paid attention to the thickening next to the urethra, with which he attributes the occurrence of these symptoms.
  • Analysis of the history of life - what diseases a person suffers, what operations he underwent.
  • General blood analysis. Allows you to identify signs of inflammation: an increase in the number of leukocytes (white blood cells), erythrocyte sedimentation rate (ESR) - red blood cells, signs of anemia (anemia).
  • General urine analysis. Allows you to identify signs of inflammation in the urinary tract: an increase in the number of white blood cells, red blood cells.
  • Blood chemistry. With this analysis, it is possible to identify signs of impaired kidney function: an increase in the end products of protein metabolism (creatinine, urea, uric acid).
  • Ultrasound examination (ultrasound) of the kidneys, bladder - studies allow us to estimate the size and structure of the kidneys and bladder, to identify signs of urine retention.
  • Magnetic resonance imaging (MRI). High-precision method for the diagnosis of kidney cysts, based on the possibility of layer-by-layer examination of an organ The method allows to determine the size, location of the tumor, the degree of spread of the disease to neighboring tissues and organs, the state of the lymph nodes.
  • Computed tomography (CT). X-ray study, which allows to obtain a spatial (3D) image of an organ. The method allows to detect lesions of the lymph nodes, the presence of metastases (secondary foci of growth of a malignant tumor) in other organs.
  • Retrograde urethrography. In the urethra through the external opening is injected radiopaque substance. The substance spreads through the urethra and is clearly visible on the x-ray. The study allows us to estimate the location and extent of the urethral tumor.
  • Intravenous urography and subsequent micronuclear urethrography. A radiopaque substance is injected into the vein, which after 2-3 minutes begins to be excreted by the kidneys. At this time, X-rays are taken at regular intervals. Then, when the entire drug is excreted by the kidneys and is released into the bladder, a picture of the urethra is taken while the patient urinates. The method allows to evaluate the function of the kidneys, the condition of the bladder, as well as to identify the location and extent of the urethral tumor.
  • Multispiral computational cystourethrography. A radiopaque substance is injected into the vein, which after 2-3 minutes begins to be excreted by the kidneys. Then, when the entire drug is excreted by the kidneys and is released into the bladder, a CT scan is performed while the patient is urinating. The most informative study, which allows to obtain 3D (in three planes) reconstruction of the entire urethra.
  • Urethrocystoscopy is the study of the urethra and bladder with the help of a special tool - a cystoscope, in the hollow metal case of which the optical system is mounted. The method allows you to perform a biopsy of education - taking a piece of the tumor using forceps for examination under a microscope.
  • A consultation with an oncologist is also possible.

Urethral Cancer Treatment

  • Radiation therapy is a method of destruction of cancer cells by radiation.
    • Local therapy - the radiator is inserted into the urethra.
    • Remote therapy - the emitter is located outside the patient's body.
  • Chemotherapeutic treatment is a method of destroying cancer cells with a preparation injected into a patient's vein.
  • Surgery:
    • removal of the urethra only (usually in women),
    • removal of the urethra along with the penis, bladder and prostate gland,
    • transurethral resection of the tumor — a resectoscope is inserted into the urethra (a metal tube with an optical system and a loop for cutting tissue), and the tumor is cut off along with the wall of the urethra.
As a rule, one treatment option is not used - resort to a combination of methods to achieve the best result.

Complications and consequences

  • Very severe pain in the genitals.
  • The impossibility of sexual intercourse.
  • The spread of tumor cells throughout the body and the development of metastases (secondary foci of growth of a malignant tumor in other organs).
  • Cachexia - a sharp decrease in body weight.
  • Anemia (anemia).
  • Bleeding from the tumor.
  • Death is death.
  • Violation of the emptying of the bladder with the formation of residual urine and the development of pyelonephritis (infection in the kidneys).
  • Chronic renal failure (depression of kidney function by urine production).
  • Complete blockage of the urethra, which leads to urinary retention.

