1.
Are most clinically apparent LN pathologically (+) in urethral cancer?: Yes (75%)
- Contrast this with penile cancer where 50% of enlarged LN are (+)
2.
At what age does urethral cancer incidence peak?: Women: 40-50
Men: 75-84 (rare in men < 55 yrs)
3.
Does location correlate to stage / prognosis of urethral cancer?: Yes
- Proximal lesion often present at higher stage & have worse prognosis
4.
In a male, what type of epithelium does the proximal & distal urethra have?: Ant:
- squamous (glandular, penile)
- Pseudostratified or stratified columnar (post prox portion of penile & bulbomembranous)
Post:
- Transitional (prostatic)
5.
In female, what type of epithelium does the proximal and distal urethra have?: Distal 2/3: squamous
Prox 1/3: transitional
6.
In locally advanced female urethral cancer (>T2) what is OS5 & LF after ant exent alone?: OS5 = 20%
LF > 66%
7.
Is there association between urethral cancer & other malignancies?: Association with bladder cancer
- Risk of urethral cancer in men with bladder cancer 4-18%
- Risk of urethral cancer in wommen with bladder cancer 2%
8.
Is there racial or gender predilection of urethral cancer?: Women > men (4:1)
Higher in white women & black men
9.
What are desired margins for a partial penectomy for urethral cancer?: 2 cm
10.
What are outcomes for adv stage pts tx with chemoRT?: - Case reports show good results with chemoRT (5FU/MMC)
- Retrospective study from UT San Antonio reported DFS of 54.2 months in T3-4N1M1 pts tx with 5FU/Cis (SCC), carbo/Taxol (TCC) compared to 23.3 months with salvage surgery alone
11.
What are outcomes for early stage (Tis-T1) male pts tx with RT alone?: Very little data
- Small series of 5 men report LC in 4
12.
What are outcomes for early- & adv-stage female urethral cancer?: OS5 = 75% (early), 34% (adv)
13.
What factors affect tx strategy of urethral cancer?: - Location (ant vs. post)
- Size
- DOI
- LN mets
- DM
14.
What is average length & anatomic divisions of female urethra?: - 4cm
- Ant: distal 1/3
- Post: prox 2/3
15.
What is average length & anatomic divisions of male urethra?: - 21 cm
- Ant (distal): glandular, penile, bulbar
- Post (prox): membranous, prostatic
16.
What is estimated annual incidence of urethral cancer in US?: 500 cases / yr
17.
What is expected outcome for advanced stage (>T2) male pts tx with surgery alone?: DFS5 = 45% (small MSKCC series)
- 6 pts tx with surgical salvage after initial tx with RT
18.
What is expected outcome for early-stage (Tis-T1) male pts tx with surgery alone?: DFS5 = 85% (small series at MSKCC)
19.
What is lymphatic drainage for urethra?: Inguinal LN
- distal (women), glandular & penile (men)
Pelvic LN
- prox (women), bulbar & prostatic (men)
20.
What is main pattern of spread of urethral cancer?: direct extension
21.
What is most common hsitological subtype of urethral cancer?: SCC followed by TCC & adenoCA
22.
What is most common site of origin or urethral cancer in men?: Bulbomembranous urethra (60%)
- occurs mainly as squamous metaplasia
- Next most common sites are penile & prostatic urethra
23.
What is N stage for urethral cancer?: N1: mets to single LN < 2cm
N2: mets to single LN > 2cm or mult LN
24.
What is OS for female pts with adv dz tx with surgery + RT?: OS5 = 29%
25.
What is T stage for TCC of the prostate?: Tis pu: CIS involving prostatic urethra
Tis pd: CIS involving prostatic ducts
T1: inv urethral subepithelium
T2: inv prostatic stroma, corpus spongiosum, periurethral m.
T3: inv corpus cavernosum, beyond prostatic capsule, bladder neck
T4: inv adj organs
26.
What is T stage for urethral cancer?: Tis: CIS
Ta: noninvasive verrucous/papillary/polypoid carcinoma
T1: inv subepithelium
T2: inv corpus spongiosum, prostate, periurethral muscle
T3: inv corpus cavernosum, prostatic capsule, ant vag, bladder neck
T4: inv adj organs
27.
What is typical single-modality RT for tx of female urethral cancer?: - Brachy alone (50-60 Gy)
- EBRT (40-45) + brachy (20-25 Gy); need to include inguinal LN
28.
What other conditions or exposures associated with urethral cancer?: - ? HPV
- Long-standing urethral infections
- Hx of STDs
- Stricture
- Trauma
- Urethritis
29.
What percent of urethral cancers are LN+ at dx?: 14-30%
30.
What percent of urethral cancers have DM at dx? What are most common sites?: 10%
- Common sites are lung, liver, bone
31.
What types of resections can be performed for male urethral cancer?: Tis-T1: transurethral resection, laser ablation, microsurg
- Radical resections (historical standard) include partial & total penectomy & penectomy + cystoprostatectomy
32.
What types of surgical resections have been used for female urethral cancer?: Tis-T1: local excision, laser, transurethral resection, partial urethrectomy
> T2: radical resection (ant exent) which removes pelvic LN, uterus, fallopian tubes, en bloc resection of pubic symphysis & inf rami