Penile Cancer

Penile cancer, though rare, is a serious disease that requires awareness and understanding of its risk factors for early detection and effective treatment. Its rarity underscores the importance of education and awareness, as early diagnosis significantly improves treatment outcomes. Understanding the causes and risk factors is key to prevention and timely medical intervention.

Squamous carcinoma type of penile cancer under the microscope. Source.

What is Penile Cancer?

Penile cancer is a rare form of cancer that occurs on the skin of the penis or within the penis. It most commonly affects the skin cells and can develop anywhere on the penis, but it most often affects the glans or foreskin. This type of cancer is categorized based on the type of cells it originates from, with the most common being squamous cell carcinoma. Early detection is crucial as penile cancer can be effectively treated, especially when caught in its early stages.

How Common is Penile Cancer?

Penile cancer is relatively rare, especially in developed countries. It accounts for less than 1% of cancers in men in the United States and Europe. However, its incidence is higher in parts of Asia, Africa, and South America. The rarity of this cancer in developed countries is largely attributed to better hygiene and widespread circumcision, which are factors known to reduce the risk of penile cancer.

What Causes Penile Cancer?

The exact cause of penile cancer is not entirely understood, but it begins with changes (mutations) in the DNA of cells in the penis, which lead to abnormal growth and the formation of a tumor. These mutations cause cells to grow and divide uncontrollably, and they can eventually spread to other parts of the body. While the precise reasons for these genetic mutations are unknown, several risk factors have been identified.

What are the Risk Factors for Penile Cancer?

Several factors can increase a man's risk of developing penile cancer. One of the most significant is infection with certain types of the human papillomavirus (HPV), particularly HPV 16 and 18, which have been closely linked to this cancer. Smoking is another major risk factor, significantly elevating the chance of developing penile cancer. 

Conditions like phimosis, where the foreskin cannot be retracted from the head of the penis, contribute to the risk, as do poor genital hygiene practices. Age also plays a role, with penile cancer more commonly occurring in men over 50. Men who are uncircumcised face a higher risk, partly due to increased susceptibility to HPV infection and potential hygiene challenges. 

Additionally, men who have undergone UV light treatment for conditions like psoriasis, using psoralens, are at an elevated risk. Moreover, men with AIDS have a higher risk of penile cancer compared to those without the disease. These risk factors highlight the importance of awareness and preventive measures in reducing the likelihood of developing penile cancer.

Can I Prevent Penile Cancer?

While there is no sure way to prevent penile cancer, certain measures can significantly lower your risk. Practicing good genital hygiene is crucial. Regularly cleaning the penis can help prevent the buildup of smegma (the white substance that collects under the foreskin), which is linked to penile cancer. For uncircumcised men, this includes cleaning under the foreskin. Vaccination against HPV can also reduce the risk of penile cancer associated with HPV infection. 

Quitting smoking is another effective measure, as smoking increases the risk of penile and other cancers. Men should also consider using condoms to reduce the risk of HPV infection. Regular self-examinations of the penis can help in early detection of any unusual signs.

What are the Signs and Symptoms of Penile Cancer?

The symptoms of penile cancer can vary, but there are several common signs to watch out for. These include a growth or sore on the penis, often on the glans or foreskin. Changes in the color of the penile skin, a rash, and a discharge with a foul odor are other symptoms. More advanced penile cancer can manifest as bleeding from the penis or a lump on the penis. It is important to consult a doctor if you notice any persistent changes or symptoms in your genital area, as early detection significantly improves the chances of successful treatment.

How is Penile Cancer Diagnosed?

If penile cancer is suspected, the diagnostic process typically starts with a thorough physical examination of the penis. A biopsy is the primary method for diagnosing penile cancer, where a small piece of tissue is removed from any suspicious areas and examined under a microscope for cancer cells. Imaging tests such as ultrasound, MRI, or CT scans may be used to determine if the cancer has spread to other parts of the body. These diagnostic tools help in determining the stage of the cancer, which is crucial for planning the treatment.

How is Penile Cancer Treated?

The treatment for penile cancer depends on the cancer's stage and the patient's overall health. For early-stage penile cancer, treatments aim to remove the cancer while preserving as much of the penis as possible. Options include laser surgery, cryosurgery (freezing cancer cells), and circumcision. In more advanced cases, partial or total penectomy (removal of part or all of the penis) may be necessary. 

Radiation therapy and chemotherapy are other treatment options, used either alone or in combination with surgery. Radiation therapy can be external or internal and is often used to treat both the primary tumor and lymph nodes. Chemotherapy might be recommended if the cancer has spread to other parts of the body.

What are the Side Effects of Penile Cancer Treatment?

Treatment for penile cancer, while necessary, can result in various side effects, depending on the type and extent of treatment. Surgical treatments, especially partial or total penectomy, can have profound physical and psychological impacts, including changes in body image and sexual function. Procedures aimed at preserving the penis may still lead to scarring or changes in sensation. Radiation therapy can cause skin irritation, fatigue, and may affect urinary and sexual function. 

Chemotherapy can lead to side effects such as nausea, hair loss, fatigue, and an increased risk of infections due to lowered immunity. It is important for patients to discuss potential side effects with their healthcare team to prepare and manage them effectively.

Can Penile Cancer Come Back?

Yes, penile cancer can recur. The likelihood of recurrence depends on the stage and type of the original cancer. Close follow-up care after treatment is crucial for early detection of recurrence. This typically involves regular medical check-ups, imaging tests, and sometimes blood tests. If cancer does recur, the treatment may involve similar strategies as the initial treatment or may require a different approach, depending on the specifics of the recurrence and the extent of the cancer.

What is the Prognosis and Survival for Penile Cancer?

The prognosis for penile cancer largely depends on its stage at diagnosis and the type of cancer cells involved. Early-stage penile cancer, which has not spread beyond the skin of the penis, generally has a favorable prognosis with high survival rates. The prognosis becomes less optimistic if the cancer has spread to lymph nodes or distant parts of the body. However, even in more advanced stages, treatment advancements have improved outcomes. The overall 5-year survival rate for penile cancer varies but tends to be higher for those diagnosed at an early stage.

Living with Penile Cancer

Living with and after penile cancer involves physical, emotional, and psychological challenges. Coping with the side effects of treatment, concerns about body image, and changes in sexual health are common experiences for many men. Emotional support from healthcare professionals, counseling services, and support groups can be beneficial. Maintaining a healthy lifestyle, including a balanced diet and regular exercise, can help manage stress and improve overall well-being. Many men find that engaging in hobbies and social activities can provide a sense of normalcy and control.

Conclusion

Penile cancer, a challenging and sensitive diagnosis, requires a comprehensive approach that encompasses effective medical treatment, management of side effects, psychological support, and lifestyle adjustments. Understanding the potential for treatment side effects, being vigilant about recurrence, knowing the prognosis, and learning how to live with the condition are all critical steps in managing this type of cancer. With advances in medical science and a focus on holistic care, individuals diagnosed with penile cancer can navigate their journey with resilience and hope.

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Further Reading

1. Arya M, Kalsi J, Kelly J, Muneer A. