What is penile cancer?
Penile cancer is rare, accounting for less than 1% of cancers affecting males in the United States. Survival rates of penile cancer are quite good if the cancer is detected early.
Squamous cell carcinoma is the most common type of penile cancer (approximately 95% of cases). Penile cancer can appear anywhere on the penis, but it usually appears in the following:
- Foreskin in men who have not been circumcised
- Head of the penis (glans)
What are the signs and symptoms of penile cancer?
Symptoms of penile cancer may include:
- Rash or wart-like lump on the penis that does not heal within 4 weeks, especially on the glans (head of the penis) or under the foreskin
- Lumps in other parts of the groin
- Bleeding from the penis or under the foreskin
- Foul-smelling discharge
- Change in the color of the penis or foreskin
- Irritation or itching
- Discomfort or sharp pain
- Penis or foreskin thickening, which makes it harder to draw the foreskin back
- Difficulty urinating
- Blood in the urine
- Swollen lymph nodes in the groin area
If you notice any of these symptoms, consult a doctor immediately. The sooner penile cancer is detected and treated, the better the prognosis in the long run.
What are the risk factors for penile cancer?
Although the specific cause of most penile cancers is unknown, they are linked to a wide variety of risk factors:
- Poor hygiene: Chronic inflammation, which has been linked to penile cancer, can be caused by poor hygiene.
- Age: The risk of developing penile cancer increases with age. About 80% of penile cancers occur in males over 55 years of age.
- Human papillomavirus (HPV) infection: HPV has been linked to certain cancers, especially penile cancer.
- Not being circumcised: Circumcision involves the removal of all (or a portion) of the foreskin. Men who were circumcised as children may have a lower risk of developing penile cancer than men who were not.
- Phimosis: In uncircumcised males, the foreskin can grow tight and become difficult to retract. Secretions can sometimes accumulate under the foreskin and form smegma, which raises the risk of penile cancer.
- Smoking and other tobacco use: Tobacco use with HPV infection increases the risk of developing penile cancer.
- Ultraviolet (UV) light treatment of psoriasis: Psoriasis is a skin disease that is occasionally treated with ultraviolet A (UVA) light therapy, which can increase the risk of penile cancer.
- Acquired immunodeficiency syndrome (AIDS): AIDS can increase the risk of penile cancer due to the compromised immune system.
What are the treatment options for penile cancer?
Treatment for penile cancer is based on the location, stage, and grade of the tumor, as well as the patient’s age and overall health. Treatment options may involve a combination of:
- Radiation therapy
Surgery is the main treatment option. Multiple surgical methods are available for the treatment of penile cancers:
- Cryosurgery: Cancer cells are frozen and destroyed using liquid nitrogen (used for superficial penile tumors).
- Laser surgery: Tumor cells are killed with a strong beam of light.
- Circumcision: Circumcision, or removal of the foreskin, is advised if penile cancer has not progressed beyond the foreskin.
- Excision: Excision involves surgically removing the tumor and some healthy tissue. Depending on the stage and grade of the tumor, the surgeon may remove only a small quantity of healthy tissue (simple excision) or a substantial amount of healthy tissue (wide local excision). If there is not enough skin left to cover the surgical area, a skin graft from another body part may be used.
- Glansectomy: All or part of the glans may be removed in early-stage penile cancers that are localized to the tip of the penis (glans). Reconstructive surgery may be performed after this operation.
- Mohs surgery: During Mohs surgery, a tiny layer of penile skin is removed and examined under a microscope for the presence of cancer cells. This is repeated until all tissue samples are cancer-free.
- Penectomy: Penectomy is the surgical removal of a portion or the entire penis. In some cases, a total penectomy may be required, followed by a perineal urethrostomy, in which the surgeon makes an opening in the perineum, between the scrotum and anus, to allow urine to drain. Because the urethral sphincter muscle (the muscle that controls urine flow) is preserved, the patient retains bladder control.
- Lymph node removal surgery: This surgery involves removing lymph nodes near the tumor to determine whether the cancer has spread.
Radiation therapy for penile cancer involves killing cancer cells with high-energy radiation beams, such as X-rays or proton beams. Radiation therapy can be combined with other treatments, such as surgery and chemotherapy, to improve treatment outcomes.
Chemotherapy uses potent anti-cancer drugs to destroy cancer cells.
Chemotherapy can be administered before surgery (neoadjuvant chemotherapy) to shrink the tumor and after surgery (adjuvant chemotherapy) to destroy remaining cancer cells.
For early-stage penile cancers, topical chemotherapy is often recommended.
What is the prognosis for penile cancer?
Unfortunately, penile tumors can recur in a small number of cases. They can, however, be successfully treated if detected early. Patients must keep their follow-up appointments, which will be scheduled at regular intervals after treatment to monitor the recurrence of cancer.
Penile cancer is curable and has high survival rates when detected early.
American Cancer Society. If You Have Penile Cancer. https://www.cancer.org/cancer/penile-cancer/if-you-have-penile-cancer.html
UMass Chan Medical School. Penile Cancer. https://www.umassmed.edu/urology/clinical-conditions/cancer/penile-cancer/
Columbia University. About Penile Cancer. https://www.columbiadoctors.org/specialties/urology/specialties/urologic-cancers/penile-cancer/about-penile-cancer
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