Urethral Cancer Prevention

  • Timely treatment of inflammatory diseases of the urethra.
  • Exclusion of injuries of the external genital organs.
  • Exclusion of casual sex.
  • Using a barrier method of contraception - condoms.
  • Healthy lifestyle:
    • refusal of bad habits (smoking, alcohol),
    • playing sports
    • rational and balanced nutrition (eating foods high in fiber (vegetables, fruits, greens), avoiding fried, canned, too hot and spicy foods).
  • Exception of hypothermia.
  • Regular (1 time per year) visits to the urologist.

1. What does the diagnosis of cancer of the urethra mean?

Secondary urethral tumors are formed against the background of bladder cancer, chronic urogenital infections and with constant injury to the epithelium of the inner surface of the urethra.

Men are less susceptible to the development of this pathology and, in general, fall ill after 50 years. In women, urethral cancer is most often detected after menopause. Due to the fact that urethral tumors are a rare pathology, there is no single protocol for the management of such patients. General principles of oncology are usually applied, but one cannot say that it always gives predictable positive results.

2. Causes and risk factors

The secondary spread of cancer from nearby organs is the only explanation that can be called a possible cause of urethral tumors. The primary malignant process can begin without any prerequisites. A number of pathogenic factors have been identified, but none of them is definitely dominant. The likelihood of developing urethral cancer is higher under the following conditions:

  • history of oncological diseases, especially if the primary tumor was located in the bladder or prostate,
  • if there are chronic infections, including venereal and asymptomatic diseases (chlamydia, mycoplasma, HPV),
  • permanent injury of the urinary canal epithelium,
  • elderly age.

3. Symptoms, types of tumor and metastasis

Symptoms of cancer of the urethra are different in women and men. For a long time, patients of both sexes may not feel pathology at all. This leads to the detection of a tumor only in the later stages, when the treatment is not so effective.

Possible symptoms of urethral cancer in women:

  • difficult or painful urination,
  • urinary incontinence,
  • lumbar pains
  • aching pain in the abdomen,
  • swollen lymph nodes
  • the presence of blood in the urine.

Signs of possible urethral cancer in men:

  • purulent or bloody discharge
  • ulcers, fistulas and purulent skin rashes,
  • palpation of the seal,
  • pain, especially during an erection,
  • difficulty urinating
  • swelling of the penis and scrotum,
  • skin pigmentation,
  • an increase in the inguinal lymph nodes.

Cancer can be in the form of polyps, ulcerations, or the actual tumor with signs of tissue death. At the stage of mastatic development, general somatic symptoms characteristic of oncological diseases develop: severe weakness, apathy, pain, low-grade fever.

Cancer of the urethra

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Cancer of the urethra (also called the urethra) is a malignant type, more common among women. The length of the urethra in men reaches up to 20 centimeters, in women - 4 centimeters. Tumors are formed in the proximal and distal parts of the canal, cancer of the urethra in a woman may appear in the area of ​​the external opening.

The development of urethral cancer may be associated with:

  • The presence of a history of tumor formation in the bladder.
  • Chronic diseases of the urethra inflammatory nature, including sexually transmitted diseases, and recurring inflammations of the urinary system. Some diseases that are transmitted through the reproductive system are characterized by an asymptomatic form. For example, research by American scientists has shown that recently the sexually transmitted microbe of Mycoplasma genitalium has extremely spread recently. The bacterium was identified in the eighties of the previous century.
  • Achievement men of sixty years and older.
  • Race, since the development of the disease is more often fixed in white females.

Symptoms of the disease in women

Clinical classifications of urethral tumors in women are based on the prevalence of the process, macroscopic forms, and other factors.

According to A. I. Serebrovaya, urethral cancer is classified in four forms:

  • Exophytic form of tumor formations
  • Single types of polyps,
  • Ulcerative tumors,
  • Tight tumor infiltration of the urethra.

Moses Iosifovich Goychberg classifies urethral cancer patients into the following groups:

  1. Patients complaining of pain when urinating.
  2. Patients complaining of bleeding from the urethra.
  3. Patients complaining of neoplasms in the urethra.
  4. Non-complaining patients in whom the disease was detected during a routine examination.

Symptoms of the disease in men

A tumor can also affect the urethra in men. The primary form of the male urethral tumor is located in the prostatic and other parts, for example, in the scaphoid fossa.

In the most frequent cases in men, a squamous cell form of this disease is detected, less commonly a transitional cell form, and even less often melanoma and adenocarcinoma.

