What is Penile Cancer?
Penile cancer is a rare type that forms in the penis (a male reproductive organ). Most penile cancers are carcinomas of squamous cells. (Squamous cells are the flat cells that line the penis).
Risk of penile cancer:
- 1. No childhood circumcision
- 2. Phimosis
- 3. Chronic inflammation
- 4. Poor hygiene of the penis
- 5. Smoking
- 6. Immunosuppression
- 7. Infection with HPV (human papillomavirus) and HIV (Human Immunodeficiency Virus)
Penile Cancer Treatment
According to the experts, the main treatment for penile cancer is surgery after an appropriate diagnosis. For treating early-stage penile tumours, local treatments are given, but the larger penile tumours are treated preferably with surgery or chemotherapy. In some conditions, radiation therapy can also be used with or without surgery.
- 1. Surgical treatment for penile cancer
- 2. Radiation therapy
- 3. Local treatments for small penile tumours
- 4. Chemotherapy
Surgery is considered the most common treatment for penile cancers at any stage. Surgery includes removing part of the penis with a benign tumour and not spreading to other parts of the penis. If penile cancer is diagnosed at an advanced stage, the entire penis must be removed. But the doctors try different techniques to prevent entire penis removal and save it from urinating properly, maintaining the appropriate look of the penis and its sexual functioning. Some of the techniques include:
Circumcision– If the tumour is diagnosed only in the foreskin, it is removed or circumcised to cure penile cancer.
Simple surgical excision- surgical excision of a localized tumour and the skin affected.
Microscopically assisted Mohs surgery includes the removal of skin layers one by one and their subsequent examination under the microscope to look for cancerous skin cells. Skin is removed until normal cells appear under a microscope.
Total or partial penectomy– the surgical removal of all or some part of the penis that is cancerous. Total penectomy is the removal of the complete penis along with its roots.
Emasculation – the surgical treatment of penile cancer that removes the penis and scrotum( sac containing testicles).
Surgical removal of lymph nodes– To treat penile cancer, the doctors preferably remove lymph nodes in the nearby region because the chances of cancer spreading to these lymph nodes are very high.
Radiation therapy as a treatment for penile cancers
The treatment of penile cancer is also done using the rays with high-energy particles that can destroy the cancerous cells of the penis. Radiation therapy is used in the following ways to treat penile cancers:
- 1. Radiations used on small penile tumours to get rid of them
- 2. If cancer spreads to lymph nodes, the radiation can be used for lymph node removal.
- 3. In certain cases where surgeries are not found to be an appropriate treatment option for penile cancer.
- 4. Radiations can also be used to shrink the tumour associated with the penis so that the surgery has the least damage and most of the portion of the penis is saved.
- 5. Radiations help relieve symptoms of the penile cancer
Two ways by which radiation therapy is given to penile cancer patients:
- 1. Brachytherapy
- 2. External beam therapy
Brachytherapy comprises plesiobrachytherapy and interstitial therapy.
In brachytherapy, the radiation source is placed near the tumour, allowing radiation from its source to travel very small distances to prevent damage to surrounding healthy tissues. After getting brachytherapy, the patient needs proper bed rest for a few days. Subsequently, a Foley catheter is placed for urine drainage. Two ways of getting brachytherapy are:
Plesiobrachytherapy– is a type of radiation therapy wherein the radiation source is placed not inside the penile tumour but in the surrounding area. Here, the radiation therapy to treat penile cancer or tumour lasts a few days.
Interstitial radiation– a type of radiation therapy wherein hollow needles are placed inside the penis for some days, and radioactive pellets are put inside the needles to treat penile cancer. Eventually, after treatment of penile cancer, the radioactive pellets are removed along with the hollow needles.
Radiation therapy: Type of radiation therapy that uses external beam radiation that is particularly aimed at a penile tumour for a few seconds to minutes. This radiation treatment is painless and usually given for a particular time. To prevent exposure to testicles and groin, molds are used as shields.
Local Penile Cancer Treatment
Local treatments of penile cancer include -laser ablation, cryosurgery, and topical treatments.
Early-stage penile cancer, like penile cancer at stage 0 or stage 1, can be treated using mild local treatment options:
Laser ablation for penile cancer treatment: To ablate penile cancerous squamous cells, the laser beam is used for their destruction. Laser treatment can be given to the penile cancer patient in case there is a recurrence of the penile tumour. The treatment is suitable for patients that cannot undergo surgical treatment. There is a shallow wound post-surgery that gets healed in some time.
Cryosurgery: The treatment of penile cancer using a freezing technique that utilizes liquid nitrogen is called cryotherapy or cryosurgery. The surgery is undertaken after giving local anaesthesia to the penile cancer patient.
