Transitional Cell Carcinoma of the Urethra

Transitional cell carcinoma of the urethra is a rare cancer that develops in the cells lining the urethra, the tube through which urine exits the body. While uncommon, this cancer requires careful attention as it can spread to nearby tissues and lymph nodes.

Table of contents

• What Is Transitional Cell Carcinoma of the Urethra?
• Understanding the Urethra
• How Common Is This Cancer?
• Risk Factors
• Signs and Symptoms
• Diagnosis
• Treatment

What Is Transitional Cell Carcinoma of the Urethra?

Transitional cell carcinoma of the urethra is a cancer that forms in special cells called transitional cells (also known as urothelial cells) that line the urethra. These cells are named “transitional” because they have a unique ability to change shape and stretch^[1][2].

Transitional cells line many parts of the urinary system, including the bladder, kidneys, ureters, and urethra. When cancer develops in these cells within the urethra specifically, it is called transitional cell carcinoma of the urethra. This is one of several types of cancer that can affect the urethra, and it represents about 10% of urethral cancers^[4].

In men, transitional cell carcinoma usually forms in the area near the urethral opening in women, and in the part of the urethra that goes through the prostate gland in men^[13]. The cancer can spread quickly to tissues around the urethra and is often found in nearby lymph nodes by the time it is diagnosed^[13].

• Urethra
• Bladder
• Prostate (in men)

Understanding the Urethra

The urethra is the tube that carries urine from the bladder to outside the body. In women, the urethra is about 1½ inches (approximately 2 inches or 4 centimeters) long and is located just above the vagina^[13][20].

In men, the urethra is much longer, about 8 inches (approximately 20 centimeters) long. It passes through the prostate gland and penis before reaching the outside of the body. In males, the urethra also carries semen and sperm^[13][20].

How Common Is This Cancer?

Transitional cell carcinoma of the urethra is very rare. According to medical reports, the overall incidence of urethral cancer in the United States is about 10% among all urethral cancer cases^[4]. The annual rate is approximately 4.3 per million for men and 1.5 per million for women^[10].

Urethral cancer is more common in men than in women. It also appears more frequently in older adults, with the median age at diagnosis being 75 years, with a range from 30 to 90 years^[4]. Additionally, it is more common in Black individuals compared to White individuals^[10].

Risk Factors

Medical researchers are not entirely sure what causes transitional cell carcinoma of the urethra. However, several factors may increase your risk of developing this cancer^[4][20]:

• Personal history of bladder cancer: If you have had bladder cancer in the past, you are at increased risk
• Smoking cigarettes: Tobacco use is a significant risk factor
• Excessive consumption of coffee or tea: Drinking more than seven cups per day may increase risk
• Chemical exposure: Working with certain chemicals used in plastic, dye, rubber, leather, paint, and textile industries
• Long-term inflammation: Conditions that cause chronic swelling in your urethra, such as frequent urinary tract infections or sexually transmitted infections
• Human papillomavirus (HPV): Particularly HPV type 16
• Age and sex: Being 60 or older, and being male

Signs and Symptoms

In most cases, symptoms only appear when the disease progresses. Many people don’t notice any signs in the earliest stages^[4][20].

The most common symptoms include:

• Blood in your urine or blood spotting from the vagina or urethra
• Trouble starting the flow of urine
• Weak or interrupted (stop-and-go) flow of urine
• Frequent urination, especially at night
• Painful or burning sensation when urinating
• Inability to empty the bladder completely (urinary retention)
• A lump or thickness in the perineum (the area between your genitals and rectum) or penis
• Swelling around the perineum
• Pain in the pelvis or during sexual activity
• Itching
• Discharge from the urethra
• Enlarged lymph nodes in the groin area

You should contact a healthcare provider if you notice any of these symptoms^[4].

Diagnosis

Healthcare providers use several tests and procedures to diagnose transitional cell carcinoma of the urethra^[4][13]:

Physical examination and medical history: Your provider will examine you and ask about your past illnesses and health habits.

Urine tests: A complete urine examination can detect blood in the urine and check for urinary tract infections. Your provider may also perform urinary cytology, which involves examining urine samples under a microscope to look for cancer cells^[4].

Blood tests: These check your general health, including kidney and liver function.

Imaging tests: Several imaging techniques may be used to see inside your body and assess the size, location, and spread of the tumor. These include CT scans (of the abdomen, pelvis, and chest), MRI, ultrasound, and X-rays^[4].

Scope tests: Your provider may use a thin, flexible tube with a light and lens to look inside your bladder (cystoscopy) or your ureter and kidney (ureteroscopy). During these procedures, the doctor can see abnormal areas directly and may take a small piece of tissue for examination^[4].

Biopsy: A transurethral biopsy involves removing a small sample of tissue from the urethra to examine under a microscope for cancer cells. This is often the definitive way to confirm the diagnosis^[4].

Treatment

Treatment for transitional cell carcinoma of the urethra depends on several factors, including the size of the cancer, where it is located, and whether it has spread to other parts of your body^[4].

The main treatment options include:

Surgery: Surgical removal of the tumor or the urethra is a primary treatment option. The extent of surgery depends on the stage and location of the cancer.

Radiation therapy: This treatment uses high-energy rays to kill cancer cells. It may be used alone or in combination with other treatments.

Chemotherapy: This involves using drugs to destroy cancer cells. Chemotherapy may be given before surgery to shrink tumors or after surgery to kill any remaining cancer cells.

Your healthcare team will discuss the most appropriate treatment plan for your specific situation, taking into account the benefits and potential side effects of each option^[4].