Genito-Urinary Cancers

Bladder cancer  ~  Kidney Cancer  ~  Urethral Cancer

The bladder is a hollow organ in the lower part of the abdomen. It is shaped like a small balloon and has a muscular wall that allows it to get larger or smaller. The bladder stores urine until it is passed out of the body. Urine is the liquid waste that is made by the kidneys when they clean the blood. The urine passes from the two kidneys into the bladder through two tubes called ureters. When the bladder is emptied during urination, the urine goes from the bladder to the outside of the body through another tube called the urethra.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bladder Cancer

There are three types of bladder cancer that begin in cells in the lining of the bladder. These cancers are named for the type of cells that become malignant (cancerous):

Transitional cell carcinoma: Cancer that begins in cells in the innermost tissue layer of the bladder. These cells are able to change shape depending on whether the bladder is full or empty and may be stretched without breaking apart. Most bladder cancers begin in the transitional cells.

Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells that may form in the bladder after long-term infection or irritation.

Adenocarcinoma: Cancer that begins in glandular (secretory) cells. Glandular cells in the lining of the bladder produce and release fluids such as mucus. Cancer that is confined to the lining of the bladder is called superficial bladder cancer. Cancer that begins in the transitional cells may spread through the lining of the bladder and invade the muscle wall of the bladder or spread to nearby organs and lymph nodes; this is called invasive bladder cancer.

Smoking, gender, and diet can affect the risk of developing bladder cancer.
Risk factors include the following:

  • Smoking

  • Being exposed to certain substances at work, such as rubber, certain dyes and textiles, paint, and hairdressing supplies

  • A diet high in fried meats and fat

  • Being older, male, or white

  • Having an infection caused by a certain parasite

  • Possible signs of bladder cancer include blood in the urine or pain during urination

These and other symptoms may be caused by bladder cancer or by other conditions. A doctor should be consulted if any of the following problems occur:

  • Blood in the urine (slightly rusty to bright red in colour)
  • Frequent urination, or feeling the need to urinate without being able to do so
  • Pain during urination
  • Lower back pain

Tests that examine the urine, vagina, or rectum are used to help detect (find) and diagnose bladder cancer.
The following tests and procedures may be used:

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
Urinalysis
: A test to check the colour of urine and its contents, such as sugar, protein, blood, and bacteria.

Internal exam: An exam of the vagina and/or rectum. The doctor inserts gloved fingers into the vagina and/or rectum to feel for lumps.

Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to find out if cancer has spread to these organs. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.

Cystoscopy: A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope (a thin, lighted tube) is inserted through the urethra into the bladder. Tissue samples may be taken for biopsy.

Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. A biopsy for bladder cancer is usually done during cystoscopy. It may be possible to remove the entire tumour during biopsy.

Urine cytology: Examination of urine under a microscope to check for abnormal cells.
Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) depends on the following:

The stage of the cancer (whether it is superficial or invasive bladder cancer, and whether it has spread to other places in the body). Bladder cancer in the early stages can often be cured.
The type of bladder cancer cells and how they look under a microscope.
The patientís age and general health.
Treatment options depend on the stage of bladder cancer.

After bladder cancer has been diagnosed, tests are done to find out if cancer cells have spread within the bladder or to other parts of the body.
The process used to find out if cancer has spread within the bladder lining and muscle or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

Cystoscopy: A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope (a thin, lighted tube) is inserted through the urethra into the bladder. Tissue samples may be taken for biopsy.
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patientís health habits and past illnesses and treatments will also be taken.
Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.

The following stages are used for bladder cancer:
Stage 0
In stage 0, the cancer is found on tissue lining the inside of the bladder only. Stage 0 is divided into stage 0a and stage 0is, depending on the type of the tumour:

Stage 0a is also called papillary carcinoma, which may look like tiny mushrooms growing from the lining of the bladder.
Stage 0b is also called carcinoma in situ, which is a flat tumour on the tissue lining the inside of the bladder.

Stage I
In stage I, the cancer has spread to the layer below the inner lining of the bladder.

Stage II
In stage II, cancer has spread to either the inner half or outer half of the muscle wall of the bladder.

Stage III
In stage III, cancer has spread from the bladder to the fatty layer of tissue surrounding it, and may have spread to the reproductive organs (prostate, uterus, vagina).

Stage IV
In stage IV, cancer has spread from the bladder to the wall of the abdomen or pelvis. Cancer may have spread to one or more lymph nodes or to other parts of the body.