The relatively late diagnosis of urethral cancer in men is associated with the poverty of its symptoms at the onset of the disease.

V. Srinnivas and other authors cited statistics according to which the cancer had palpable tumor, paraurethral abscess, initial hematuria, severe erections for the body, and so on. The emergence of pain in the perineal region is associated with the germination of a neoplasm. Because of the infiltrating growth of the tumor, the flow of lymph and blood is disturbed, which leads to a violation of the swelling of the penis and scrotum.

According to Goikhberg, there is a certain sequence of clinical symptoms of this disease: first, dysuria (pain during urination) and hematuria (detection of blood in the urine) occur, after which pain occurs in the perineum and urethra, mucus and pus are released. Next, there is an increase in the lymph nodes and the formation of a tuberous infiltrate in the perineum, fistulae begin to appear, the scrotum and penis swell, erections appear, leading to severe painful consequences.

Treatment of the disease

Factors for choosing a treatment option for people who have a urethral tumor have been found are the location of the tumor, the measure of differentiation of tumor cells and the level of prevalence of the tumor. The form of treatment of such patients should be complex.

The speed of treatment of this disease depends on the size of the tumor, its location and prevalence, regardless of whether it is female or male.

In a woman, this treatment consists of the following types of interventions:

  • A circular resection of the urethra within the boundaries of undamaged tissues,
  • The urethra is removed with the genitals of the external type and the anterior vaginal wall,
  • The urethra with the bladder neck, the genitals of the external type, the anterior vaginal wall is removed, and then the imposition of the vesical fistula located in the suprapubic area is performed,
  • The urethra is removed together with the bladder, genital organs of the external type, the anterior vaginal wall, after which the ureters are transplanted into the skin tissue.

In a man, this treatment consists of the following types of interventions:

  • A transurethral resection of the tumor in the first stage of cancer,
  • An open urethra is resected together with a tumor within the unaffected tissues in the first two stages of the cancer, which is located in the spongy part of the urethra,
  • In partial form, a member is amputated when a tumor is localized in the anterior part of the urethra, and the germination of the tumor in the cavernous bodies is recorded,
  • The penis is fully amputated, while the tumor is located in the posterior part of the urethra.

Causes of Urethral Cancer

The true causes of urethral cancer are not clear. It is believed that the main risk factors are chronic urethritis, including specific etiology. A history of patients often has gonorrhea, mycoplasmosis, chlamydia, human papillomavirus infection, and other venous diseases.

Other risk factors include permanent trauma to the urethral mucosa, bladder cancer, prostate cancer, urethral diverticula. Among the optional precancerous leukoplakia is considered.

Classification

The histological type of urethral cancer is caused by the type of epithelium from which the tumor develops. So, in the distal urethra, lined with squamous epithelium, squamous cell carcinoma develops, in the proximal part, covered with transitional epithelium, transitional cell carcinoma of the urethra. Adenocarcinomas in men come from the glandular tissue of the prostate, in women - from the paraurethral glands. Sarcomas and urethral melanomas are less common in oncourology.

According to the TNM-classification, the following stages of invasive cancer of the female and male urethra are distinguished:

  • T1 - tumor invasion of subepithelial connective tissue
  • T2 - the tumor spreads to the periurethral muscles, spongy body, prostate
  • T3 - the spread of the tumor on the prostate, prostatic capsule, the cavernous body, the anterior wall of the vagina, the bladder neck T4 - the tumor invasion of adjacent organs.
  • N1 - single metastasis in the regional lymph node less than 2 cm
  • N2 - single or multiple metastases in the lymph nodes more than 2 cm in maximum size
  • M0 - the absence of distant metastases
  • M1 - the presence of distant metastases

According to the degree of differentiation (G), urethral cancer may be highly differentiated, moderately differentiated, poorly differentiated or undifferentiated. According to the type of clinical and anatomical variant of tumor growth, exophytic, polypous, ulcerative and infiltrative forms of urethral cancer are distinguished.

Metastasis of urethral cancer can occur via the lymphogenous and hematogenous mechanism. In the first case, the iliac and inguinal lymph nodes are affected, in the second - the lungs, pleura, bones, liver, adrenal glands, salivary glands, brain, glans penis.

