Penile Cancer

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Overview

Penile cancer happens when the cells present in the penis begin to grow abnormally and form a tumour.

Penile cancer is one of the rare cancers, and it is more common among uncircumcised men. Apart from this, chronic HPV infection is also a risk factor for penile cancer.

Penile cancers are treated best when they are detected in their early stages. Therefore, it is important for one to not ignore any symptoms and consult a doctor for immediate medical attention.

Types

Based on the cell type that they originate from, penile cancers are categorised into the following types:

1. Squamous Cell Carcinoma: This cancer type arises from the small, flat cells known as the squamous cells. Although it can be found anywhere, it is more commonly found on or under the foreskin. This cancer type accounts for about 95% of penile cancers.
2. Melanoma: This cancer type forms in the pigment-producing cells, and it is relatively aggressive, i.e., it spreads quickly.
3. Sarcoma: Sarcoma forms in the blood vessels and connective tissues, namely fat tissue, muscles and cartilage.
4. Basal Cell Carcinoma: This cancer type is slow-growing, and it starts growing in the deepest layers of the skin. Basal cell carcinoma is unlikely to spread to other organs.
5. Adenocarcinoma: Adenocarcinoma forms when the cells present in sweat glands start growing uncontrollably. This is also one of the rare penile cancers.

Symptoms

Penile cancers are easy to detect in their early stages as a change in the texture and appearance of the penis is one of the first symptoms of penile cancer. Following are other key symptoms of penile cancers:

Ulcer formation on the foreskin, shaft, etc.
Thickening of the penis skin
Changes in the skin colour of the penis
Foul-smelling discharge from the region below the foreskin
Pain in the penis tip or shaft
Formation of bluish-brown irregular lesions or marks below the foreskin and other parts of the penis
Unexplained bleeding from the tip of the penis
Velvety rash below the foreskin, which could appear like an unhealed scab
Tiny, crusty bumps present beneath the foreskin
Swelling of groin area lymph nodes

Not always do these symptoms indicate penile cancer; they could be a result of an infection, too. However, to be sure, one must consult a doctor without any delay.

Courses

The exact causes of penile cancer are unknown. However, there are a few risk factors that can increase the chances of one getting penile cancer. Following are the important risk factors associated with penile cancer:

Chronic HPV Infection: HPV infection is a sexually-transmitted condition that has to be treated immediately. Men with chronic HPV infection are at an increased risk of getting penile cancer.
No Circumcision: In men who are not circumcised, a thick build-up called smegma and fluids gets accumulated beneath the foreskin. Smegma can cause irritation and inflammation, and if this is not addressed on time, it may increase the risk of penile cancer.
Age: Penile cancer is more prevalent among men who are aged 60 and above.
Smoking: Certain harmful chemicals present in tobacco can trigger the formation of penile cancer, along with many other cancers.
Compromised Immune System: Those with a weaker immune system also are at a higher risk of getting penile cancer.
Phimosis: Phimosis is a condition, wherein the foreskin becomes tight, and this can make thorough cleaning difficult. Poor penile hygiene is a risk factor for penile cancer.
History of Psoriasis Treatment: Those who have received PUVA therapy (Psoralen and ultraviolet A light) for psoriasis are at a higher risk of getting penile cancer.

Diagnosis

Penile cancers are relatively easier to treat when they’re diagnosed early. There are various tests recommended by the doctor for the detection and diagnosis of penile cancer:

a. Physical Examination and Medical History Assessment: When a patient presents himself with penile cancers symptoms, the doctor recommends a physical exam before any test. During this procedure, the doctor thoroughly examines the organ for the presence of lesions, lumps and bumps along with changes in the colour and texture. The doctor may also take a note of the patient’s medical history wherein questions about the patient’s underlying medical conditions, previous treatments, allergies, if any, may be asked.

b. Biopsy: If the doctor finds a lump or any other abnormalities, a biopsy may be recommended. During the biopsy, a small amount of tissue may be collected from the suspected area and examined for the presence of cancer. Biopsy plays a significant role in achieving a definitive diagnosis for penile cancers.

c. Cystoscopy: To check if penile cancer has spread to nearby organs, the doctor may suggest a cystoscopy. During this procedure, a flexible tube that is fitted to a light source and video camera is inserted through the bladder into the penis. Through cystoscopy, the doctor examines different regions of the penis for the signs of cancer.

d. Imaging Tests: Imaging tests, such as MRI scan, PET CT scan, etc., may be recommended to check if penile cancer has spread to other organs. These tests are also employed in disease staging, treatment planning, treatment monitoring and disease restaging.

e. Lymph Node Dissection: Lymph node dissection is a surgical procedure performed to remove the lymph nodes that are present close to the tumour. These lymph nodes are later examined for the presence of cancer cells. This procedure helps doctors in determining if the cancer has started spreading to other organs.