Different types of treatment are available for patients with bladder 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 ďstandardĒ treatment, the new treatment may become the standard treatment. Four types of standard treatment are used:

Surgery
One of the following types of surgery may be done:

Transurethral resection (TUR) with fulguration: Surgery in which a cystoscope (a thin lighted tube) is inserted into the bladder through the urethra. A tool with a small wire loop on the end is then used to remove the cancer or to burn the tumour away with high-energy electricity. This is known as fulguration.
Radical cystectomy: Surgery to remove the bladder and any lymph nodes and nearby organs that contain cancer. This surgery may be done when the bladder cancer invades the muscle wall, or when superficial cancer involves a large part of the bladder. In men, the nearby organs that are removed are the prostate and the seminal vesicles. In women, the uterus, the ovaries, and part of the vagina are removed. Sometimes, when the cancer has spread outside the bladder and cannot be completely removed, surgery to remove only the bladder may be done to reduce urinary symptoms caused by the cancer. When the bladder must be removed, the surgeon creates another way for urine to leave the body.
Segmental cystectomy: Surgery to remove part of the bladder. This surgery may be done for patients who have a low-grade tumour that has invaded the wall of the bladder but is limited to one area of the bladder. Because most of the bladder remains intact, a patient is able to urinate normally after recovering from this surgery.
Urinary diversion: Surgery to make a new way for the body to store and pass urine.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy after surgery to kill any cancer cells that are left. Treatment given after 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.

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, a body cavity such as the abdomen, or an organ, the drugs mainly affect cancer cells in those areas. Bladder cancer may be treated with intravesical (into the bladder through a tube inserted into the urethra) chemotherapy. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Biologic therapy
Biologic therapy is a treatment that uses the patientís immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the bodyís natural defences against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

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

Chemoprevention
Chemoprevention is the use of drugs, vitamins, or other substances to try to reduce the risk of developing cancer or reduce the risk cancer will recur (come back).

Photodynamic therapy
Photodynamic therapy (PDT) is a cancer treatment that uses a drug that is not active until it is exposed to light. When exposed to light, the cancer cells are killed.

Treatment Options by Stage

Stage 0 Bladder Cancer (Carcinoma in Situ)
Treatment of stage 0 bladder cancer may include the following:

Transurethral resection with fulguration.
Transurethral resection with fulguration followed by intravesical biologic therapy or chemotherapy.
Segmental cystectomy.
Radical cystectomy.
A clinical trial of photodynamic therapy.
A clinical trial of biologic therapy.
A clinical trial of chemoprevention therapy given after treatment to stop cancer from recurring (coming back).

Stage I Bladder Cancer
Treatment of stage I bladder cancer may include the following:

Transurethral resection with fulguration.
Transurethral resection with fulguration followed by intravesical biologic therapy or chemotherapy.
Segmental or radical cystectomy.
Radiation implants with or without external radiation therapy.
A clinical trial of chemoprevention therapy given after treatment to stop cancer from recurring (coming back).
A clinical trial of intravesical therapy.

Stage II Bladder Cancer
Treatment of stage II bladder cancer may include the following:

Radical cystectomy with or without surgery to remove pelvic lymph nodes.
External radiation therapy combined with chemotherapy.
Radiation implants before or after external radiation therapy.
Transurethral resection with fulguration.
Segmental cystectomy.
A clinical trial of chemotherapy before or after surgery.
A clinical trial of chemotherapy combined with external radiation therapy.

Stage III Bladder Cancer
Treatment of stage III bladder cancer may include the following:

Radical cystectomy.
External radiation therapy with or without radiation implants.
Segmental cystectomy.
External radiation therapy combined with chemotherapy.
A clinical trial of chemotherapy before or after surgery.
A clinical trial of chemotherapy combined with external radiation therapy.

Stage IV Bladder Cancer
Treatment of stage IV bladder cancer may include the following:

Radical cystectomy.
External radiation therapy (may be as palliative therapy to relieve symptoms and improve quality of life).
Urinary diversion as palliative therapy to relieve symptoms and improve quality of life.
Cystectomy as palliative therapy to relieve symptoms and improve quality of life.
Chemotherapy.
A clinical trial of chemotherapy before or after surgery.
A clinical trial of chemotherapy combined with external radiation therapy.

Treatment Options for Recurrent Bladder Cancer
Treatment of recurrent bladder cancer depends on previous treatment and where the cancer has recurred. Treatment for recurrent bladder cancer may include the following:

Surgery.
Chemotherapy.
Radiation therapy.
A clinical trial of chemotherapy.

