Penile Cancer: Comprehensive Cancer Information

Penile Cancer

Penile cancer typically originates in the glans (the head or tip) of the penis. This condition is classified based on the specific type of cell from which the malignancy develops.

While penile cancer is relatively uncommon, with many men diagnosed each year in India, the incidence rate is significantly higher in countries like India.

Types of Penile Cancer

The main types of penile cancer include:

Squamous Cell Carcinoma

Kaposi Sarcoma

Adenocarcinoma

Melanoma

Basal Cell Carcinoma

Sarcoma

Penile Cancer Risk Factors

Any factor that increases a man's likelihood of developing penile cancer is considered a risk factor. These include:

Age

Most cases are observed in men between 50 and 70 years old, though approximately a third of cases occur in men under 50.

Tobacco Use

Smoking and tobacco use increase the risk.

Human Papillomavirus (HPV)

This sexually transmitted infection has numerous subtypes, with HPV 16 and HPV 18 being the most frequently linked to penile cancer.

Lack of Circumcision

Lack of circumcision at birth increases risk.

Phimosis

A condition where the foreskin is difficult to retract. This can lead to the build-up of body oils, bacteria, and other debris, known as smegma, which may increase risk.

UV Light Treatment

UV light treatment of psoriasis increases risk.

AIDS

Acquired Immune Deficiency Syndrome increases risk.

Penile Cancer Symptoms

The signs and symptoms of penile cancer can vary from person to person. While some men experience noticeable signs in the early stages, others may not develop symptoms until the disease is more advanced. These signs and symptoms are nearly always located on the glans penis (head of the penis) or the skin immediately surrounding it.

Early Signs and Symptoms

A reddish rash

Pruritus (itchy skin)

Small crusty bumps

Flat, bluish-brown growths

A wart-like growth that may or may not be painful

Later Signs and Symptoms

An open ulcer that fails to heal

Bleeding from the mass

Swelling at the end of the penis

Advanced Signs and Symptoms

A persistent, malodorous mass with discharge or bleeding under the foreskin

A painful growth that replaces the normal penile structure

Swollen lymph nodes in the groin, indicating the cancer has spread

When to Seek Medical Advice: It is important to note that other conditions, such as sexually transmitted diseases, allergic reactions, and drug reactions, can share some of these signs and symptoms. These conditions can be serious. Males who have persistent signs or symptoms related to the penis that last for more than two weeks should consult their doctor for evaluation.

Penile Cancer Diagnosis

Timely and accurate diagnosis is critical for successful treatment. If you observe any changes, it is important to consult your doctor.

Experts at SSCHRC utilise advanced technology and remarkable skill to precisely diagnose penile cancer. Although this cancer often presents with visible changes on the skin, which can be noticed early, a reluctance to seek medical advice can unfortunately delay necessary treatment.

Your doctor will conduct a thorough physical examination and discuss your health, family medical history, and lifestyle (including smoking and drinking habits). If penile cancer is suspected, one or more of the following diagnostic and staging tests may be used:

Biopsy

This is typically the first test performed. The type of biopsy depends on the size and nature of the lesion:

  • Incisional biopsy: A small part of the abnormal tissue is removed, often used for larger, ulcerated, or deeply spread lesions.
  • Excisional biopsy: The entire growth or lesion is removed, usually for small abnormal areas. For lesions on the foreskin, a circumcision may be suggested.
  • Fine needle aspiration (FNA): A thin needle is inserted into the groin area to examine the tissue in the lymph nodes for cancer spread.

Imaging Tests

These non-invasive tests help determine if the cancer has spread and can also be used to monitor the effectiveness of treatment. They may include:

  • CT or CAT (Computed Axial Tomography) scans
  • MRI (Magnetic Resonance Imaging) scans
  • PET (Positron Emission Tomography) scans
  • X-Rays
  • Ultrasound

Treatment for Penile Cancer

When you are treated at SSCHRC for penile cancer, a dedicated team of specialists focuses their expertise on ensuring you receive the most advanced care with the least possible impact on your body. As one of the nation's leading cancer centres, SSCHRC sees a significant number of penile cancer patients, offering a higher level of experience and expertise crucial for successful treatment and recovery.

Your personalised treatment plan will be determined by several factors, including the type and stage of the cancer and your general health. While surgery is the most frequent form of treatment, laser therapy and radiation may be used for smaller tumours. The treatment approach is primarily dictated by how far the cancer has spread.

One or more of the following therapies may be recommended:

Penile Cancer Surgery

Surgery to remove all or part of the penis is called a penectomy. Penile preservation surgery (where the penis is not removed) is always preferred whenever medically possible.

  • Circumcision: Surgical removal of the foreskin and some adjacent skin. This may be done if the cancer has not spread beyond the foreskin or before radiation therapy.
  • Partial penectomy: The tumour is removed along with a margin of healthy tissue. Surgeons aim to spare as much of the glans and shaft as possible to preserve urinary and sexual function.
  • Total penectomy: Removal of the entire penis for large tumours. The surgeon reroutes the urethra (the tube through which urine passes) behind the testicles, creating an urethrostomy (a new opening for urination). Penile reconstruction surgery is a rare procedure that has been performed using a skin flap from the forearm.
  • Mohs surgery (microscopically-controlled surgery): The surgeon removes a thin layer of skin and immediately examines it under a microscope. This process is repeated until all margins are free of cancer cells.
  • Laser surgery: Light from a laser is used to vaporise penile cancer cells.

Radiation Therapy

New techniques and the skill of doctors at SSCHRC allow for more precise targeting of the cancer, delivering the maximum radiation dose with minimal damage to healthy cells. Radiation therapy may be used for early-stage tumours, in conjunction with surgery to remove lymph nodes, and in advanced cases to control spread and alleviate symptoms.

Chemotherapy

SSCHRC offers modern and advanced chemotherapy options for penile cancer.

  • Topical chemotherapy: An anti-cancer medicine, typically 5-fluorouracil (5-FU) in cream form, is applied over several weeks. This is generally reserved for precancerous or very early-stage penile cancer.
  • Systemic chemotherapy: Medicine injected into a vein or taken orally.
  • Imiquimod: A cream-based drug that stimulates the body's immune system, sometimes used for very early-stage penile cancer.
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