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Questions and Answers
What is the reported 5-year progression-survival rate for patients with distal urethra involvement?
Which treatment approach is considered a primary mode of management for carcinoma of the female urethra?
What has been observed to improve local control in patients with urethral carcinoma?
Which histological type of urethral carcinoma is associated with the worst prognosis?
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What percentage of survival rate can patients with meatal tumors achieve if diagnosed early?
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Which surgical procedure is commonly performed for lesions not involving the bladder neck?
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What is a potential treatment option for patients who are not surgical candidates due to anesthesia risks?
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What is a key feature of the management of carcinoma of the female urethra?
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Which of the following is NOT a type of radiation therapy mentioned?
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For patients with locally invasive urethral carcinoma, which therapy is often recommended in addition to surgical extirpation?
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What does multimodality therapy typically include for patients with locally advanced urethral cancer?
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What is often adequate for larger and more invasive lesions (stage T1 and T2) of distal urethral cancer?
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For patients with recurrent anterior urethral lesions, what procedure may be considered curative?
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In the presence of limited inguinal node involvement, what treatment is indicated?
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Which chemotherapy agents are commonly referenced for combined modality therapy?
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What is the recommended approach if no inguinal adenopathy exists in a patient with invasive lesions?
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What is the usual approach for managing lesions less than 2 cm in posterior urethral cancer?
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When considering treatment options for recurrent urethral cancer after surgery, what is typically recommended?
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Which of the following techniques is used to treat small meatal and distal urethral lesions?
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What is a significant characteristic of posterior urethral cancer concerning metastasis and prognosis?
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For patients with metastatic urethral cancer, what treatment option is considered?
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In treating early localized dietary diseases, what type of implant is typically used?
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What does perineal closure and vaginal reconstruction involve when treating urethral cancer?
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What planning method should be the standard of care for radiation therapy in urethral cancer?
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Study Notes
Urethral Cancer Survival Rates
- Patients with lesions confined to the proximal urethra have a 100% local control rate
- Patients with tumors involving the distal urethra have a 69% 5-year progression-survival rate
- Patients with involvement of the entire free urethra have a 12% survival rate
- Patients with meatal tumors diagnosed early and treated appropriately can achieve an 80-90% survival rate
Urethral Cancer Treatment
- Brachytherapy improves local control
- External beam radiation therapy alone is associated with higher recurrence rates
- High-dose intraoperative brachytherapy followed by external beam radiation appears to improve local control
- Histology of the primary lesion is less important in determining prognosis
- Patients with adenocarcinoma have a good prognosis
- Primary melanoma of the urethra has a very poor prognosis
General Management
- No established therapeutic guidelines
- Surgical resection is a primary mode of treatment
- Early-stage lesions may be amenable to organ-sparing radiation therapy or conservative surgical management
- Surgical approaches include:
- Nd:YAG laser coagulation
- Mohs micrographic surgery
- Partial or total urethrectomy
- Radiation therapy may include:
- External-beam radiation
- Interstitial brachytherapy
- Combination of both
- Outpatient HDR intracavitary and intraluminal brachytherapy may be an option for medically nonsurgical candidates
Multimodality Therapy
- Anterior exenteration may be required for locally invasive urethral carcinoma
- Adjuvant radiation therapy and/or combined irradiation and chemotherapy may be advocated for more advanced disease
- Preoperative cisplatin-based chemotherapy may benefit patients with positive nodes
- Multimodality therapy achieves similar or better overall results compared to single modality treatments
- Combination therapy often consists of either chemotherapy with radiotherapy or radiotherapy with surgery
Anterior (Distal) Urethral Cancer
- Stage 0 and I lesions can be treated with:
- Open excision
- Electroexcision
- Fulguration
- Laser coagulation
- Larger and more invasive lesions (stage T1 and T2) can be managed with surgical resection of the distal third of the urethra
- Interstitial irradiation or a combination of interstitial and external-beam irradiation can also be considered
- T3 to T4 or recurrent anterior urethral lesions may require anterior exenteration and urinary diversion
- Adjuvant radiation therapy may be required
Posterior (Proximal) Urethral Cancer
- Cancers of the posterior or entire urethra are usually associated with:
- Invasion of the bladder
- High incidence of inguinal and pelvic lymph node metastases
- Worse prognosis
- Lesions <2 cm can be treated with:
- Radical resection
- Definitive radiation therapy
- Combined treatment
- Larger lesions or locally advanced disease may require:
- Preoperative irradiation
- Exenterative surgery
- Urinary diversion
- Pelvic lymphadenectomy
- Inguinal node dissection
- Transpubic approach can be considered to maximize surgical margin
Recurrent Urethral Cancer
- Locally recurrent urethral cancer after surgery can be treated with combination radiation therapy and wider surgical resection
- Locally recurrent urethral cancer after radiation therapy should be treated by surgical excision
- Local reirradiation may be considered for nonsurgical candidates
- Patients with metastatic urethral cancer should be considered for investigational chemotherapy protocols
- Palliative radiation therapy may provide good symptomatic relief
Radiation Therapy Techniques
- Small meatal and distal urethral lesions can be cured with limited therapy
- Interstitial implants are used to treat meatal carcinomas
- Both LDR and HDR afterloading implants using 192Ir have replaced radium
- For early localized disease, a volume implant composed of 8 to 12 needles arranged in an arc around the urethral orifice is used
- Radiographs are used to verify needle placement
- Computer planning with CT-based simulation and 3-D treatment planning should be the standard of care to spare adjacent normal organs
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Description
This quiz explores survival rates and treatment options for urethral cancer. It covers local control rates for various tumor stages and evaluates the effectiveness of different therapeutic approaches. Test your knowledge on the prognosis and management of this rare cancer.
