Urethral Cancer

Owen C. Thomas and Neha Vapiwala

Background

What is the estimated annual incidence of urethral cancer in the U.S.?

~500 cases/yr of urethral cancer in the U.S.

Is there a racial or gender predilection for urethral cancer?

Yes. The incidence of urethral cancer is greater in women at a 4:1 ratio. It is higher in white women and black men.

At what age does urethral cancer incidence peak?

The peak incidence of urethral cancer occurs in women age 40–50 yrs and in men age 75–84 yrs. It is very rare in men <55 yrs.

What are the conditions or exposures associated with urethral cancer?

Exposures associated with urethral cancer include possibly HPV in women. Many men have long-standing urethral infections, Hx of STDs, stricture, trauma, or urethritis.

Is there an association between urethral cancer and other malignancies?

Yes. There is an association between bladder cancer and urethral cancer. The risk of urethral cancer in men with bladder cancer has been reported as 4%–18%. A recent series of women with bladder cancer reports a 2% incidence of concurrent urethral cancer (Stenzyl A et al., J Urol 1995).

What are the avg length and anatomic divisions of the female urethra?

The avg length of the female urethra is 4 cm. It is anatomically divided into the distal one third (ant urethra) and proximal two thirds (post urethra).

In a female, what type of epithelium does the proximal and distal urethra have?

The distal two thirds of the female urethra has squamous epithelium. The proximal one third has transitional epithelium.

What are the avg length and anatomic divisions of the male urethra?

The avg length of the male urethra is 21 cm. It is divided into ant (distal) and post (proximal) portions, which are further subdivided from most distal to proximal as follows:

Anterior urethra: glandular, penile, bulbar
Posterior urethra: membranous, prostatic

In a male, what type of epithelium does the proximal and distal urethra have?

In the male urethra:

Squamous epithelium is present in the glandular and penile regions.
Pseudostratified or stratified columnar epithelium is present in the post proximal portion of the penile and bulbomembranous portions.
Transitional cell epithelium is present in the prostatic portion.

What is the histologic prevalence of urethral cancers?

Squamous cell carcinomas are the most common urethral cancers in both men and women → transitional cell carcinomas (TCCs) and adenocarcinoma.

What is the most common site of origin of urethral cancer in men?

In men, urethral cancer occurs most frequently in the bulbomembranous urethra (~60%). It occurs mainly as squamous metaplasia. The next most common sites are the penile urethra and prostatic urethra.

What is the main pattern of spread in urethral cancer?

The main pattern of spread is direct extension.

What is the lymphatic drainage for the urethra?

Traditionally, the distal urethra in women and glandular and penile urethra in men are drained by inguinal nodes, and the more proximal regions (bulbar and prostatic in men) are drained by pelvic nodes. However, crossover can occur, particularly with direct extension of Dz.

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