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Penile Cancer

Penile cancer is a rare type of cancer that begins in the cells of the male reproductive organ, the penis. It occurs due to the uncontrollable growth of skin or other cells in the penis. Almost all penile cancers are squamous cell carcinomas. The diagnosis of penile cancer typically starts with suspicion of a lesion in this area and is confirmed through biopsy.

What is penis?


The penis is a part of the male reproductive and urinary systems. The main structures of the male reproductive system include the testes, epididymis, seminal vesicles, prostate, and penis. The internal parts of the male reproductive system are located within the lower pelvic cavity between the hip bones. The penis hangs in front of the scrotum, the skin sac where the testes are located. The penis consists of three main parts: the root, the shaft, and the glans, which is the cone-shaped tip of the penis. The glans of the penis is covered by a layer of skin called the foreskin.


When the penis is stimulated, the penile arteries dilate, and muscles contract. This leads to an erection, which is necessary for sexual intercourse. The urethra is also a part of the urinary system, responsible for carrying urine from the bladder out of the body. At the base of the penis, there is a valve (sphincter) that allows urine to flow through the urethra and out of the body when it is relaxed.


What is penile cancer?


Cancer that originates in the cells of the penis is referred to as penile cancer. The majority of penile cancer cases (approximately 95%) are squamous cell carcinoma. This means that the cancer starts in the squamous cells of the penis. Most squamous cell penile cancers begin on the foreskin or the tip of the penis (glans). Squamous cell penile cancer typically grows slowly. The success rate of treatment is high when diagnosed early.


Among other types of penile cancer, there are basal cell carcinomas, sarcomas, melanomas, or urethral carcinomas. Penile cancer, which is a rare type of cancer, is more commonly observed in uncircumcised men, particularly in regions such as Africa, Southeast Asia, and South America.


What are the risk factors of penile cancer?


The following are generally considered risk factors associated with penile cancers:

  1. Lack of circumcision: Penile cancer is more common in uncircumcised men compared to those who are circumcised. Newborn circumcision can significantly reduce the risk of penile cancer.

  2. Age: Most cases of penile cancer occur in men aged 50-70. About one-third of cases are seen in men under the age of 50.

  3. Smoking - Tobacco use

  4. Human papillomavirus (HPV): HPV types 16 and 18 are associated with penile cancer.

  5. Phimosis: Phimosis is a condition where the foreskin cannot be easily retracted from the head of the penis (glans). This may lead to accumulation of body oils, bacteria, and other residues known as smegma.

  6. UV light therapy for psoriasis: UV light therapy used for certain skin conditions like psoriasis may increase the risk of penile cancer.

  7. AIDS (Acquired Immunodeficiency Syndrome): People with AIDS are at a higher risk for developing penile cancer.


What are the symptoms of penile cancer?


Among the most commonly observed symptoms of penile cancer are changes in skin color or thickness, unusual discharge, ulcers, pain, and swelling at the tip of the penis. While the symptoms of penile cancer can vary from person to person, the general signs include:

  1. Changes in the skin of the penis or pain at the tip of the penis.

  2. Painful or painless growths or lesions resembling warts.

  3. Non-healing open sore.

  4. Bleeding beneath the foreskin.

  5. Reddish rash.

  6. Small lumps.

  7. Flat, bluish-brown growths.

  8. Persistent, foul-smelling discharge under the foreskin.

  9. Enlarged lymph nodes in the groin when cancer has spread.


How is penile cancer diagnosed?


If a doctor suspects penile cancer, they will request a biopsy procedure. This is because the definitive diagnosis of penile cancer is made through a biopsy procedure. A biopsy involves taking a sample of tissue from the penis or lymph nodes and examining it in a laboratory.


There are three types of biopsy procedures that can be performed:

  1. Incisional Biopsy: This involves removing only a portion of the abnormal tissue. It is typically used for larger lesions, ulcers, wounds, and lesions that appear to be deepening in the tissue.

