Genitourinary Cancer

The genitourinary system is the part of the body that plays a role in reproduction, getting rid of waste products in the form of urine, or both. This section describes testicular and urethral cancer.

 

Testicular Cancer

 

Testicular cancer is a cancer that forms in tissues of the testis (one of two egg-shaped glands inside the scrotum that make sperm and male hormones). Testicular cancer usually occurs in young or middle-aged men. The two main types of testicular cancer are seminomas (cancers that grow slowly and are sensitive to radiation therapy) and nonseminomas (different cell types that grow more quickly than seminomas).

 

Staging of Testicular Cancer:

 

Stage 0 (Carcinoma in Situ): In stage 0, abnormal cells are found in the tiny tubules where the sperm cells begin to develop. These abnormal cells may become cancer and spread into nearby normal tissue. All tumor marker levels are normal. Stage 0 is also called carcinoma in situ.

Stage I: In stage I, cancer has formed. Stage I is divided into stage IA, stage IB, and stage IS and is determined after a radical inguinal orchiectomy is done.

  • In stage IA, cancer is in the testicle and epididymis and may have spread to the inner layer of the membrane surrounding the testicle. All tumor marker levels are normal.
  • In stage IB, cancer:
    • is in the testicle and the epididymis and has spread to the blood vessels or lymph vessels in the testicle; or
    • has spread to the outer layer of the membrane surrounding the testicle; or
    • is in the spermatic cord or the scrotum and may be in the blood vessels or lymph vessels of the testicle.

    All tumor marker levels are normal.

  • In stage IS, cancer is found anywhere within the testicle, spermatic cord, or the scrotum and either:
    • all tumor marker levels are slightly above normal; or
    • one or more tumor marker levels are moderately above normal or high.

Stage II: This stage is divided into stage IIA, stage IIB, and stage IIC and is determined after a radical inguinal orchiectomy is done.

All tumor marker levels are normal or slightly above normal.

  • In stage IIA, cancer:
    • is anywhere within the testicle, spermatic cord, or scrotum; and
    • has spread to up to 5 lymph nodes in the abdomen, none larger than 2 centimeters.

    All tumor marker levels are normal or slightly above normal.

  • In stage IIB, cancer is anywhere within the testicle, spermatic cord, or scrotum; and either:
    • has spread to up to 5 lymph nodes in the abdomen; at least one of the lymph nodes is larger than 2 centimeters, but none are larger than 5 centimeters; or
    • has spread to more than 5 lymph nodes; the lymph nodes are not larger than 5 centimeters.
  • In stage IIC, cancer:
    • is anywhere within the testicle, spermatic cord, or scrotum; and
    • has spread to a lymph node in the abdomen that is larger than 5 centimeters.

All tumor marker levels are normal or slightly above normal.

Stage III: This stage is divided into stage IIIA, stage IIIB, and stage IIIC and is determined after a radical inguinal orchiectomy is done.

Tumor marker levels may range from normal to slightly above normal.

  • In stage IIIA, cancer:
    • is anywhere within the testicle, spermatic cord, or scrotum; and
    • may have spread to one or more lymph nodes in the abdomen; and
    • has spread to distant lymph nodes or to the lungs.
  • In stage IIIB, cancer:
    • is anywhere within the testicle, spermatic cord, or scrotum; and
    • may have spread to one or more lymph nodes in the abdomen, to distant lymph nodes, or to the lungs.

    The level of one or more tumor markers is moderately above normal.

  • In stage IIIC, cancer:
    • is anywhere within the testicle, spermatic cord, or scrotum; and
    • may have spread to one or more lymph nodes in the abdomen, to distant lymph nodes, or to the lungs.

    The level of one or more tumor markers is high. Cancer:

    • is anywhere within the testicle, spermatic cord, or scrotum; and
    • may have spread to one or more lymph nodes in the abdomen; and
    • has not spread to distant lymph nodes or the lung but has spread to other parts of the body.

 

Treatment of Testicular Cancer:

 

Three types of standard treatment are used:

  • Surgery
  • Radiation therapy
  • Chemotherapy
  • Watchful waiting

 

New types of treatment are being tested in clinical trials.

 

  • High-dose chemotherapy with stem cell transplant

Patients may want to think about taking part in a clinical trial. Patients can enter clinical trials before, during, or after starting their cancer treatment.

Search for clinical trials in Georgia.

References for this section at: National Cancer Institute (NCI) at

http://www.cancer.gov/cancertopics/types/testicular/. (Accessed August 2013)

 

Urethral Cancer

 

Urethral cancer is a disease in which malignant (cancer) cells form in the tissues of 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 long and is just above the vagina. In men, the urethra is about 8 inches long, and goes through the prostate gland and the penis to the outside of the body. In men, the urethra also carries semen.

