Urethral Cancer Treatment Option Overview

by National Cancer Institute

(Page 3 of 3)

There are different types of treatment for patients with urethral cancer.

Different types of treatments are available for patients with urethral cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Three types of standard treatment are used:

Surgery

Surgery is the most common treatment for cancer of the urethra. One of the following types of surgery may be done:

Open excision: Removal of the cancer by surgery.

Electro-resection with fulguration: Surgery to remove the cancer by electric current. A lighted tool with a small wire loop on the end is used to remove the cancer or to burn the tumor away with high-energy electricity.

Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove or destroy tissue.

Lymph node dissection: Lymph nodes in the pelvis and groin may be removed.

Cystourethrectomy: Surgery to remove the bladder and the urethra.

Cystoprostatectomy: Surgery to remove the bladder and the prostate.

Anterior exenteration: Surgery to remove the urethra, the bladder, and the vagina. Plastic surgery may be done to rebuild the vagina.

Partial penectomy: Surgery to remove the part of the penis surrounding the urethra where cancer has spread. Plastic surgery may be done to rebuild the penis.

Radical penectomy: Surgery to remove the entire penis. Plastic surgery may be done to rebuild the penis.

If the urethra is removed, the surgeon will make a new way for the urine to pass from the body. This is called urinary diversion. If the bladder is removed, the surgeon will make a new way for urine to be stored and passed from the body. The surgeon may use part of the small intestine to make a tube that passes urine through an opening (stoma). This is called an ostomy or urostomy. If a patient has an ostomy, a disposable bag to collect urine is worn under clothing. The surgeon may also use part of the small intestine to make a new storage pouch (continent reservoir) inside the body where the urine can collect. A tube (catheter) is then used to drain the urine through a stoma.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Watchful waiting

Watchful waiting is closely monitoring a patient's condition without giving any treatment until symptoms appear or change.

New types of treatment are being tested in clinical trials. These include the following:

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Treatment Options for Urethral Cancer

Anterior Urethral Cancer

Treatment of anterior urethral cancer is different for men and women.

For women, treatment may include the following:

• Radiation therapy followed by surgery (anterior exenteration and urinary diversion).
• Surgery (open excision, electro-resection with fulguration, lymph node dissection, or anterior exenteration and urinary diversion).
• Laser surgery.
• External and/or internal radiation therapy.

For men, treatment may include the following:

• Surgery (open excision, electro-resection with fulguration, lymph node dissection, or partial or radical penectomy).
• Laser surgery.
• Radiation therapy.

Posterior Urethral Cancer

Treatment of posterior urethral cancer is different for men and women.

For women, treatment may include the following:

• Radiation therapy followed by surgery (anterior exenteration with lymph node dissection and urinary diversion).

• Radiation therapy with or without surgery (other than anterior exenteration and urinary diversion).

• Surgery (other than anterior exenteration and urinary diversion) alone.

For men, treatment may be radiation therapy followed by surgery (cystoprostatectomy, penectomy, lymph node dissection, and urinary diversion).

Urethral Cancer Associated with Invasive Bladder Cancer

Treatment of urethral cancer that develops with invasive bladder cancer may include the following:

• Surgery (cystourethrectomy or cystoprostatectomy).
• Watchful waiting.

Recurrent Urethral Cancer

Treatment of recurrent urethral cancer that comes back near the urethra depends on the type of treatment the patient received before, as follows:

• Surgery: For patients who were first treated with radiation therapy.

• Radiation therapy with surgery: For patients who were first treated with surgery alone.

Treatment of recurrent urethral cancer that comes back in distant parts of the body is usually a clinical trial of chemotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

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