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Kidney Cancer

Renal cell cancer is a disease in which malignant  cells form in tubules of the kidney.
Renal cell cancer (also called kidney cancer or renal adenocarcinoma) is a disease in which malignant (cancer) cells are found in the lining of tubules (very small tubes) in the kidney. There are 2 kidneys, one on each side of the backbone, above the waist. The tiny tubules in the kidneys filter and clean the blood, taking out waste products and making urine. The urine passes from each kidney into the bladder through a long tube called a ureter. The bladder stores the urine until it is passed from the body.

Cancer that starts in the ureters or the renal pelvis (the part of the kidney that collects urine and drains it to the ureters) is different from renal cell cancer. Smoking and misuse of certain pain medicines can affect the risk of developing renal cell cancer. Risk factors include the following:

  • Being a smoker
  • Misusing certain pain medicines, including over-the-counter pain medicines, for a long  time
  • Having certain genetic conditions, such as von Hippel-Lindau disease or hereditary papillary renal cell carcinoma
  • Possible signs of renal cell cancer include blood in the urine and a lump in the abdomen.
    These and other symptoms may be caused by renal cell cancer or by other conditions

There may be no symptoms in the early stages. Symptoms may appear as the tumour grows. A doctor should be consulted if any of the following problems occur:

  • Blood in the urine
  • A lump in the abdomen
  • A pain in the side that doesn't go away
  • Loss of appetite
  • Weight loss for no known reason
  • Anaemia
  • Tests that examine the abdomen and kidneys are used to detect (find) and diagnose renal cell cancer

The following tests and procedures may be used:

Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patientís health habits and past illnesses and treatments will also be taken.

Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it.

Urinalysis: A test to check the colour of urine and its contents, such as sugar, protein, blood, and bacteria.

Liver function test: A procedure in which a sample of blood is checked to measure the amounts of enzymes released into it by the liver. An abnormal amount of an enzyme can be a sign that cancer has spread to the liver. Certain conditions that are not cancer may also increase liver enzyme levels.

Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to check for cancer. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.

Ultrasound: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. A thin needle is inserted into the tumour and a sample of tissue is withdrawn. A pathologist then views the tissueunder a microscope to check for cancer cells.

The prognosis  and treatment options depend on the following:

The stage of the disease.

The patient's age and general health.

After renal cell cancer has been diagnosed, tests are done to find out if cancer cells have spread within the kidney or to other parts of the body.
The process used to find out if cancer has spread within the kidney or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.

The following stages are used for renal cell cancer:
Stage I
In stage I, the tumour is no larger than 7 centimetres and is found in the kidney only.

Stage II
In stage II, the tumour is larger than 7 centimetres and is found in the kidney only.

Stage III
In stage III, cancer is found:

in the kidney and in 1 nearby lymph node; or
in an adrenal gland or in the layer of fatty tissue around the kidney, and may be found in 1 nearby lymph node; or
in the main blood vessels of the kidney and may be found in 1 nearby lymph node.
Stage IV
In stage IV, cancer has spread:

beyond the layer of fatty tissue around the kidney and may be found in 1 nearby lymph node; or to 2 or more nearby lymph nodes; or to other organs, such as the bowel, pancreas, or lungs, and may be found in nearby lymph nodes.

Four types of standard treatment are used:

Surgery
Surgery to remove part or all of the kidney is often used to treat renal cell cancer. The following types of surgery may be used:

Partial nephrectomy: A surgical procedure to remove the cancer within the kidney and some of the tissue around it. A partial nephrectomy may be done to prevent loss of kidney function when the other kidney is damaged or has already been removed.
Simple nephrectomy: A surgical procedure to remove the kidney only.
Radical nephrectomy: A surgical procedure to remove the kidney, the adrenal gland, surrounding tissue, and, usually, nearby lymph nodes.
A person can live with part of 1 working kidney, but if both kidneys are removed or not working, the person will need dialysis (a procedure to clean the blood using a machine outside of the body) or a kidney transplant (replacement with a healthy donated kidney). A kidney transplant may be done when the disease is in the kidney only and a donated kidney can be found. If the patient has to wait for a donated kidney, other treatment is given as needed.

When surgery to remove the cancer is not possible, a treatment called arterial embolization may be used to shrink the tumour. A small incision is made and a catheter (thin tube) is inserted into the main blood vessel that flows to the kidney. Small pieces of a special gelatine sponge are injected through the catheter into the blood vessel. The sponges block the blood flow to the kidney and prevent the cancer cells from getting oxygen and other substances they need to grow.

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 2 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.