Urethral cancer is a rare cancer that occurs more often in women than in men. There are different types of urethral cancer that begin in cells that line the urethra. These cancers are named for the types of cells that become malignant (cancerous):

  • Squamous cell carcinoma is the most common type of urethral cancer. It forms in cells in the part of the urethra near the bladder in women, and in the lining of the urethra in the penis in men.
  • Transitional cell carcinoma 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.
  • Adenocarcinoma forms in glands near the urethra in both men and women.

Urethral cancer can metastasize (spread) quickly to tissues around the urethra and is often found in nearby lymph nodes by the time it is diagnosed1.

 

Stages of Urethral Cancer

 

Urethral cancer is staged and treated based on the part of the urethra that is affected and how deeply the tumor has spread into tissue around the urethra. Urethral cancer can be described as distal or proximal. In women, the entire urethra may be affected. In men, the prostate gland may be affected, and in both genders, the bladder may be affected.

 

Distal urethral cancer

In distal urethral cancer, the cancer usually has not spread deeply into the tissue. In women, the part of the urethra that is closest to the outside of the body (about ½ inch) is affected. In men, the part of the urethra that is in the penis is affected.

Proximal urethral cancer

Proximal urethral cancer affects the part of the urethra that is not the distal urethra. In women and men, proximal urethral cancer usually has spread deeply into tissue.

 

Urethral cancer can be staged more specifically as well.

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the inside lining of the urethra. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage A

In stage A, cancer has formed and spread into the layer of tissue beneath the lining of the urethra.

Stage B

In stage B, cancer is found in the muscle around the urethra. In men, the penile tissue surrounding the urethra may be affected.

Stage C

In stage C, cancer has spread beyond the tissue surrounding the urethra, and: in women, may be found in the vagina, vaginal lips, or nearby muscle; in men, may be found in the penis or in nearby muscle.

Stage D

Stage D is divided into stage D1 and stage D2, based on where the cancer has spread.

  • In stage D1, cancer has spread to nearby lymph nodes in the pelvis and groin.
  • In stage D2, cancer has spread to distant lymph nodes or to other organs in the body, such as the lungs, liver, and bone2.
Treatment of Urethral Cancer:

Surgery

Surgery is the most common treatment for cancer of the urethra. One of the following types of surgery may be done:

  • Open excision: Removal of the cancer by surgery.
  • Electro- resection with fulguration: Surgery to remove the cancer by electric current. A lighted tool with a small wire loop on the end is used to remove the cancer or to burn the tumor away with high-energy electricity.
  • Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove or destroy tissue.
  • Lymph node dissection: Lymph nodes in the pelvis and groin may be removed.
  • Cystourethrectomy: Surgery to remove the bladder and the urethra.
  • Cystoprostatectomy: Surgery to remove the bladder and the prostate.
  • Anterior exenteration: Surgery to remove the urethra, the bladder, and the vagina. Plastic surgery may be done to rebuild the vagina.
  • Partial penectomy: Surgery to remove the part of the penis surrounding the urethra where cancer has spread. Plastic surgery may be done to rebuild the penis.
  • Radical penectomy: Surgery to remove the entire penis. Plastic surgery may be done to rebuild the penis.

If the urethra is removed, the surgeon will make a new way for the urine to pass from the body. This is called urinary diversion. If the bladder is removed, the surgeon will make a new way for urine to be stored and passed from the body. The surgeon may use part of the small intestine to make a tube that passes urine through an opening (stoma). This is called an ostomy or urostomy. If a patient has an ostomy, a disposable bag to collect urine is worn under clothing. The surgeon may also use part of the small intestine to make a new storage pouch (continent reservoir) inside the body where the urine can collect. A tube (catheter) is then used to drain the urine through a stoma.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Watchful waiting

Watchful waiting is closely monitoring a patient’s condition without giving any treatment until symptoms appear or changes3.

Patients may want to think about taking part in a clinical trial. Patients can enter clinical trials before, during, or after starting their cancer treatment.

Search for clinical trials in Georgia.

Adapted from the National Cancer Institute's PDQ Database:

1http://www.cancer.gov/cancertopics/pdq/treatment/urethral/patient. (Accessed June 2016)

2http://www.cancer.gov/cancertopics/pdq/treatment/urethral/Patient/page2. (Accessed June 2016)

3http://www.cancer.gov/cancertopics/pdq/treatment/urethral/Patient/page4. (Accessed June 2016)