Ch 38 Tumours of the urethra (part of 35) – Flashcards

"Diverticulum Probably Has Cancerous BLIP" Diverticulum Polyp HPV (same as penile Ca- pcHburst) Caruncles Bladder Ca Leukoplakia (also precursor of penile cancer bpcpcL, but not bladder) Inflamm/infection Parturition

HPV Bladder Cancer Chronic Inflammation

CIS Multifocal bladder ca Bladder neck involvement Previous prostatic ca Previous intravesical therapy Previous upper tract Ca

SCC UCa AdenoCa Melanoma Lymphoma Paraganglioma Sarcoma Undifferentiated

Male 1. bulbomembranous (60%) - predominant SCC 2. penile (30%) - predominant SCC 3. prostatic (10%) - predominant UC Female Distal/anterior- SCC

1. Stage (including LN status) 2. Size at presentation 3. Extent of involvement 4. Location (distal better) *(not grade or histopathology)* (for Bladder Ca = grade, stage, multifocality, CIS, size, early recurrence, micropap, LVI, p53)

1. Palpable disease (no benefit to LND in non-palpable disease especially if distal urethral Ca) 2. Location = Proximal disease (prostate/bulb) 3. Advanced disease

For all, tis/ta and even t1 can be treated with local excision- tur or excision. In the bulbomembranous urethra this excision results in a U-U however these BM cancers are usually advanced and require a CPUP. Penile- partial penectomy (distal >T1), total (prox >t1) Bulbomembranous- radical CPU with penectomy and LND (>t1) Prostatic- radical CPU with penectomy and LND (>t1)

Tx, T0 Tis- CIS Ta- non-invasive, polypoid, verrucous T1- subepithelium T2- corpus spongiosum, prostate stroma, periurethral muscle *T3*- corpus cavernosum, beyond prostatic capsule, bladder neck (or ant. vag- female) T4- adj. organs (NOT BN, ant vag, prostate) *SEPARATE T-staging for prostatic urethra Tis-pu CIS prostatic urethra Tis-pd CIS prostatic ducts T1-T4 = same* Nx, N0 N1- single 5cm Mx,M0 M1- distant Nodes same as ureteral. Sized similar to testicular cancer but N1 for urethral can not be multiple LN <2cm like testes where N1 can be upto 5 LN<2cm. Numbered similar to Penile cancer (which does not have size). ------------------For testes:pN1- 5LN or ENE pN3- >5cm

Penile --> inguinal Bulb to prostate --> pelvic and inguinal

Distal (1/3)- local excision including ant. vagina for small, superficial disease (laser also an option) Proximal (2/3)- Ant exenteration incl. clitoris and maybe partial pubis

1. Palpable disease (and no distant mets) No benefit for non-palpable disease. 2. Nodes on imaging (and no distant mets) 3. Development of nodes after surveillance

UCa- MVAC, Gen/Cis SCC- male: MTX, cisplatin, bleo SCC- female: 5-FU, MMC

Prepuce and skin- superficial inguinal Glans- superficial then deep inguinal, then to ipsilateral pelvis only

Sup: ASIS to sup border of external ring Med: pubic tubercle (and 15cm down) Lat: ASIS (and 20cm down) Inf: see above

(1) shorter skin incision (2) limitation of the dissection by excluding the area lateral to the femoral artery and caudal to the fossa ovalis Sup: 2cm above inguinal lig. Med: adductus longus Lat: fem. artery Inf: fossa ovalis (where the saphenous penetrates the fascia lata) (3) preservation of the saphenous vein (4) elimination of the need to transpose the sartorius muscle

Pathology reveals an inflammatory infiltrate and normal stroma. Urethral caruncle is an inflammatory lesion of the distal urethra that is most commonly diagnosed in post-menopausal women. It usually appears as a reddish exophytic mass at the urethral meatus, which is covered with mucosa. These lesions are often symptomatic and noted incidentally on gynecologic examination. When irritated, they may cause underwear spotting or become painful. Less commonly they may cause voiding symptoms. Rarely, these lesions may thrombose, resulting in a discolored periurethral mass. Etiologically, they are related to mucosal prolapse. Chronic irritation contributes to hemorrhage, necrosis, and inflammatory growth of the tissue that corresponds to the histology of excised lesions.