Manifestations of urethral cancer are variable and low-specific. Cancer of the male urethra is characterized by difficulty urinating, up to its complete delay, the presence of palpable consolidation in the urethra, pussy discharge, microhematuria, urethrorrhagia. Later joins pain in the urethra and perineum, the formation of periurethral abscesses and fistulas, enlarged inguinal lymph nodes, the development of swelling of the scrotum and penis. Cases of the occurrence of prolonged painful erections (malignant priapism) are described. With melanoma of the urethra, pigment spots are found on the head of the penis.

In women, urethral cancer is manifested by burning and pain in the urethra, cutting during urination, pain during intercourse, urethrorrhagia and contact bleeding, urinary incontinence, ulceration of the vulvar mucosa. The transition of the tumor to the walls of the vagina is accompanied by pain in the lower abdomen, vaginal bleeding, and the formation of urethro-vaginal fistulas. With the germination of urethral cancer in the bladder, gross hematuria becomes the determining symptom. When the tumor is located in the area of ​​the external opening of the urethra, the mass formation is easily determined visually and by palpation. In the case of tumor thrombosis of lymphatic vessels, lymphostasis develops with edema of the lower half of the body. Metastasis of urethral cancer to parenchymal organs is accompanied by the development of appropriate symptoms.

Prognosis and prevention

On average, 5-year survival for urethral cancer is 40%. Factors favorable prognosis are early detection of urethral cancer, non-invasive tumor growth, the absence of metastases, the radical nature of treatment.

Preventive measures include timely treatment of urethritis, STIs, early access to a urologist for any symptoms of urinary tract trouble.

How does urethral cancer in women, photo

Symptoms of urethral cancer in women, as in men, will depend on what kind of tumor struck the epithelium of the urethra, especially if it is not the primary focus, but metastasis of another tumor.

Treatment of malignant tumors of the urethra, as well as the treatment of all malignant pathologies, depends on the stage of the tumor process, the degree of differentiation of the tumor, the germination of the neoplasm in the surrounding organs, the presence of metastases. Only having all these data, the doctor can determine the necessary amount of therapeutic measures. In oncology, at the moment, the most effective method is recognized as a surgical method of treatment, to which, if necessary, add chemotherapy, radiation therapy, immunotherapy and other methods of influencing tumor cells.

Treatment options for urethral cancer in men:

  • transurethral resection (excision) of a small neoplasm in combination with postoperative radiotherapy and chemotherapy,
  • open segmental resection of the urethra along with a tumor, without affecting healthy tissue, when located in the spongy part of the urethra,
  • partial amputation of the penis with the focus of cancer in the anterior part of the urethra and its germination in the cavernous bodies,
  • complete amputation of the penis, scrotum and testicles at the concentration of the tumor in the posterior urethra, the bulbomembranous part and scrotum with the perineal urethrocaneostomy and removal of the regional lymph nodes plus radiation and chemotherapy before and after surgery,
  • complete amputation of the penis in combination with prostate vesiculectomy and cystectomy during tumor germination in the bladder and prostate, with involvement of the bones in the malignant process — resection of a part of the pubic bones with excision of the symphysis after prior irradiation. In this case, postoperative mortality is high, and relapses are 42% in the first postoperative month.

Malignant tumors of the urethra

Cancer of the urethra, or, as it is also called, the urethra, is one of the rare diseases that occurs among women and men. The low level of occurrence of this pathology leads to a lack of study of the disease and poor treatment outcomes.

Epidemiologically, cancer MIC in men is rare. A tumor can be detected at any age, but more often in males older than 45 years. In women, pathology appears in postmenopausal women.

The causes of MIC cancer are oncological formations of the bladder, inflammatory diseases of the urinary tract, provoking the transformation of normal cells into tumor, mechanical injuries, infectious (chlamydia) and venereal (syphilis, gonorrhea) pathology.

Infectious agents leading to the malignancy of urethral mucosa cells are staphylococcus, Escherichia coli, gonococci, chlamydia, viruses, fungi, etc.

The development of a tumor is directly dependent on the type of epithelium that covers the MIC. The ascending part of the organ is lined with transitional epithelium, which gives rise to transitional cell tumors, the descending part is flattened, leading to squamous cell carcinoma.

