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Primary Urethral Cancer Table of Contents

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Information for Patients English Primary urethral cancer Table of contents What is primary urethral cancer? ....................................................................... 3 Risk factors .................................................................................................................................. 3 Symptoms .................................................................................................................................... 4 Diagnosis ....................................................................................................................................... 4 Clinical examination............................................................................................................ 4 Urinary cytology ..................................................................................................................... 4 Urethrocystoscopy and biopsy ................................................................................ 4 Imaging testing ........................................................................................................................ 5 MRI scan ......................................................................................................................................... 5 CT scan ............................................................................................................................................. 5 Ultrasound ................................................................................................................................... 5 Staging and subtype of primary urethral cancer ................................. 5 Treatment for men with localised urethral cancer ........................... 6 Partial urethrectomy .......................................................................................................... 6 Partial or complete penile amputation ........................................................... 7 Treatment for women with localised urethral cancer ................... 7 Primary radical urethrectomy .................................................................................... 7 Primary radical urethrectomy .................................................................................... 7 Radiation therapy ................................................................................................................... 7 Treatment of locally advanced primary urethral cancer ............. 8 This information was produced by the European Preoperative chemotherapy ........................................................................................ 8 Association of Urology Preoperative chemoradiotherapy .......................................................................... 8 This leaflet contains general information about primary Treatment of urothelial carcinoma of the prostate ......................... 8 urethral cancer. If you have any specific questions Metastatic disease .............................................................................................................. 8 about your individual medical situation you should Treatment of bone metastases .............................................................................. 8 consult your doctor or other professional healthcare Follow-up, support and clinical trials .............................................................. 9 provider. Glossary of terms .............................................................................................................. 10 This information is in line with the EAU Guidelines on Primary Urethral Cancer 2017. This information was updated by the EAU Patient Information Working Group, March 2018. You can find this and other information on urological diseases at our website: http://patients.uroweb.org * The underlined terms are listed in the glossary. - 2 - Primary urethral cancer What is primary urethral cancer? A tumour that grows towards the centre of the urethra without growing into deeper layers or adjacent organs is You have been diagnosed with primary urethral cancer. This superfi cial and represents an early stage of cancer. Urethral means you have a cancerous growth (malignant tumour) cancer becomes advanced as it grows into deeper layers of in your urethra. The urethra carries urine out of the body ti ssue; into the penis, the vagina, or adjacent organs; or into from the bladder, also known as urinary bladder. In men, the the surrounding muscles. This type of cancer has a higher urethra runs through the prostate and the penis (Fig. 1a). In chance of spreading to other parts of the body (metastati c women, it leads tothe genital area in front of the vagina (Fig. disease) and is harder to treat. In some cases, it may be fatal. 1b). If urethral cancer spreads to other parts of the body such bladder as the lymph nodes or other organs, it is called metastati c urethral cancer. At this stage, cure is unlikely, and treatment is rectum seminal vesicles limited to controlling the spread of the disease and reducing pubic bone symptoms. prostate Risk factors urethra Several biological factors and harmful substances can increase the risk of developing cancer. A higher risk does not necessarily mean that you will get cancer. Someti mes urethral scrotum cancer develops without any known cause. ©2018 patients.uroweb ALL RIGHTS RESERVED Men may have a higher risk of primary urethral cancer if they Fig. 1a: The genital tract in men. have had radiati on therapy, chronic infl ammati on, or a sexual transmitt ed disease. Using a catheter several ti mes a day to urinate (intermitt ent catheter) also increases risk for men. Ovary Ureter Fallopian tube Women who have chronic infecti on or recurrent urinary Uterus tract infecti on may have an increased risk of primary urethral cancer. Development of a pouch (diverti culum) in the urethra Bladder also increases risk for women (Fig. 2). Pubic bone Rectum Uterus Urethra Rectum Vaginal canal Bladder Vaginal canal ©2018 patients.uroweb ALL RIGHTS RESERVED Fig. 1b: The genital tract in women. Urethral diverti culum Urethra Primary urethral cancer is rare and is found more frequently in men and in pati ents older than age 75 years. It is not ©2018 patients.uroweb ALL RIGHTS RESERVED contagious. Fig. 2: Bladder and urethra plus diverti culum. * The underlined terms are listed in the glossary. - 3 - Risk factors for urethral cancer: If you are female, your doctor will perform a careful • Age of 75 years or older—primary urethral cancer examination of your external genital tract and a bimanual develops slowly and is more common in older people examination (Fig. 3b) to exclude the presence of cancer in • Urethral strictures or chronic irritation after intermittent the colon, rectum, and reproductive organs. The bimanual catheter use or surgery in the urethra examination can be performed under anaesthesia if it is • Radiation therapy (external or seed implantation) for painful for you. Your doctor will also feel the lower part of other causes your abdomen, including the groin and the area above your • Chronic urethral inflammation or inflammation following pelvis, to detect enlarged lymph nodes. a sexually transmitted disease • Urethral diverticula and recurrent urinary tract infections Symptoms Primary urethral cancer has no typical early symptoms. Most patients experience bloody discharge from the urethra Pubic bone (haematuria). If you have advanced cancer, you may be able Uterus to feel a hard mass in your genital tract. You have problems Bladder Ovary urinating if the tumour blocks the opening of your bladder Vaginal canal or fills out the urethra completely. Other symptoms could be Rectum pain in your pelvis or during sexual activity. If you have these symptoms, it does not mean you have cancer, but you should be examined by your doctor. ©2018 patients.uroweb ALL RIGHTS RESERVED Fig. 3b: bimanual examination female. Diagnosis If you have suspicious symptoms, your doctor will make a Urinary cytology diagnosis to rule out cancer. Your doctor will take a detailed You doctor may take a urine sample to look for cancer cells medical history and ask questions about your symptoms. and to exclude other possibilities like urinary tract infection. Your doctor may refer to this test as urinary cytology, which Clinical examination means your urine is examined under a microscope to identify If you are male, your doctor will perform a digital rectal cancer cells. examination (Fig. 3a ) and a physical examination of the external genitalia in case a hard mass can be felt. Urethrocystoscopy and biopsy The detection of urethral tumours depends on an internal examination of the urethra, called urethrocystoscopy. This test allows your doctor to look at the inside of your urethra and your bladder using a thin, lighted tube called a cystoscope. Rectum After the urethra is anaesthetised, the cystoscope—a flexible Prostate or rigid tube connected to a camera that transmits pictures from inside your body—is inserted into the urethra and the bladder (Fig. 4). If a tumour can be seen or if a probe of fluid from the bladder contains cancer cells, tissue samples are needed for examination (biopsy). Small tissue samples can be taken immediately with the cystoscope. Larger biopsies or removal of tumours also known as transurethral resection of the ©2018 patients.uroweb ALL RIGHTS RESERVED bladder tumour (TURBT), are usually done under general anaesthesia. Fig. 3a: digital rectal examination male. * The underlined terms are listed in the glossary. - 4 -
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