Female Anterior Urethral Cancer
Male Anterior Urethral Cancer
Current Clinical Trials

Female Anterior Urethral Cancer

If the malignancy is at or just within the meatus and superficial parameters (stage 0/Tis, Ta), open excision or electroresection and fulguration is possible. Tumor destruction using Nd:YAG or CO₂ laser vaporization-coagulation represents an alternative option. For large lesions and more invasive lesions (stage A and stage B, T1 and T2, respectively), interstitial radiation therapy or a combination of interstitial radiation therapy and external-beam radiation therapy is an alternative to surgical resection of the distal third of the urethra. Patients with T3 anterior urethral lesions or lesions treated by local excision or radiation therapy, which then recur, require anterior exenteration and urinary diversion.

If inguinal nodes are palpable, frozen section confirmation of tumor is obtained. If positive for malignancy, ipsilateral node dissection is indicated, as cure is still achievable with limited regional nodal metastases. If no inguinal adenopathy exists, node dissection is not recommended, but careful inguinal palpation is mandatory at 3- to 4-month intervals.[1-3]

Standard treatment options:

1. Open excision or electroresection and fulguration, or laser vaporization-coagulation (Tis, Ta, T1 lesions).
2. External-beam radiation therapy or interstitial radiation therapy or a combination of both (T1, T2 lesions).
3. Anterior exenteration with or without preoperative radiation and diversion (T3 lesions/recurrent lesions).

If the malignancy is in the pendulous urethra and is superficial, the potential for cure is high. In the rare case that involves mucosa only (stage 0/Tis, Ta), resection and fulguration is justified as initial therapy. For infiltrating lesions in the fossa navicularis, amputation of the glans penis may be adequate treatment. For lesions involving more proximal portions of the distal urethra, excision of the involved segment of the urethra, preserving the penile corpora, may be feasible for superficial tumors. Infiltrating lesions require penile amputation 2 cm proximal to tumor. Local recurrences after amputation are rare. The role for radiation therapy in the treatment of anterior urethral carcinoma in the male is not well defined. Some anterior urethral cancers have been cured with radiation alone.[4,5]

If inguinal nodes are palpable, ipsilateral node dissection is indicated after frozen section confirmation of tumor, as cure is still achievable with limited regional nodal metastases. If no inguinal adenopathy exists, node dissection is not recommended, but careful inguinal palpation is mandatory at 3- to 4-month intervals.[6-8]

Standard treatment options:

1. Open excision or electroresection and fulguration, or laser vaporization-coagulation.
2. Amputation of penis (T1, T2, T3 lesions).
3. Radiation (T1, T2, T3 lesions, if amputation is refused).

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with anterior urethral cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site.

References

1. Johnson DE, O'Connell JR, Delclos L: Carcinoma of the urethra. In: Javadpour N, ed.: Principles and Management of Urologic Cancer. 2nd ed. Baltimore, Md: Williams and Wilkins, 1983, pp 598-621. 
   
   
2. Bracken RB, Johnson DE, Miller LS, et al.: Primary carcinoma of the female urethra. J Urol 116 (2): 188-92, 1976.  [PUBMED Abstract]
   
   
3. Sailer SL, Shipley WU, Wang CC: Carcinoma of the female urethra: a review of results with radiation therapy. J Urol 140 (1): 1-5, 1988.  [PUBMED Abstract]
   
   
4. Chao KS, Perez CA: Penis and male urethra. In: Perez CA, Brady LW, eds.: Principles and Practice of Radiation Oncology. 3rd ed. Philadelphia, Pa: Lippincott-Raven Publishers, 1998, pp 1717-1732. 
   
   
5. Donat S, Cozzi P, Herr H: Surgery of penile and urethral carcinoma. In: Walsh PC, Retik AB, Vaughan ED, et al., eds.: Campbell's Urology. 8th ed. Philadelphia: Saunders, 2002, pp 2983-2991. 
   
   
6. Mullin EM, Anderson EE, Paulson DF: Carcinoma of the male urethra. J Urol 112 (5): 610-3, 1974.  [PUBMED Abstract]
   
   
7. Ray B, Canto AR, Whitmore WF Jr: Experience with primary carcinoma of the male urethra. J Urol 117 (5): 591-4, 1977.  [PUBMED Abstract]
   
   
8. Webster GD: The urethra. In: Paulson DF, ed.: Genitourinary Surgery. Vol. 2. New York: Churchill Livingston, 1984, pp 399-583. 
   
   

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