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, a body cavity such as the abdomen, or an organ, the drugs mainly affect cancer cells in those areas. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Biologic therapy
Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defences against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

Other types of treatment are being tested in clinical trials. These include the following:
Stem cell transplantation
Stem cells (immature blood cells) are removed from the blood or bone marrow of a donor and given to the patient through an infusion. These re-infused stem cells grow into (and restore) the body's blood cells.

Treatment Options by Stage
Stage I Renal Cell Cancer
Standard treatment of stage I renal cell cancer may include the following:

Surgery (radical nephrectomy, simple nephrectomy, or partial nephrectomy).
Radiation therapy as palliative therapy to relieve symptoms in patients who cannot have surgery.
Arterial embolization, as palliative therapy.

Stage II Renal Cell Cancer
Standard treatment of stage II renal cell cancer may include the following:

Surgery (radical nephrectomy or partial nephrectomy).
Surgery (nephrectomy), before or after radiation therapy.
Radiation therapy as palliative therapy to relieve symptoms in patients who cannot have surgery.
Arterial embolization, as palliative therapy.
New treatments for stage II renal cell cancer are being studied in clinical trials. Information about these and other ongoing clinical trials is available from the NCI Cancer.gov Web site.

Stage III Renal Cell Cancer
Standard treatment of stage III renal cell cancer may include the following:

Surgery (radical nephrectomy). Blood vessels of the kidney and some lymph nodes may also be removed.
Arterial embolization followed by surgery (radical nephrectomy).
Radiation therapy, as palliative treatment to relieve symptoms and improve the quality of life.
Arterial embolization, as palliative therapy.
Surgery (nephrectomy), as palliative treatment.
Radiation therapy before or after surgery (radical nephrectomy).
One of the treatments being studied in clinical trials for stage III renal cell cancer is biologic therapy following surgery.

Stage IV Renal Cell Cancer
Standard treatment of stage IV renal cell cancer may include the following:

Biologic therapy.
Radiation therapy as palliative treatment to relieve symptoms and improve the quality of life.
Surgery (nephrectomy), as palliative treatment.
Surgery (radical nephrectomy, with or without removal of cancer from other areas where it has spread).
New treatments for stage IV renal cell cancer are being studied in clinical trials.

Treatment Options for Recurrent Renal Cell Cancer
Standard treatment of recurrent renal cell cancer may include the following:

Biologic therapy.
Radiation therapy as palliative treatment to relieve symptoms and improve the quality of life.
Chemotherapy.

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Urethral Cancer

What is cancer of the urethra?
Cancer of the urethra, a rare type of cancer, is a disease in which cancer (malignant) cells are found in the urethra. The urethra is the tube that empties urine from the bladder, the hollow organ in the lower abdomen that stores urine. In women, the urethra is about 1 1/2 inches long and opens to the outside of the body above the vagina. In men, the urethra is about 8 inches long and goes through the prostate gland and then through the penis to the outside of the body. Cancer of the urethra affects women more often then men.
There may be no symptoms of early cancer of the urethra. A doctor should be seen if there is a lump or growth on the urethra, or pain, bleeding, or other difficulty during urination.

If there are symptoms, a doctor will examine the patient and feel for lumps in the urethra. In men, a thin lighted tube called a cystoscope may be inserted into the penis so the doctor can see inside the urethra. If the doctor finds cells or other signs that are not normal, a small piece of tissue (called a biopsy) may be cut out and looked at under a microscope for cancer cells.

The chance of recovery (prognosis) and choice of treatment depend on the stage of the cancer (whether it is just in one area or has spread to other places) and the patientís general state of health

Stage Explanation

Stages of cancer of the urethra
Once cancer of the urethra is found, more tests will be done to find out if cancer cells have spread to other parts of the body (staging). A doctor needs to know the stage of the disease to plan treatment. For cancer of the urethra, patients are grouped into stages depending on where the tumour is and whether it has spread to other places. The following stage groupings are used for cancer of the urethra:

Anterior urethral cancer
The part of the urethra that is closest to the outside of the body is called the anterior urethra, and cancers that start here are called anterior urethral cancers.

Posterior urethral cancer
The part of the urethra that connects to the bladder is called the posterior urethra, and cancers that start here are called posterior urethral cancers. Because the posterior urethra is closer to the bladder and other tissues, cancers that start here are more likely to grow through the inner lining of the urethra and affect nearby tissues.

Urethral cancer associated with invasive bladder cancer
Occasionally, patients who have bladder cancer also have cancer of the urethra. This is called urethral cancer associated with invasive bladder cancer.

