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9 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
Urethral cancer grows in the tube that carries urine out of the body, with fewer than one case per million people a year. With no randomised trials, it is treated by borrowing from bladder, anal or vulvar cancer depending on cell type and location; chemotherapy with radiotherapy before or instead of surgery lets more patients keep their organs.
Primary urethral carcinoma is defined by where in the urethra it starts and by the lining it arises from: urothelial carcinoma in the prostatic and proximal urethra, squamous cell carcinoma in the distal (penile or anterior) urethra, and adenocarcinoma, often of Skene or Littre gland origin or arising in a diverticulum, particularly in women. Risk factors include chronic stricture and inflammation, prior radiotherapy, urethral diverticulum and HPV infection for squamous tumours. Presentation is with bleeding, obstruction or a palpable mass, and diagnosis is frequently delayed because symptoms mimic stricture or infection.
There are no randomised trials. Distal tumours are treated with organ-sparing surgery (partial urethrectomy or distal penectomy in men; distal urethrectomy in women) or with radiotherapy; proximal and locally advanced tumours have historically required radical cystoprostatectomy or anterior exenteration, but the modern approach favours neoadjuvant or definitive platinum-based chemotherapy with or without radiotherapy, extrapolated from bladder cancer (cisplatin-based combinations for urothelial histology) and anal or vulvar cancer (mitomycin or cisplatin with fluorouracil and radiotherapy for squamous histology). Multi-institutional series such as those from the international collaboration on primary urethral carcinoma show better survival with multimodal therapy than with surgery alone, and the EAU has published a dedicated guideline.
| Setting | Approach | Guideline |
|---|---|---|
| Distal, localised | Organ-sparing surgery (distal urethrectomy, partial penectomy) or radiotherapy including brachytherapy. | not mapped |
| Proximal or locally advanced | Neoadjuvant platinum-based chemotherapy (or chemoradiation for squamous histology) followed by surgery; definitive chemoradiation as organ-preserving alternative. | NCCN Category 2A (in Bladder Cancer guideline, primary carcinoma of the urethra section) |
| Metastatic | Treat by histology: urothelial-type regimens (enfortumab vedotin plus pembrolizumab, gemcitabine-cisplatin) or squamous regimens; clinical trials. | not mapped |