Stage Information for Urethral Cancer
Prognosis and treatment decisions are both determined by:
- 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. 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.
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.|
|TX||Primary tumor cannot be assessed.|
|T0||No evidence of primary tumor.|
|Ta||Noninvasive papillary, polypoid, or verrucous carcinoma.|
|T1||Tumor invades subepithelial connective tissue.|
|T2||Tumor invades any of the following: corpus spongiosum, prostate, periurethral muscle.|
|T3||Tumor invades any of the following: corpus cavernosum, beyond prostatic capsule, anterior vagina, bladder neck.|
|T4||Tumor invades other adjacent organs.|
|Urothelial (Transitional Cell) Carcinoma of the Prostate|
|Tis pu||Carcinomain situ, involvement of the prostatic urethra.|
|Tis pd||Carcinomain situ, involvement of the prostatic ducts.|
|T1||Tumor invades urethral subepithelial connective tissue.|
|T2||Tumor invades any of the following: prostatic stroma, corpus spongiosum, periurethral muscle.|
|T3||Tumor invades any of the following: corpus cavernosum, beyond prostatic capsule, bladder neck (extraprostatic extension).|
|T4||Tumor invades other adjacent organs (invasion of the bladder).|