Symptoms and Diagnosis
Primary urethral cancer has no typical early symptoms. Most patients experience bloody discharge from the urethra (haematuria). If you have advanced cancer, you may be able to feel a hard mass in your genital tract. You have problems urinating if the tumour blocks the opening of your bladder or fills out the urethra completely. Other symptoms could be pain in your pelvis or during sexual activity. If you have these symptoms, it does not mean you have cancer, but you should be examined by your doctor.
If you have suspicious symptoms, your doctor will make a diagnosis to rule out cancer. Your doctor will take a detailed medical history and ask questions about your symptoms.
Terms your doctor may use:
- Distal cancer: local, limited to the urethra.
- Proximal cancer: locally advanced, beyond the urethra and into surrounding tissue.
- Cystoscopy: a test that allows your doctor to examine your urethra and bladder using a thin lighted tube called a cystoscope.
If you are male, your doctor will perform a digital rectal examination (Fig. 2.1) and a physical examination of the external genitalia in case a hard mass can be felt.
Fig. 1.2: bladder and urethra plus diverticulum.
If you are female, your doctor will perform a careful examination of your external genital tract and a bimanual examination to exclude the presence of cancer in the colon, rectum, and reproductive organs. The bimanual examination can be performed under anaesthesia if it is painful for you. Your doctor will also feel the lower part of your abdomen, including the groin and the area above your pelvis, to detect enlarged lymph nodes.
Fig. 2.2: bimanual examination female.
You doctor may take a urine sample to look for cancer cells and to exclude other possibilities like urinary tract infection. Your doctor may refer to this test as urinary cytology, which means your urine is examined under a microscope to identify cancer cells.
Urethrocystoscopy and biopsy
The detection of urethral tumours depends on an internal examination of the urethra, called urethrocystoscopy. This test allows your doctor to look at the inside of your urethra and your bladder using a thin, lighted tube called a cystoscope.
After the urethra is anaesthetised, the cystoscope—a flexible or rigid tube connected to a camera that transmits pictures from inside your body—is inserted into the urethra and the bladder (Fig. 2.3).
Fig. 2.3: urethrocystoscopy.
If a tumour can be seen or if a probe of fluid from the bladder contains cancer cells, tissue samples are needed for examination (biopsy). Small tissue samples can be taken immediately with the cystoscope. Larger biopsies or removal of tumours also known as transurethral resection of the bladder tumour (TURBT), are usually done under general anaesthesia.
After the examination, you might have some blood in your urine for a few days. Drinking an additional 500 mL per day (e.g., two extra glasses of water) will help dilute the urine and push out the blood. You might also have painful urination or have to urinate more often or more urgently. These short-term effects will pass. If they persist for more than 2 days, you might have a urinary tract infection and should contact your doctor.
If cancer is detected, your doctor will recommend further testing to determine the size and depth of the tumour and to detect or rule out possible spread to other organs or lymph nodes (metastatic disease). Different imaging techniques are used to acquire this information, including magnetic resonance imaging (MRI scan) and computed tomography (CT scan). Additional ultrasound may be useful to examine the lymph nodes in the abdomen.
MRI uses strong magnetic fields and radio waves to make images of your body. In urethral cancer, it is used to measure tumour size and depth in the pelvis. If you are allergic to contrast dye, MRI may be an alternative to CT to look for cancer spreading.
A CT scan gives your doctor information about the lymph nodes and abdominal organs. A contrast agent is injected into the body through a vein to improve the visibility of certain internal body parts and pathways during the CT scan. The scan, called CT urography, takes approximately 10 minutes and uses x-rays. It is the most accurate imaging technique for diagnosing cancer in the urinary tract.
CT urography is noninvasive, so no instruments are inserted into your body. For this examination, your kidneys must function adequately. The contrast agent can cause an allergic reaction, so please let your doctor know if you have had any allergic reactions in the past. The staff will also ask you about allergies. If you are taking any antidiabetic medications, your doctor might ask you to stop taking them for a few days.
Ultrasound is a noninvasive diagnostic tool that can visualise large masses in your pelvis. It cannot detect small tumours that have spread, and it cannot replace CT or MRI.