Treatment

There are multiple treatment options available for the management of penile cancers. A multitude of factors, namely the disease stage, the exact location of the tumour, its grade, the patient’s age, the overall condition of the patient, etc., are considered before devising a treatment plan.

Usually, the treatment plans for penile cancers comprise surgery, radiation therapy and chemotherapy.

a. Surgery: Surgery is the main line of treatment recommended for penile cancer management. The surgery aims to remove cancer cells and preserve the organ’s structure and function whenever feasible. Multiple surgical procedures are available for the management of penile cancers, and one of them may be recommended depending on the severity of the condition:

1. Cryosurgery: This procedure uses liquid nitrogen to freeze the cancer cells and destroy them. Cryosurgery may be recommended for superficial penile tumours.
2. Laser Surgery: Laser surgery is another treatment option recommended for early-stage penile cancers. It uses an intense beam of light to kill the tumour cells.
3. Circumcision: Circumcision is recommended in cases where penile cancer has not spread beyond the foreskin. This procedure removes the foreskin entirely with a small amount of nearby skin.
4. Excision: Excision involves the removal of the tumour along with some healthy tissue. Depending on the severity of the condition, the surgeon may remove a small amount of healthy tissue (simple excision) or a large amount of healthy tissue (wide local excision). A skin graft from another body part may be used to cover the area if there isn’t enough skin remaining to cover the operated area.
5. Glansectomy: In early-stage penile cancers that are confined to the tip of the penis (glans), all or a part of the glans may be removed. This procedure may be followed by reconstructive surgery.
6. Mohs surgery: During Mohs surgery, the surgeon removes a thin layer of penile skin and immediately examines it under a microscope for the presence of cancer cells. This procedure is repeated until the examined samples are cancer-free.
7. Penectomy: Penectomy involves the removal of a part or the entire penis. During partial penectomy, the doctor may try to preserve as much of the shaft as possible.During the total penectomy, the entire penis is removed. A total penectomy may be followed by a perineal urethrostomy, wherein the surgeon makes a new incision in the perineum, the area between the scrotum and the anus, to allow urine to drain. Because the sphincter muscle (the muscle that controls the urine flow) in the urethra is kept intact, the patient will still have bladder control. For more information on follow-up care after penectomy and perineal urethrostomy, patients and their caregivers must talk to their doctor.
8. Lymph Node Surgery: This procedure involves the removal of lymph nodes that are close to the tumour to check if cancer has begun to spread.

b. Radiation Therapy: Radiation therapy for penile cancer involves destroying the cancer cells using high-energy radiation beams, which could either be X-rays or proton beams. Radiation therapy may be combined with other treatment options, namely surgery and chemotherapy, to positively impact the treatment response. Radiation therapy may be administered externally or internally.

This treatment may also be recommended to ease the symptoms caused by the disease.

c. Chemotherapy: Chemotherapy is a systemic therapy that destroys cancer cells by using powerful anticancer drugs. Chemotherapy may be administered before the surgery (neoadjuvant chemotherapy) to shrink the tumour and/or after the surgery (adjuvant chemotherapy) to destroy the residual cancer cells and bring down the risk of a relapse.

Chemotherapy may be administered orally, intravenously or topically. Topical chemotherapy is usually recommended for early-stage penile cancers.

Frequently Asked Questions

1. Are penile cancers treatable?

Yes, penile cancers are treatable. In many cases, it can be treated with positive clinical outcomes and excellent survival rates, and patients can go back to their normal lives without many challenges.

Nevertheless, for penile cancers to be treated successfully, they have to be detected in the early stages. It is important to not ignore any changes in the structure, texture or swelling, and if any of these are witnessed, one must immediately consult a doctor.

2. Is there any way to detect penile cancer early?

There is no standard screening procedure available for penile cancer. However, early detection may still be possible.

One can look out for any changes in the skin, namely the colour, texture, abnormal growths, blisters or sores regularly. Many are usually uncomfortable reporting the anomalies that they see. However, this should be avoided. Anything abnormal should be immediately reported to the doctor, as this is one of the easiest ways to catch penile cancers in their early stages.

3. Can penile cancer come back?

Unfortunately, penile cancers can come back in a few cases. However, they can be treated successfully if they are caught early.

In order to catch recurrences early, patients must keep up their follow-up appointments that will be scheduled at regular intervals after the treatment.

4. How can I prevent penile cancer?

There are no known ways to prevent penile cancers completely. However, you can follow a few measures that can bring down your penile cancer risk:

Avoid HPV Infection: Practise safe sex and avoid having multiple sexual partners. This helps in reducing your HPV infection risk and thereby, penile cancer risk.
Ensure To Have Good Hygiene Practices: Always keep your pubic region clean and if you are not circumcised, make sure to keep the region below the foreskin clean.
Quit Smoking: If you don’t smoke, never pick up smoking and if you do, quit it. Smoking is known to cause various types of cancers, and you can reduce their risk by refraining from tobacco consumption.