Penile cancer is an uncommon malignant disease. It occurs with a frequency of 0.1-7.9 per 100,000 male population. However, it can cause severe psychological difficulties in the patient and pose a challenge for a urologist or oncologist who should treat it.
Types and Causes of Penile Cancer
According to a report by Joshua S. Engelsgjerd and Chad A. LaGrange published on NCBI, the most common form of such disease is squamous cell carcinoma (SCC), but non-squamous penile malignant neoplasms may also occur. These include the following:
- basal cell carcinoma (BCC), a type of skin cancer, an extremely rare entity (read a case report here);
- melanoma, also a rare disease, but about 100 cases were confirmed (see a case report and review of the literature);
- primary penile sarcoma, this is a rare soft tissue tumor with an incidence of approximately 0.6-1.0 occasions per 100,000 population;
- adenosquamous carcinoma, a highly malignant, but an extremely rare disease.
Causes (Risk Factors)
- Smoking. This bad habit damages not only the lungs, as it is known, it has a negative effect on almost all organs and systems of the human body. Most of the chemicals in tobacco smoke are absorbed into the bloodstream and spread throughout the organism, affecting the DNA of the cells in the penis. Such exposure is especially dangerous if a man has human papillomavirus (see below), it exacerbates the risks.
- Poor hygiene and subsequent accumulation of smegma (the substance which helps to lubricate the penis). Smegma is fatty secretions and dead skin parts, as well as bacteria that accumulate under the foreskin.
- Phimosis or narrowing of the foreskin. This is a physiological feature that does not allow the penis glans to be exposed. Phimosis can cause smegma to be accumulated and can lead to the difficulty or impossibility of proper hygienic care.
- Chronic inflammatory processes in the glans penis and foreskin. Therefore, for any penile illness, an urgent need to consult a doctor.
The correlation between penile cancer and HPV (16/18 type), which is detected in 50% of males with the disease, has been proven.
Symptoms and Diagnosis
Most squamous cell carcinomas occur on the glans penis, in the coronal sulcus, or under the foreskin. They usually look like small reddish lesions and may be located under the skin for a long period of time.
Due to good visibility a large number of penile tumors are often found early. The appearance of a painful or painless formation on the penis in any form (warts, blisters, thickening of the skin area and discoloration, bleeding ulcers, white spots) should make a man alert and urgently make an appointment with a doctor.
Usually, penile tumors are superficially located and the doctor can easily examine them in detail. On examination, it is already possible to preliminarily determine the nature of the disease. The following methods can be used for diagnosis:
- Biopsy (taking a piece of the tumor for cytological examination). The tumor can even be completely removed if it is very small. A fine needle biopsy can be done in some patients.
- Chest X-ray can be prescribed with a presumably severe stage of the disease and makes it possible to identify lung metastases.
- Computed tomography can detect tumor metastasis to the liver and other internal organs (also in severe cases).
- Immunohistochemical and molecular diagnostics can also be performed.
Penile cancer progresses without treatment, usually resulting in death within 2 years due to the spread of tumors throughout the body (metastasis). With early therapy, the disease is usually curable. However, neglecting the disease multiplies the risk of fatal outcome.
Due to low prevalence of this cancer type and the lack of randomized trials in this area, there is a lot of controversy regarding the optimal treatment tactics for this category of patients. It is advised to choose a treatment method based on the location, size and type of tumor growth. Surgery is the key method of treating a primary tumor. In some patients, local application of chemotherapy drugs is applied. In addition, radiation therapy used concomitantly with systemic treatment (or without it), can be beneficial.
Local treatment with special drugs and laser ablation is effective for small superficial lesions. Circumcision can be performed if the foreskin is affected. Wide excision can be performed for recurrent lesions or in patients who cannot be reliably monitored.
Invasive and huge tumors require more radical resection. Resection of the penis is indicated if the malignant formation can be fully excised with adequate indentation and leaving the stump of the penis to preserve adequate urination and some level of sexual function. Penile amputation is indicated for large infiltrative tumors.