Penile Cancer

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Penile cancer is a malignant growth found on the skin or in the tissues of the penis. A Squamous cell carcinoma usually originating in the glans or foreskin is by far the most common type, occurring in 9 out of 10 cases. Penile cancer is very rare in Europe and North America, occurring in about one in 100,000 men in the latter. It accounts for 0.2% of cancers and 0.1% of deaths from cancer amongst males in the United States. However, in some parts of Africa and South America it accounts for up to 10% of cancers in men

Penile cancer is uncommon, but, when it is diagnosed, it is psychologically devastating to the patient and often presents a challenge to the urologist. Benign, premalignant, and malignant conditions must be differentiated. Penile squamous cell carcinoma, the most common penile malignancy, behaves similarly to squamous cell carcinoma in other parts of the skin. Metastasis, which is possible with this type of carcinoma, is often lethal.

patients with carcinoma of the penis tend to delay seeking medical attention, with 15-50% delaying medical attention for more than 1 year from onset. This delay is attributed to embarrassment, guilt, fear, ignorance, and personal neglect. Patients often try to treat themselves with various skin creams and lotions. These may appear to be effective for a time, which further delays the diagnosis and worsens the prognosis.

Types

The following are common types of penile cancer:

  • Squamous cell carcinoma
  • Adenocarcinoma
  • Melanomas
  • Basal cell penile cancer
  • Sarcomas

Symptoms of Penile cancer

Penile cancer starts on the glans (head), or tip, of the penis and spreads from there. Some men may have obvious symptoms in the early stages, while others may not have any symptoms until the disease has advanced. Although it may not mean cancer, any abnormalities of the penis should be reported to your doctor as soon as possible. Unfortunately, many men are reluctant to discuss these issues with their physician, and may delay seeking treatment until the disease is advanced and harder to treat.

Men who have retained their foreskin need to examine the area underneath the foreskin regularly, as well as to keep the area clean to lower their risk. Penile cancer symptoms may include:

  • A wart-like growth or lesion
  • An open sore that won\’t heal
  • A reddish rash
  • Persistent, smelly discharge under the foreskin

Causes of Penile Cancer

Infection of HPV
HPV is a virus that is transmitted from skin to skin contact during sexual intercourse. It is a very common virus and doesn\’t always prevent symptoms. HPV is also the leading cause of cervical cancer in women.

Smoking increases your risk factor for penile cancer
Smoking increases your risk factor many types of cancers, not just penile cancer. When you smoke, you inhale harmful chemicals and substances that cause damage to cells\’ DNA. These carcinogens can cause damage to cells in the penis, thus causing penile cancer. Smoking also makes it difficult for the body to fight an HPV infection.

Age and Gender
Just being a male over the age of sixty increases your risk factor for penile cancer.

Being infected with AIDS virus
Having AIDS increases your risk factor for penile cancer, also. It is believed that the lowered immune system of people with AIDS is the factor.

Personal hygiene
Personal hygiene in the genital area is very important. Oily secretions, dead skin and bacteria can build up under the foreskin. This buildup is called smegma. Smegma can sometimes have a foul odor. It is believed that smegma may have cancer causing properties to it.

Treatment options overview

There are different types of treatment for patients with penile cancer.

Different types of treatments are available for patients with penile cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Surgery
Surgery is the most common treatment for all stages of penile cancer. A doctor may remove the cancer using one of the following operations:

Mohs microsurgery: A procedure in which the tumor is cut from the skin in thin layers. During the surgery, the edges of the tumor and each layer of tumor removed are viewed through a microscope to check for cancer cells. Layers continue to be removed until no more cancer cells are seen. This type of surgery removes as little normal tissue as possible and is often used to remove cancer on the skin. It is also called Mohs surgery.

Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor.

Cryosurgery: A treatment that uses an instrument to freeze and destroy abnormal tissue. This type of treatment is also called cryotherapy.

Circumcision: Surgery to remove part or the entire foreskin of the penis.

Wide local excision: Surgery to remove only the cancer and some normal tissue around it.

Amputation of the penis: Surgery to remove part or the entire penis. If part of the penis is removed, it is a partial penectomy. If the entire penis is removed, it is a total penectomy.

Lymph nodes in the groing may be taken out during surgery.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly onto the skin (topical chemotherapy) or into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Topical chemotherapy may be used to treat stage 0 penile cancer.

New types of treatment are being tested in clinical trials. These include the following:

Biologic therapy

Biologic therapy is a treatment that uses the patient\’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body\’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy. Topical biologic therapy may be used to treat stage 0 penile cancer.

Radiosensitizers

Radiosensitizers are drugs that make tumor cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers helps kill more tumor cells.

Sentinel lymph node biopsy followed by surgery
Sentinel lymph node biopsy is the removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. It is the first lymph node the cancer is likely to spread to from the tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes. After the sentinel lymph node biopsy, the surgeon removes the cancer.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site

Treatment options by stage

Stage 0 (carcinoma in situ)

Treatment of stage 0 may be one of the following:

  • Mohs microsurgery.
  • Topical chemotherapy.
  • Topical biologic therapy.
  • Laser surgery.
  • Cryosurgery.

Stage I penile cancer

If the cancer is only in the foreskin, wide local excision and circumcision may be the only treatment needed.
Treatment of stage I penile cancer may include the following:

  • Surgery (partial or total penectomy with or without removal of lymph nodes in the groin.
  • External or internal radiation therapy.
  • Mohs microsurgery.
  • A clinical trial of laser therapy.

Stage II penile cancer

Treatment of stage II penile cancer may include the following:

  • Surgery (partial or total penectomy, with or without removal of lymph nodes in the groing).
  • External or internal radiation therapy followed by surgery.
  • A clinical trial of sentinel lymph node biopsy followed by surgery.
  • A clinical trial of laser surgery.

Stage III penile cancer

Treatment of stage III penile cancer may include the following:

  • Surgery (penectomy and removal of lymph nodes in the groin) with or without radiation therapy.
  • Radiation therapy.
  • A clinical trial of sentinel lymph node biopsy followed by surgery.
  • A clinical trial of radiosensitizers.
  • A clinical trial of chemotherapy before or after surgery.

Stage IV penile cancer

Surgery (wide local excision and removal of lymph nodes in the groin).
Radiation therapy.

Surgery (wide local excision and removal of lymph nodes in the groin).A clinical trial of chemotherapy before or after surgery.

Treatment options for recurrent penile cancer

Treatment of recurrent penile cancer may include the following:

  • Surgery (penectomy).
  • Radiation therapy.
  • A clinical trial of biologic therapy
  • A clinical trial of chemotherapy.

HPV Vaccine

Infection with HPV is associated with some penile cancers. A quadri-valent vaccine (Gardasil) to prevent infection by the four most common variants of HPV has been developed, successfully tested, and approved by the US Food and Drug Administration for females between the ages of 9 and 26, and as of 2009, males between the ages of 16 and 26. Gardasil has been shown to also be effective in males, and has been approved by the FDA to be marketed as such.