  2. Excisional Biopsy: This removes the entire lesion or abnormal growth. An excisional biopsy is usually done when the abnormal area is small.

  3. Lymph Node Biopsy: This is usually done when the cancer has invaded the tissues within the penis. It helps the doctor determine whether the cancer has spread beyond the penile tissue. Often, lymph node biopsy is done using a fine needle aspiration (FNA) procedure, where the doctor inserts a thin needle into the lymph node(s) to draw out cells and fluid to determine if cancer is present. In some cases, all lymph nodes are surgically removed to control the cancer.


Additionally, imaging tests can assist doctors in diagnosing and staging penile cancer. Some of the imaging tests used to diagnose penile cancer and determine its stage include:

  • CT scan (Computed Tomography scan)

  • MRI (Magnetic Resonance Imaging)

  • Ultrasound


What are the stages of penile cancer?


The staging of penile cancer is as follows:


Stage 0: Only the superficial layer of the skin of the penis shows signs of cancer. It is limited to the surface and does not spread.

Stage 1: The cancer has grown into the tissue beneath the top layer of skin on the penis. However, there is no involvement in lymph or blood vessels.

Stage 2: At this stage, the cancer continues to spread beyond the skin and tissue of the penis. It may involve nerves, lymph vessels, or blood vessels.

Stage 3: In stage 3, the cancer may have invaded the spongy erectile tissue of the penis. Additionally, it might have spread to lymph nodes in the groin.

Stage 4: At this advanced stage, the cancer might have spread to the scrotum, prostate, pelvic bone, and other structures in the area. It could also be present in lymph nodes.


What are the treatment methods of penile cancer?


Treatment methods for penile cancer generally include surgical procedures, radiation therapy, and chemotherapy. These treatment approaches can be used alone or in combination, depending on the stage of the disease, the type of cancer, and the overall health of the patient.


Surgical Procedure: Surgery is the primary treatment for penile cancer. In a surgical procedure, the tumor and some surrounding healthy tissue (margin) will be removed. The extent and type of surgery depend on the location, type, and stage of the tumor. In most cases, any physical changes to the penis that occur after surgery can be corrected through reconstructive surgery.


Photodynamic Therapy (PDT): Photodynamic therapy uses special drugs called photosensitizing agents in combination with light to kill cancer cells. These drugs are only activated or "turned on" by light.


Cryosurgery: Cryosurgery uses liquid nitrogen to freeze and destroy cancer cells.


Radiation Therapy: Radiation therapy uses high-energy X-rays to destroy cancer cells. One advantage of radiation therapy is that it preserves the anatomical structure of the penis. However, a disadvantage is that penile cancers are relatively resistant to radiation therapy and it can lead to various complications such as fistulas, edema, skin necrosis, and pain.


Chemotherapy: Chemotherapy involves using drugs to kill or slow the growth of cancer cells. Chemotherapy has a limited role in the treatment of penile cancer: It is mainly used when cancer has spread to lymph nodes and other tissues. The role of primary neoadjuvant chemotherapy can be considered in about 50% of cases with resectable fixed inguinal metastasis.


On the other hand, for very small lesions on the foreskin, circumcision and laser surgery can be therapeutic. While laser treatment offers the advantage of preserving the penis, the depth of laser penetration is limited.


FREQUENTLY ASKED QUESTIONS ABOUT PENILE CANCER

How does penile cancer affect a man's sexuality?


In a man diagnosed with penile cancer, a partial penectomy (removal of some cancerous tissue along with a portion of healthy penis tissue) or a total penectomy (complete removal of the penis) can be performed. Dealing with the side effects of the surgical procedure used to treat penile cancer can be challenging. Psychological support may be necessary for a man to cope with the loss of a part or all of his penis.


Does circumcision prevent penile cancer?


Penile cancer is almost never seen in newborn circumcised males. The incidence of penile cancer is higher when circumcision is postponed to adolescence. Adult circumcision does not provide protection against penile cancer.

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