Staging and subtype of primary urethral cancer
Tumours are classified by stage and subtype to describe the extent of cancer spread. The potential of the tumour to grow aggressively (tumour grade) will also be assessed. The kind of treatment you receive will depend on these elements.
Tumour stage and subtype are based on whether or not the cancer is limited to the urethra (localised disease) (Fig. 2.4) and the degree to which the tumour has invaded the urethral wall (Fig. 2.5). This information, based on the TNM system, is important for determining the risk of recurrence (risk stratification) of the disease.
Fig. 2.4: localised urethral cancer.
Stages Ta, T1, and Cis (Carcinoma in situ, also known as Tis) indicate that the tumour is localised in the urethra:
- Ta tumours are noninvasive finger-like protusion on the urethral lining.
- T1 tumours have invaded the connective tissue under the urethral lining but have not grown into adjacent tissue.
CIS tumours are velvet-like tumours connected to the mucous tissue (mucosa) lining of the urethra.
Stages T2, T3, and T4 indicate invasive urethral cancer. Tumours have grown into the penis or the vaginal wall; the prostate; or the muscle tissue around the urethra, the bladder neck or adjacent organs.
Lymph nodes or distant metastasis are detected by imaging techniques and graded for aggressiveness.
Fig. 2.5a: advanced urethral cancer female.
Fig. 2.5b: advanced urethral cancer male.