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Stage Information for Urethral Cancer

    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 2. Primary Tumor (T) (Male and Female)a

    a Reprinted 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.
    TisCarcinomain 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 puCarcinomain situ, involvement of the prostatic urethra.
    Tis pdCarcinomain 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).
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