Stage Information for Urethral Cancer

Distal Urethral Cancer
Proximal Urethral Cancer
Urethral Cancer Associated with Invasive Bladder Cancer
Stage Definitions by Depth of Invasion
Definitions of TNM

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

aReprinted 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.
Tis	Carcinoma in situ.
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	Carcinoma in situ, involvement of the prostatic urethra.
Tis pd	Carcinoma in 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).

Table 3. Regional Lymph Nodes^a

aReprinted 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.
NX	Regional lymph nodes cannot be assessed.
N0	No regional lymph node metastasis.
N1	Metastasis in a single lymph node 2 cm or less in greatest dimension.
N2	Metastasis in a single node more than 2 cm in greatest dimension, or in multiple nodes.

Table 4. Distant Metastasis^a

aReprinted 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.
M0	No distant metastasis.
M1	Distant metastasis.

Table 5. Anatomic Stage/Prognostic Groups^a

Stage	T	N	M
aReprinted 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.
0a	Ta	N0	M0
0is	Tis	N0	M0
	Tis pu	N0	M0
	Tis pd	N0	M0
I	T1	N0	M0
II	T2	N0	M0
III	T1	N1	M0
	T2	N1	M0
	T3	N0	M0
	T3	N1	M0
IV	T4	N0	M0
	T4	N1	M0
	Any T	N2	M0
	Any T	Any N	M1

References

1. Urethra. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 508-9. 
   
   
2. Grigsby PW, Corn BW: Localized urethral tumors in women: indications for conservative versus exenterative therapies. J Urol 147 (6): 1516-20, 1992.  [PUBMED Abstract]
   
   
3. Ryu J, Kim B: MR imaging of the male and female urethra. Radiographics 21 (5): 1169-85, 2001 Sep-Oct.  [PUBMED Abstract]
   
   
4. Pavlica P, Barozzi L, Menchi I: Imaging of male urethra. Eur Radiol 13 (7): 1583-96, 2003.  [PUBMED Abstract]
   
   
5. Trabulsi DJ, Gomella LG: Cancer of the urethra and penis. In: DeVita VT Jr, Lawrence TS, Rosenberg SA: Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2011, pp 1272-79. 
   
   
6. Erckert M, Stenzl A, Falk M, et al.: Incidence of urethral tumor involvement in 910 men with bladder cancer. World J Urol 14 (1): 3-8, 1996.  [PUBMED Abstract]