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Guidelines

Primary Urethral Carcinoma

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  1. Introduction
  2. Methods
  3. Epidemiology Aetiology And Pathology
  4. Staging And Classification Systems
  5. Diagnostic Evaluation And Staging
  6. Prognosis
  7. Disease Management
  8. Follow Up
  9. References
  10. Conflict Of Interest
  11. Citation Information
4. Staging And Classification Systems
  • 1. Introduction
  • 2. Methods
  • 3. Epidemiology Aetiology And Pathology
  • 4. Staging And Classification Systems
  • 5. Diagnostic Evaluation And Staging
  • 6. Prognosis
  • 7. Disease Management
  • 8. Follow Up
  • 9. References
  • 10. Conflict Of Interest
  • 11. Citation Information
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4. STAGING AND CLASSIFICATION SYSTEMS

4.1. Tumour, Node, Metastasis (UICC/TNM) staging system

In men and women, urethral carcinoma is classified according to the 8th edition of the TNM classification [7] (Table 4.1). It should be noted that there is a separate TNM staging system for prostatic UC [7]. Of note, for cancers occurring in the urethral diverticulum, stage T2 is not applicable as urethral diverticula are lacking periurethral muscle [33].

Table 4.1: TNM classification (8th edition) for urethral carcinoma

TNM classification (8th edition) for urethral carcinoma
T - Primary Tumour
TXPrimary tumour cannot be assessed
T0No evidence of primary tumour
Urethra (male and female)
TaNon-invasive papillary, polypoid, or verrucous carcinoma
TisCarcinoma in situ
T1Tumour invades subepithelial connective tissue
T2Tumour invades any of the following: corpus spongiosum, prostate, periurethral muscle
T3Tumour invades any of the following: corpus cavernosum, beyond prostatic capsule, anterior vagina, bladder neck (extraprostatic extension)
T4Tumour invades other adjacent organs (invasion of the bladder)
Urothelial (transitional cell) carcinoma of the prostate
Tis puCarcinoma in situ, involvement of prostatic urethra
Tis pdCarcinoma in situ, involvement of prostatic ducts
T1Tumour invades subepithelial connective tissue (for tumours involving prostatic urethra only)
T2Tumour invades any of the following: prostatic stroma, corpus spongiosum, periurethral muscle
T3Tumour invades any of the following: corpus cavernosum, beyond prostatic capsule, bladder neck (extraprostatic extension)
T4Tumour invades other adjacent organs (invasion of the bladder or rectum)
N - Regional Lymph Nodes
NXRegional lymph nodes cannot be assessed
N0No regional lymph node metastasis
N1Metastasis in a single lymph node
N2Metastasis in multiple lymph nodes
M - Distant Metastasis
M0No distant metastasis
M1Distant metastasis

4.2. Tumour grade

Non-urothelial urethral carcinoma is graded by a trinomial system that differentiates between well-differentiated (G1), moderately-differentiated (G2), and poorly-differentiated tumours (G3). In primary urothelial carcinoma histological subtypes are extremely rare. Table 4.2 lists the different grading systems according to the WHO 2022 system [34].

Table 4.2: Histopathological grading of urothelial and non-urothelial primary urethral carcinoma [34]

Urothelial urethral carcinoma
PUNLMPPapillary urothelial neoplasm of low malignant potential
Low gradeWell differentiated
High gradePoorly differentiated
Non-urothelial urethral carcinoma
GxTumour grade not assessable
G1Well differentiated
G2Moderately differentiated
G3Poorly differentiated

4.3. Handling of tumour specimens

Specimen handling should follow the general rules as published by the International Collaboration on Cancer Reporting (ICCR) [35].

Table 4.3: Required and recommended elements for pathology reporting of carcinoma of the urethra in urethrectomy specimens [7, 35]

RequiredRecommended
Operative procedure Clinical informationPrevious history of urinary tract disease or distant metastasis
Additional specimens submitted  Previous therapy
Maximum tumour dimensionCannot be assessed Other clinical information
No macroscopically visible tumourTumour focality 
Maximum tumour dimension (largest tumour)Other tumour dimensions (than maximum dimension) of the largest tumour 
Macroscopic tumour site Block identification key 
Macroscopic extent of invasion Associated epithelial lesions 
Histological tumour typeHistological subtype/variant (urothelial carcinoma)Extranodal spread for involved regional lymph node(s) 
Non-invasive carcinoma Coexistent pathology 
Histological tumour grade Ancillary studies 
Microscopic extent of invasion   
Lymphovascular invasion   
Margin status   
Regional lymph node statusNo regional lymph nodes submitted  

4.4. Recommendation for staging and classification systems

RecommendationStrength rating
Use the 2017 Tumour, Node, Metastasis (TNM) classification and 2022 WHO grading system for pathological staging and grading of primary urethral carcinoma.Strong
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