Male+Urethra

Distal urethra lymphatics drain into: Posterior urethra lymphatics drain into:
 * **Epidemiolgy:** || Urethral cancer is the only urologic cancer that has higher incidence in women than men. Diagnosed mostly between 55 to 60 years of age and has no correlation to race. The locations of male urethral cancers are:
 * 60% within the bulbar and membranous areas.
 * 30-35% in the anterior urethra.
 * 5-10% in the prostatic urethra. [1] ||
 * **Etiology:** || Common links to urethral cancer include chronic inflammation, HPV, and past stricture formation.[1] ||
 * **Signs & Symptoms:** || Some of the signs and symptoms of male urethral cancer are: [1]
 * Chronic inflammation
 * HPV infection
 * Previous stricture formation
 * Decreased force in urinary stream
 * Overflow incontinence
 * Hematuria
 * Purulent discharge
 * Mass ||
 * **Diagnostic Procedures:** || Some of the diagnostic procedures to evaluate staging and extent of cancer (spread) are: [1]
 * CT
 * MRI
 * Urethoscopy and biopsy
 * Manual exam
 * Chest roentgenography
 * Serum chemistries
 * Fine needle aspiration ||
 * **Histology:** || Most (over 80%) are classified as squamous cell carcinomas, usually well or moderately differentiated. Other types include transitional cell (15%), adenocarcinoma (5%), and undifferentiated or mixed carcinomas (1%). [2] ||
 * **Lymph node drainage:** || Lymph node metastasis play a role in distant dissemination and are associated with lower survival. [2] Usually, metastases occur by lymphatic embolization to regional lymph nodes. Hematogenous spread is rare.
 * The superficial and deep inguinal lymph nodes
 * Occasionally, they will drain to the external iliac lymph nodes
 * Pelvis lymph nodes, including presacral, obturator, and external iliac. [1] ||
 * **Metastatic spread:** || Distant mets are rare. Spread is predominantly by local extension into adjacent organs, then by lymphatic, then hematogenous metastases. Lungs, liver, and bone are the most common sites for metastasis. [1] ||
 * **Grading:** || Due to the rarity of this cancer early diagnosis is challenging which makes early staging difficult, the stage of the tumor at the time of diagnosis appears to be independent of tumor histology or grade.[2] ||  ||   ||
 * GX || Grade cannot be assessed ||
 * G1 || Well differentiated ||
 * G2 || Moderately well differentiated ||
 * G3-4 || Poorly differentiated ||  ||
 * **Staging:** || Urethral tumors can be classified as those involving the distal half of the urethra and those located in the proximal or entire urethra. There are several staging systems used for staging male urethra carcinomas American Joint Committee on Cancer AJCC (TNM) and Ray and Associates.[2]

The AJCC staging system may also be used as shown in the table below.[2] ||=  ||   ||
 * Primary tumor || male and female ||
 * TX || Primary tumor cannot be assessed. ||
 * T0 || No evidence of primary tumor. ||
 * Ta || Noninvasive papillary, polyoid or verrucous carcinoma. ||
 * Tis || Carcinoma in situ. ||
 * T1 || Tumor invades subeptihelial connective tissue. ||
 * T2 || Tumor invades any part of (corpus spongiosum, prostate, periurethral muscle). ||
 * T3 || Tumor invades T2 and (corpus cavernosum, beyond prostatic capsule, anterior vagina, bladder neck). ||
 * T4 || Tumor invades other adjacent organs. ||


 * Urothelial carcinoma of the prostate (transitional cells) ||
 * Primary tumor || Male ||
 * T is pu || Carcinoma in situ, involvement of the prostatic urethra ||
 * T is pd || Carcinoma in situ, involvement of the prostatic ducts ||
 * T1 || Tumor invades subeptihelial connective tissue ||
 * T2 || Tumor invades any part of (prostatic stroma, corpus spongiosum, prostate, periurethral muscle). ||
 * T3 || Tumor invades T2 and (corpus cavernosum, beyond prostatic capsule, anterior vagina, bladder neck (extraprostatic extension)). ||
 * T4 || Tumor invades other adjacent organs. ||

Ray and associates proposed staging is most common for staging in males and not females. [2]
 * Urethral carcinoma (males) || Ray and associates (proposed)[2] ||
 * Stage |||| Description ||
 * 0 |||| Tumor confined to mucosa only ||
 * A |||| Tumor extension into lamina propria. ||
 * B |||| tumor extension into corpus spongiosum or prostate but not beyond ||
 * C |||| Direct extension into tissues beyond corpus spongiosum or beyond prostatic capsule ||
 * D1 |||| Regional metastasis. Including nodes of the pelvis and lower abdomen (inguinal and pelvic). ||
 * D2 |||| Distant metastasis. ||
 * D2 |||| Distant metastasis. ||
 * **Radiation side effects:** || Erythema, dry or moist desquamation, and swelling of the subcutaneous tissue. Telangiectasia and fibrosis are asymptomatic and are late consequences of radiation. There is a rare complication of necrosis or ulceration of the skin but this is rare. [2] ||
 * **Prognosis:** || Prognosis is dependent on tumor size and location[3]. The longer male urethra is divided into anterior and posterior components, while the female urethra is approximately 4 cm in length and does not require subdivisions[3]. In both the male and female urethra, the histologic pattern of the urethral mucous membrane progresses from transitional epithelium to squamous epithelium as it continues distally[3]. These mucosal cells are what histologically classify urethral cancer as squamous-cell cancer, transitional-cell carcinoma, or even adenocarcinoma secondary to transitional cell metaplasia[3]. ||
 * **Treatments:** || The typical treatment for Male Urethral cancer is surgical excision is the treatment of choice[3]. For distal urethra it is a penectomy or radiation therapy[3].
 * **Treatments:** || The typical treatment for Male Urethral cancer is surgical excision is the treatment of choice[3]. For distal urethra it is a penectomy or radiation therapy[3].

Anterior (distal) urethra: same as carcinoma of the penis Bulbomembranous urethra is treats the groins and pelvis using parallel-opposed fields, followed by perineal and inguinal boost[3]. The Prostatic urethra is similar to treatment of the prostate[3].

The chemotherapy does not have a well-defined role in the treatment of penis and male urethra carcinomas[3]. ||
 * **TD 5/5:** || TD 5/5[4]:

Rectum (severe proctitis,necrosis,fistula,stenosis) 6000 – – 8000 – – Femoral head 5200 – – 6500 – – Spinal cord (20 cm) 4700 (10 cm) 5000 (5 cm) 5000 – (10 cm) 7000 (5 cm) 7000 Small intestine (obstruction,perforation) 4000 – 5000 5500 – 6000 Stomach (ulceration,perforation) 5000 5500 6000 6500 6700 7000 Colon (obstruction,perforation,ulceration) 4500 – 5500 5500 – 6500 || 2. Chao KS, Perez CA, Brady LW. Radiation Oncology: Management Decisions. Philadelphia, PA: Lippincott Williams & Wilkins; 2002. 3.Powell, C. Urethral Cancer. Urethral Cancer. June 1, 2011. Available at: [|http://emedicine.medscape.com/article/451496-overview - aw2aab6b2b1aa]. Accessed on: June 12, 2012. 4. Emami B, Lyman J, Brown A, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys. 1991. || Back to Week 4
 * **References:** || 1. Lenhard RE, Osteen R, Gansler T. The American Cancer Society’s Clinical Oncology. Williston, VT: Blackwell Publishing, Inc; 2001.