Overview

When you use the bathroom, urine moves from your bladder through a tube called the urethra. The urethra goes through the prostate and the penis in men. In women, the tube is shorter and ends just above the opening to the vagina. If you have urethral cancer, cells in the area grow abnormally and out of control.

 

Who’s at Risk?

People over age 60, most often. Your risk might be higher, too, if you’ve had bladder cancer, frequent urinary tract infections, or sexually transmitted diseases that lead to an inflammation of the urethra. Urethral cancer has been linked to human papillomavirus, especially HPV 16. The HPV vaccine protects against type 16. Doctors recommend it for girls and boys at ages 11 or 12. The FDA has approved the Gardasil 9 HPV vaccine for males and females ages 9 to 45.

 

Symptoms of Urethral Cancer

You may not have any symptoms at first. Over time, you might notice it’s hard for you to pee. Maybe you have a weak urine flow or can’t hold it when you do have to go. Or perhaps you go to the bathroom more often, especially at night. You might see blood in the toilet or notice a discharge from your urethra. A swollen spot or a painless lump may appear in your groin or penis. These aren’t always signs of cancer, but can be signs of something else. See your doctor to know for sure.

​

​

Types of Urethral Cancer

There are three -- squamous cell carcinoma, transitional cell carcinoma, and adenocarcinoma.

Squamous cell carcinoma. In women, it starts in the part of the urethra near the bladder. In men, it forms in the cells that line the urethra in the penis. This is the most common kind of urethral cancer. Transitional cell carcinoma. In women, cancer cells grow near where the urethra opens. In men, they grow where the tube passes through the prostate. Adenocarcinoma. In this form of the disease, cancerous cells begin to grow in the glands around the urethra.

​

How Is It Diagnosed?

If you have problems when you pee or any of the symptoms listed above, see your doctor. They’ll ask questions about your medical history and do a physical exam. This may include a pelvic and rectal exam. Your doctor might order blood tests and ask for a urine sample to look for abnormal cells.

They may recommend a cystoscopy. That’s where they use a tool called a cystoscope to examine the inside of your urethra.

They may do a biopsy. That means they’ll take cells from the urethra and bladder and look at them under a microscope to see if they’re cancerous.

If your doctor finds that you have urethral cancer, they’ll order more tests to see if cancer has spread to other parts of your body. (Cancer cells can move to other parts of your body through tissue, blood, and the lymph system. ) These tests may include chest X-rays, a CT scan of the pelvis and abdomen, or a magnetic resonance imaging test (MRI) of the pelvis.

A procedure called urethrography can help your doctor see if there’s cancer in tissue close to the urethra. This is a series of X-rays your doctor performs after they inject contrast dye into the urethra and bladder.

​

How Is It Treated?

Most often, through surgery. But that depends on where the cancer is located. Sometimes, doctors can get rid of it just by removing the tumor. Other times, the urethra and bladder may be taken out. Your surgeon will need to make a new place for your body to store urine and build another way for the body to release it. After surgery, you may need to wear a bag outside your body to collect the urine.

The vagina or part or all of the penis might also be removed. Plastic surgery may be performed to reconstruct the reproductive organs.

Your doctor may use radiation or chemotherapy (“chemo”), either with or without surgery, to kill cancer cells. They may also use something called “active surveillance” to monitor the cancer. This means you’re not given treatment right away. Instead, your doctor will perform tests often to see if the cancer gets worse. If it does, they’ll develop a treatment plan.

​

Overview

Cancer of the ureter (ureteral cancer) is an abnormal growth of cells on the inside lining of the tubes (ureters) that connect your kidneys to your bladder. Ureters are part of the urinary tract, and they carry urine produced by the kidneys to the bladder.

Ureteral cancer is uncommon. It occurs most often in older adults and in people who have previously been treated for bladder cancer.

Ureteral cancer is closely related to bladder cancer. The cells that line the ureters are the same type of cells that line the inside of the bladder. People diagnosed with ureteral cancer have a greatly increased risk of bladder cancer, so your doctor will recommend tests to look for signs of bladder cancer. Treatment for ureteral cancer typically involves surgery. In certain situations, chemotherapy or immunotherapy may be recommended.

 

Symptoms

Signs and symptoms of ureteral cancer include:

• Blood in urine

• Back pain

• Pain when urinating

• Losing weight without trying

• Fatigue

​

When to see a doctor

Make an appointment with your doctor if you have any persistent signs and symptoms that worry you.