Chemotherapy to treat penile cancer
Use of drugs for treating penile cancer is divided into – topical treatment and systemic treatment
The topical treatment of penile cancer takes advantage of drugs that kill the cancerous cells specifically. They can be in the form of skin creams, pills or injectables like 5- fluorouracil. This medication is applied on the penile region or skin with cancerous cells. Imiquimod is also an anti-cancer medicine that boosts the immune system to treat abnormal cancerous cells.
Systemic treatment or systemic chemotherapy for penile cancer includes drugs or medicines that can be injected or taken orally. These anti-cancer drugs take the route of blood vessels and reach the cancer cells. Systemic chemotherapy is advantageous before surgery to shrink the penile tumours for subsequent surgery. There is a proper cycle of chemotherapy to treat penile cancer, which includes medications like :
- 1. Mitomycin C
- 2. Taxol
- 3. Fluorouracil
- 4. Cisplatin
Penile cancer treatment stage wise
Treating penile cancer after diagnosing the stage like stage 0, stage 1, stage 3, stage 4, and recurrent stages of penile cancer
Stage 0 penile cancer treatment :involves skin tissue like the foreskin and can be treated with topical treatment or circumcision.
Stage 1 penile cancer treatment: This stage of penile cancer has tumours beneath the foreskin and can be treated with mild surgery or radiation therapy, circumcision, or laser ablation.
Stage 2 penile cancer treatment: This type of penile cancer has depth tumours beneath the penile or urethral tissues. They are restricted to the penile and urethral tissues and do not spread lymph nodes. This penile cancer can be treated via penectomy (partial or total). Radiation therapy is used in patients who are not recommended surgery.
Stage 3 penile cancer treatment: This stage of penile cancer has cancerous lymph nodes along with deep tumours in the penis and urethra. The treatment requires chemotherapy along with surgery or radiation therapy. This stage of penile cancer is comparatively hard to treat
Stage 4 penile cancer treatment: Complicated stage of penile cancer wherein the tumour spreads to many nearby tissues and organs like the scrotal sac, urinary bladder, prostate, and abdominal walls. This stage needs extensive treatment strategies, including surgery, chemotherapy, and radiation therapy. The stage is hard to treat, and the main focus is alleviating the symptoms and complications resulting from stage 4 penile cancer.
Types of Penile Cancer
There are four different types of penile cancers:
- 1. Squamous penile carcinoma
- 2. Basal carcinoma
- 3. Melanoma
- 4. Sarcoma
Squamous cell carcinoma: Most common cancer is the squamous carcinoma of the penis, also called epidermoid penile carcinoma. This type of penile carcinoma usually occurs on the foreskin of the penis.
Basal carcinoma: Type of penile carcinoma that has cancerous basal cells (cells present beneath the layer of squamous cells). This type of cancer is not as common as squamous cell penile carcinoma.
Melanoma– Type of penile cancer occurring in the deepest skin layer in the melanocytes. This type of penile cancer is considered as most serious cancer.
Sarcoma: Type of penile carcinoma that occurs in the connective tissues like blood vessels.
Symptoms Of Penile Cancer
- 1. The skin of the penis and surrounding area becomes comparatively thick
- 2. Change in penile skin colour.
- 3. A lump appears on the penis
- 4. A sore ulcer on the penis
- 5. A red and velvety skin rash on the penis and near the foreskin.
- 6. Minute penile bumps.
- 7. Blue-brown penile outgrowths.
- 8. Bleeding or fluid discharge that has a foul smell
- 9. Itchy and burning penis
Penile Cancer Causes
- 1. Main causes of penile cancer
- 2. Virus infection (HPV- Human Papilloma Virus)-
- 3. HPV causes a viral infection that spreads via oral sex or skin contact
- 4. History of STDs (sexually transmitted Diseases) like HIV-AIDS (Human immunodeficiency virus- Acquired Immunodeficiency Syndrome)
- 5. Skin-to-skin contact of genitals
- 6. Vaginal, anal or oral sex.
- 7. Sharing sex toys
- 8. Weak immune system
- 9. Uncircumcised penis – removal of foreskin or circumcision helps prevent penile cancers. Largely, men not circumcised have a higher risk of developing penile cancer. Most importantly, the men circumcised as babies have almost no risk of developing penile cancer, while men circumcised at a young age are moderately protected from penile cancer.
Penile Cancer Surgery
Penile cancer surgery or removing some part of the penis or the entire penis is called penectomy. The removal of the penis (some part or complete removal) has devastating effects on physiology as well as the psychology of the individual. Complete penile removal is suggested in most complicated cases where no alternative options are available to save the cancer patient’s life.
How Common is Penile Cancer?