Adenocarcinoma occurs in the male sex from the tissues of the prostate gland, in the female - from the paraurethral glands. The urethral tumor can be located in the proximal or distal section, in the area of ​​its external opening - in women, in the scaphoid fossa - in men.

How are malignant tumors

MIC cancer in women is observed in 50–60% of cases as a squamous process. Transitional cell carcinoma occurs in 20–30%, and adenocarcinoma - in 5–10%. In the initial stages of this malignant neoplasm can be confused with benign tumors.

Only after a period of time, after the consistency of the tumor hardens, bleeding will appear and the mucous membrane will become infiltrated by tumor cells, cancer of the urethra can be suspected.

In the early stages of the patient does not bother. Symptoms may appear - slight discomfort and pain when urinating, discharge in the form of mucous or mucopurulent contents is possible. As a result of taking antibiotic therapy, there is a slight improvement in the condition for a short time. After discontinuation of antibiotics, symptoms recur.

As the oncological process progresses, dysuric disorders appear in the form of difficulty urinating, painful during an act in the suprapubic area and in the area of ​​the MIC. The pain may be of a different nature: stabbing, cutting, occur at rest or during sexual intercourse.

Hematuria may be characteristic of urination (the presence of blood clots in the urine due to mechanical damage to the MIC mucosa.) At the very last stages, the cancer is able to capture nearby organs, spreading to the surrounding tissues. This leads to bleeding, pain in the lower abdomen. In the event of the above symptoms, an urgent need to consult a doctor.

Based on complaints, examinations, results of laboratory and instrumental methods of examination, the doctor will be able to diagnose and prescribe treatment.

On examination, the physician should palpate the suprapubic area and regional lymph nodes. At the same time roundish education can be found. During oncological processes, the urethra itself is initially affected, then regional inguinal lymph nodes, after adjacent organs and tissues. The inguinal lymph nodes are enlarged, densely fused with the lymphatic tissues and transformed into solid ones.

The development of urethral cancer in men may be pilus or infiltrative in nature.

Clinical manifestations in men

In cancer of the urethra in men, the following symptoms appear:

  • pain in the suprapubic region, often during erection,
  • difficulty urinating
  • skin rashes of a different nature with pigmentation of integuments,
  • swelling extending through the urethra to the penis and scrotum,
  • enlarged inguinal regional lymph nodes.

In the later stages and as the urethral cancer progresses, the general symptoms typical for oncopathology are found in patients: weakness, reduced physical exertion, apathy, severe pain, an increase in body temperature to 38ºС.

The presence of these symptoms and signs is not pathohomonic, that is characteristic for this disease. Accordingly, for diagnosis it is necessary to consult with a specialist.

Research methods

The main diagnostic instrumental methods for detection of urethral cancer are:

  • Ultrasound of the pelvic organs,
  • CT scan,
  • urological methods for the study of the pelvic organs,
  • biopsy of tumor neoplasms.

The most informative is ultrasound, which determines the dense formation of various shapes and sizes, examines the localization of the tumor itself and foci of metastasis.

On computed tomography, you can determine the localization, tumor size, growth (exophytic or endophytic), the degree of malignancy, the stage of the oncological process and the presence of foci of metastasis.

A biopsy of the urethra is important and is performed to determine the histological structure of the tumor. Biological material is obtained by puncture biopsy using a urethroscope.

Cystoscopy and cystography are necessary to determine the germination of a tumor in adjacent structures and tissues. In the presence of fistulas, fistulous passages spend fistulography.

When neglected oncological process, in the later stages of cancer is carried out:

  • lymphadenography - to determine foci of metastasis in regional (inguinal, pelvic, iliac) lymph nodes,
  • magnetic resonance imaging - to determine the foci of metastasis in distant organs and tissues,
  • Ultrasound examination of abdominal organs (distant metastases in the liver),
  • fluoroscopy (distant metastases in the lungs),
  • excretory urography, etc.

Differential diagnostics of urethral tumors should be performed if urethral stricture is suspected (narrowing of the lumen of the MIC), prostate tuberculosis, cancer or prostate adenoma (benign prostatic hyperplasia), chronic urethritis, etc.

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