 

Causes

It's not clear what causes ureteral cancer. Ureteral cancer happens when cells on the inside lining of the ureter develop changes (mutations) in their DNA. A cell's DNA contains the instructions that tell a cell what to do. The changes tell the cells to multiply rapidly and to continue living beyond their typical life cycle. The result is a growing mass of abnormal cells that can grow to block the ureter or spread to other areas of the body.

​

Risk factors

Factors that can increase the risk of ureteral cancer include:

• Increasing age. The risk of ureteral cancer increases with age. Most people diagnosed with this cancer are in their 70s and 80s.

• Previous bladder or kidney cancer. People who have been diagnosed with bladder cancer or kidney cancer have an increased risk of ureteral cancer.

• Smoking. Smoking tobacco increases the risk of ureteral cancer, as well as other urinary tract cancers, including kidney cancer and bladder cancer.

• Family history of cancer. Lynch syndrome, also called hereditary nonpolyposis colorectal cancer (HNPCC), increases the risk of colon cancer and other cancers, including ureteral cancer. If you have a strong family history of cancer, discuss it with your doctor. Together you may decide whether to consider genetic testing for Lynch syndrome and other inherited cancer syndromes.

 

Diagnosis

Tests and procedures used to diagnose ureteral cancer include:

• Physical examination. Your doctor will ask you questions about your signs and symptoms and perform a physical examination to better understand your condition.

• Imaging tests. Imaging tests may be used to help your doctor assess the extent of your ureteral cancer. Imaging tests may include intravenous pyelogram or CT urography. In certain cases, a magnetic resonance urogram may be used if you can't undergo CT imaging.

• Urine tests. You may undergo a urinalysis to analyze your urine for any abnormalities. A urine cytology test may be used to look for abnormal cells in a urine sample.

• Use of a thin, lighted tube to view the ureters. During a procedure called ureteroscopy, your doctor will insert a thin, lighted tube equipped with a camera (ureteroscope) into your urethra. The scope is passed through your bladder and into your ureters.

Ureteroscopy allows your doctor to visually inspect your ureters and, if necessary, remove a small sample of tissue for laboratory testing (biopsy).

In the laboratory, a doctor who specializes in analyzing blood and body tissue (pathologist) will carefully examine your cells for signs of cancer. This may include sophisticated analysis of the gene mutations involved in your cancer.

• Tests for bladder cancer. Your doctor may examine your bladder using imaging tests or a scope to see inside your bladder (cystoscopy) to look for signs of bladder cancer. People diagnosed with ureteral cancer have a high risk of bladder cancer. It may occur at the same time as your ureteral cancer or grow soon after treatment.

 

Treatment

Ureteral cancer treatment typically involves surgery. Your treatment options for cancer of the ureter will vary depending on the size and location of your cancer, how aggressive the cells are, and your own goals and preferences.

 

Surgery

Surgery is often recommended to remove ureteral cancer. The extent of your surgery will depend on your situation.

For very early-stage ureteral cancer, surgery may involve removing only a portion of the ureter. For more-advanced ureteral cancer, it may be necessary to remove the affected ureter, its associated kidney (nephroureterectomy) and a portion of the bladder.

 

Chemotherapy

Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy is sometimes used before surgery to shrink a tumor and make it easier to remove during surgery. Chemotherapy may be used after surgery to kill any cancer cells that may remain.

For advanced ureteral cancer, chemotherapy may be used to control signs and symptoms of the cancer.

 

Immunotherapy

Immunotherapy uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process. Immunotherapy might be an option for treating advanced ureteral cancer that hasn't responded to other treatments.

​

Follow-up examinations

After your treatment, your doctor will create a schedule of follow-up exams to look for signs that your cancer has returned. These exams also look for signs of bladder cancer, since people diagnosed with ureteral cancer have an increased risk of bladder cancer.

The tests you'll undergo and the schedule of exams will depend on your situation. But expect to see your doctor every few months for the first year and then less frequently after that. If you have any signs or symptoms that worry you, make an appointment with your doctor.

If you're diagnosed with ureteral cancer, you'll likely be referred to a doctor who specializes in conditions that affect the urinary system (urologist) or a doctor who specializes in treating cancer (oncologist).

​