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Urethral Cancer Treatment (PDQ®)

Health Professional Version
Last Modified: 10/23/2014

Stage Information for Urethral Cancer

Distal Urethral Cancer
Proximal Urethral Cancer
Urethral Cancer Associated with Invasive Bladder Cancer
Stage Definitions by Depth of Invasion
Definitions of TNM

Prognosis and treatment decisions are both determined by:[1]

  • The anatomical location of the primary tumor.
  • The size of the tumor.
  • The stage of the cancer.
  • The depth of invasion of the tumor.

The histology of the primary tumor is of less importance in estimating response to therapy and survival.[2] Endoscopic examination, urethrography, and magnetic resonance imaging are useful in determining the local extent of the tumor.[3,4]

Distal Urethral Cancer

These lesions are often superficial.

  • Female: Lesions of the distal third of the urethra.
  • Male: Anterior, or penile, portion of the urethra, including the meatus and pendulous urethra.
Proximal Urethral Cancer

These lesions are often deeply invasive.

  • Female: Lesions not clearly limited to the distal third of the urethra.
  • Male: Bulbomembranous and prostatic urethra.
Urethral Cancer Associated with Invasive Bladder Cancer

Approximately 5% to 10% of men with cystectomy for bladder cancer may have or may develop urethral cancer distal to the urogenital diaphragm.[5,6]

Stage Definitions by Depth of Invasion
  • Stage 0 (Tis, Ta): Limited to mucosa.
  • Stage A (T1): Submucosal invasion.
  • Stage B (T2): Infiltrating periurethral muscle or corpus spongiosum.
  • Stage C (T3): Infiltration beyond periurethral tissue.
    • Female: Vagina, labia, muscle.
    • Male: Corpus cavernosum, muscle.
  • Stage D1 (N+): Regional nodes; pelvic and inguinal.
  • Stage D2 (N+, M+): Distant nodes; visceral metastases.
Definitions of TNM

The American Joint Committee on Cancer has designated staging by TNM classification to define urethral cancer.[1]

Table 1. Primary Tumor (T) (Male and Female)a
aReprinted with permission from AJCC: Urethra. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 507-13.
TXPrimary tumor cannot be assessed.
T0No evidence of primary tumor.
TaNoninvasive papillary, polypoid, or verrucous carcinoma.
TisCarcinoma in situ.
T1Tumor invades subepithelial connective tissue.
T2Tumor invades any of the following: corpus spongiosum, prostate, periurethral muscle.
T3Tumor invades any of the following: corpus cavernosum, beyond prostatic capsule, anterior vagina, bladder neck.
T4Tumor invades other adjacent organs.
Urothelial (Transitional Cell) Carcinoma of the Prostate
Tis puCarcinoma in situ, involvement of the prostatic urethra.
Tis pdCarcinoma in situ, involvement of the prostatic ducts.
T1Tumor invades urethral subepithelial connective tissue.
T2Tumor invades any of the following: prostatic stroma, corpus spongiosum, periurethral muscle.
T3Tumor invades any of the following: corpus cavernosum, beyond prostatic capsule, bladder neck (extraprostatic extension).
T4Tumor invades other adjacent organs (invasion of the bladder).

Table 2. Regional Lymph Nodesa
aReprinted with permission from AJCC: Urethra. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 507-13.
NXRegional lymph nodes cannot be assessed.
N0No regional lymph node metastasis.
N1Metastasis in a single lymph node 2 cm or less in greatest dimension.
N2Metastasis in a single node more than 2 cm in greatest dimension, or in multiple nodes.

Table 3. Distant Metastasisa
aReprinted with permission from AJCC: Urethra. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 507-13.
M0No distant metastasis.
M1Distant metastasis.

Table 4. Anatomic Stage/Prognostic Groupsa
Stage T N M 
aReprinted with permission from AJCC: Urethra. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 507-13.
0aTaN0M0
0isTisN0M0
Tis puN0M0
Tis pdN0M0
IT1N0M0
IIT2N0M0
IIIT1N1M0
T2N1M0
T3N0M0
T3N1M0
IVT4N0M0
T4N1M0
Any TN2M0
Any TAny NM1

References
  1. Urethra. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 508-9. 

  2. Grigsby PW, Corn BW: Localized urethral tumors in women: indications for conservative versus exenterative therapies. J Urol 147 (6): 1516-20, 1992.  [PUBMED Abstract]

  3. Ryu J, Kim B: MR imaging of the male and female urethra. Radiographics 21 (5): 1169-85, 2001 Sep-Oct.  [PUBMED Abstract]

  4. Pavlica P, Barozzi L, Menchi I: Imaging of male urethra. Eur Radiol 13 (7): 1583-96, 2003.  [PUBMED Abstract]

  5. Trabulsi DJ, Gomella LG: Cancer of the urethra and penis. In: DeVita VT Jr, Lawrence TS, Rosenberg SA: Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2011, pp 1272-79. 

  6. Erckert M, Stenzl A, Falk M, et al.: Incidence of urethral tumor involvement in 910 men with bladder cancer. World J Urol 14 (1): 3-8, 1996.  [PUBMED Abstract]