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Penile Cancer

Penile cancer

Introduction

Cancer that develops in the penis is termed penile cancer. Penile tissue contains many types of cells including skins cells, neurons, smooth muscle fibers and blood vessels. Cancers usually develop in the skin cells.

Penile cancer is relatively rare in countries in North America and Europe, however it is more common in Asia, South America and Africa.

It is also typically seen in men over the age of 60 and prognosis is favorable when the cancer is detected in its early stages.

Cause

Cancer develops when cells in the body start dividing uncontrollably. There are different kinds of penile cancers depending on the tissue that develops the malignancy.

Squamous cell carcinoma: This is the most common form of penile cancer that develops in the squamous cells. These cells are epithelial cells and form the main part of the dermis or skin. While the cancer can develop anywhere on the penis, it mainly affects the foreskin or the tip of the penis (glans). In the earliest stage of squamous carcinoma, the cancer develops on the superficial layers of the skin. These are termed carcinoma in situ and are given the name Bowen’s disease when it affects the penile shaft. A rare form of squamous cancer is verrucous carcinoma, which manifests itself as deep growing genital warts.

Melanoma: is a cancer that affects the melanocyte cells in the skin. Melanocytes are cells that produce the pigment melanin and are responsible for skin color. Melanomas spread quickly and can sometimes affect the penis.

Basal cell carcinoma: affects the basal cells of the skin. It is relatively harmless.

Adenocarcinoma: develops in the sweat glands of the penis.

Sarcomas: affect the blood vessels and smooth muscle fibers of the penis.

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Risk Factors:

While it is not known what exactly causes cells in the penis to become cancerous, certain conditions and factors have been associated with a high risk of the disease.

1. Lack of circumcision: Not being circumcised is sometimes associated with poor penile hygiene because of secretions that become trapped within the foreskin. These secretions are termed smegma and contain oils, epithelial cells and sweat. Chronic retention of smegma has been associated with penile cancer.

2. Phimosis: is a condition wherein the foreskin cannot be pulled back over the penis. This can lead to smegma retention and therefore penile cancer.

3. Human papilloma virus (HPV): Some types of HPV such as HPV-16 have shown strong correlation with penile cancer.

4. Cigarette smoking and use of other tobacco products

5. HIV/AIDS and genital warts

6. Having multiple sexual partners

7. Ultraviolet light treatment for psoriasis

8. Tears or other injury to the penis

Clinical Presentation

Signs and symptoms of penile cancer include penile discharge, bleeding, sores, irritation, pain, rashes and discoloration. Sometimes a lump or growth may be seen on the penis.

Penile cancer is a primary malignancy that eventually spreads to other areas in the body.

Differential

Cancer in the penis may be the result of secondary malignancies spread from other parts of the body such as in the case of metastatic skin cancer. Genital warts, sometimes seen with penile cancer may also be caused by HPV infection.

Diagnosis

Early diagnosis of penile cancer is imperative for treating it effectively, with minimum disfiguration. However, because it is rare, penile cancer may often go overlooked until the later stages. Diagnosis involves recording the patient’s medical history and performing a physical exam. A biopsy may be done if lumps are found so as to eliminate any cancerous  etiology. There are multiple ways of getting tissue samples, such as fine-needle aspiration, incisional biopsy and excisional biopsy. Once the cancer has been diagnosed, imaging studies are done to detect the stage of the cancer (which is determined by the size and growth of the cancer as well as its spread). These tests include MRI, CT scans and Ultrasound exams. A lymph node biopsy may be done to check whether the cancer has spread to the lymph nodes.

Treatment

Treatment depends on the stage of the cancer. If detected early, penile cancer can be cured successfully. Treatment options include surgery, radiation and/or chemotherapy. Surgery is the most common treatment for penile cancer. Depending on the stage of the cancer, certain surgeries may be recommended such as circumcision, laser ablation and cryotherapy in the early stages. Wide excision or a partial or total penectomy may be necessary during later stages. Radiation is a common option in men unable to have surgeries for various reasons. Chemotherapy is necessary to treat the cancer when it has spread to other areas in the body.

Prevention

  1. Circumcision and better personal hygiene can protect against penile cancer. Not coincidentally, the disease is far more common in parts of the world where circumcision is practiced.
  2. Vaccination against HPV can prevent men from developing HPV-related penile cancer
  3. Early detection is key and lesions or sores in the skin should be looked at for possible malignancies.