Penile cancer is rare cancer. The disease incidence is higher in underdeveloped or developing countries like India compared to developed countries like the USA. According to the studies, the annual incidence of 3.32 Indian men is found to have penile cancer per 100,000men. On the contrary, in the United States, only 1 in 100,000men have penile cancer. These estimations are the annual incidence of penile cancer in the respective regions of the world.
How do you know if you have penile cancer?
- 1. Rash on penis
- 2. Bleeding from the rash on penile skin or the foreskin
- 3. Foul smell discharge
- 4. Phimosis
Penile Cancer Prevention
- 1. Circumcision – removal of foreskin called circumcision has an important role in preventing low penile cancer.
- 2. Maintaining penile hygiene- an uncircumcised penis has more chances of developing unhygienic conditions, thus leading to infections and risk of penile cancer.
- 3. Infection with human papillomavirus is a common infection that spreads easily from one person to another.
- 4. Tobacco consumption- a high risk of penile cancer is associated with men who consume tobacco.
- 5. Phimosis- inability to retract the foreskin causes an increased risk of penile cancer.
- 6. Having safe sex: Opting for safer sex practices will prevent a lot of infection and eventually the risk of developing penile cancer.
What is the survival rate of penile cancer?
According to an Indian clinicoepidemiological study, the survival rates of penile cancer in stage I individuals are 87% and stage II 60%.
Diagnosis & Tests
Diagnosis of penile cancer at early stages is important as a delayed diagnosis will cause enhanced disfigurement and increased complications.
Diagnostic tests for detection of various stages of penile cancer include:
Evaluation of medical history- doctors will evaluate the patient’s entire medical history, and the detailing of symptoms is analyzed.
Physical examination of the penile cancer patient- possible signs, including lesions in the genital area and affected skin, are observed closely. Lymph nodes are also felt to look for swelling.
Other tests include imaging and biopsy of the penile tissues to confirm the diagnosis:
Imaging tests- include X-ray, Computed tomography (CT), Ultrasound, and Magnetic resonance Imaging (MRI).
Biopsies – Excisional biopsy, incisional biopsy, and lymph node
X-rays, sound waves and magnetic radiations are used to analyze the internal cross-section of the penis or lymph nodes.
Ultrasound- ultrasound uses sound waves and gives visual images of the penis and its internal masses. It will also enable doctors to look for enlarged lymph nodes. It is not exposing one’s body to harmful radiation. The area to be examined is lubricated using a gel-like substance, and a transducer is moved over that area.
Magnetic Resonance Imaging- to get the detailing of penile tissues, radio waves and magnetic waves are used in MRI. The erect penis provides better pictures for evaluation and examination using MRI. The erection for diagnosis can be achieved by injecting the prostaglandin hormone into the penis.
CT scan or Computed Tomography: To get the cross-sectional penile images, X-rays are used in CT scans. The technique helps show the tumours associated with the penis and lymph nodes. An added advantage of a CT scan is that it helps guide biopsies of particular body masses. A sample can be easily taken with the assistance of a CT scan-guided biopsy needle, and eventually observed, the tissue is taken for malignancy.
What do early signs of penile cancer look like?
- 1. The penile region becoming comparatively thick
- 2. Alteration in penile skin colour
- 3. An ulcer, lump or lesion getting complicated, leading to bleeding
- 4. Rashes in the penile region
- 5. Lumps in and around the groin
What are the main symptoms of penile cancer?
- 1. An ulcer, lump or lesion getting complicated, leading to bleeding
- 2. Foul smelly discharge
- 3. Phimosis (inability to retract the foreskin)
- 4. Excessive red rash on foreskin
What is the age of occurrence of penile cancer?
Most commonly, penile cancer occurs in people above 50 years of age. In some regions, the age might differ; it can be diagnosed at later stages or older. Therefore, the chances of getting penile cancer are higher at 50-65 years and older.
Is penile cancer a lump?
In many cases, penile cancer patients have observed a lump on their penis and its discolouration that eventually resulted in the diagnosis of penile cancer. Hence, it can be said that a painless lump is usually noticed in patients with penile cancer.
Can a 20-year-old get penile cancer?
It is not observed in younger men, as age is a considerable risk factor for penile cancer. It has been observed in a large number of studies that penile cancer is not affecting people less than 40 years of age.
What happens if penile cancer goes untreated?
There are chances of spreading penile malignancy via the lymphatic system to lymph nodes if the penile cancer is left untreated. It will develop from stage I to its later stages, making it hard to treat. It decreases the survival chances of the patient.
Can penile cancer go away on its own?
No, penile cancer won’t go away on its own. It needs proper attention and treatment even if it is at its early stage, and topical medications are needed to cure it. The delay in getting treatment worsens the condition to the extent that it becomes life-threatening.