Recurrent urethral cancer
Recurrent cancer means that the cancer has come back (recurred) after it has been treated. It may come back in the same place, or in another part of the body.

Treatment Option Overview

How cancer of the urethra is treated
There are treatments for all patients with cancer of the urethra. Three kinds of treatment are used:

  • Surgery (taking out the cancer in an operation).
  • Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells)
  • Chemotherapy (using drugs to kill cancer cells).

Surgery is the most common treatment of cancer of the urethra. A doctor may take out the cancer using one of the following operations:

  • Electrofulguration uses an electric current to remove the cancer. The tumour and the area around it are burned away and then removed with a sharp tool.
  • Laser therapy uses a narrow beam of intense light to kill cancer cells.
  • Cystourethrectomy removes the bladder and the urethra.

In men, the part of the penis containing the urethra that has cancer may be removed in an operation called a partial penectomy. Sometimes the entire penis is removed (penectomy). A patient may need plastic surgery to make a new penis if all or part of the penis is removed. The bladder and prostate may also be removed in an operation called cystoprostatectomy. Lymph nodes in the pelvis may also be removed (lymph node dissection). Lymph nodes are small bean-shaped structures that are found throughout the body. They produce and store infection-fighting cells.

In women, surgery to remove the urethra, the bladder, and the vagina (anterior exenteration) may also be done. Lymph nodes in the pelvis may be removed (lymph node dissection). Plastic surgery may be needed to make a new vagina after this operation.

If the urethra is removed, the doctor will need to make a new way for the urine to pass from the body. This is called urinary diversion.

If the bladder is removed, the doctor will need to make a new way for the patient to store and pass urine. There are several ways to do this. Sometimes the doctor will use part of the small intestine to make a tube through which urine can pass out of the body through an opening (stoma) on the outside of the body. This is sometimes called an ostomy or urostomy. If a patient has an ostomy, a special bag will need to be worn to collect urine. This special bag, which sticks to the skin around the stoma with a special glue, can be thrown away after it is used. This bag does not show under clothing, and most people take care of these bags themselves. The doctor may also use part of the small intestine to make a new storage pouch (a continent reservoir) inside the body where the urine can collect. The patient would then need to use a tube (catheter) to drain the urine through a stoma.

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes (internal radiation therapy) in the area where cancer cells are found. Radiation may be used alone or with surgery and/or chemotherapy.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put in the body through a needle in a vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body and can kill cancer cells outside the urethra.

Treatment by stage
Treatment depends on where the cancer is found, whether it has spread to other areas in the body, and the patientís sex, age, and overall health.

Anterior Urethral Cancer
Treatment is different for men and women. For women, treatment may be one of the following:

  1. Electrofulguration
  2. Laser therapy
  3. External and/or internal radiation therapy
  4. Radiation therapy followed by surgery or surgery alone to remove the urethra and the organs in the lower pelvis (anterior exenteration), or the tumour only, if it is small. A new way is made for urine to pass out of the body (urinary diversion).

For men, treatment may be one of the following:

  1. Electrofulguration.
  2. Laser therapy.
  3. Surgery to remove a part of the penis (partial penectomy).
  4. Radiation therapy.

Posterior Urethral Cancer
Treatment is different for men and women. For women, treatment will probably be radiation therapy followed by surgery or surgery alone to remove the urethra, the organs in the lower pelvis (anterior exenteration), or the tumour only, if it is small. Lymph nodes in the pelvis are usually removed (lymph node dissection), and lymph nodes in the upper thigh may or may not be removed. A new way is made for urine to pass out of the body (urinary diversion).

For men, treatment will probably be radiation therapy followed by surgery or surgery alone to remove the bladder and prostate (cystoprostatectomy) and the penis and urethra (penectomy). Lymph nodes in the pelvis are usually removed (lymph node dissection), and lymph nodes in the upper thigh may or may not be removed. A new way is made for urine to pass out of the body (urinary diversion)

Urethral Cancer Associated With Invasive Bladder Cancer
Because people with bladder cancer sometimes also have cancer of the urethra, the urethra may be removed at the same time the bladder is taken out (cystourethrectomy). If the urethra is not removed during surgery for bladder cancer, the doctor may follow the patient closely so treatment can be started if cancer of the urethra develops.

Recurrent Urethral Cancer
Treatment depends on what treatment the patient received before. If the patient had surgery, treatment may be radiation therapy and surgery to remove the cancer. If the patient had radiation therapy, treatment may be surgery to remove the cancer. Clinical trials are testing chemotherapy for cancer of the urethra that has spread to other parts of the body.

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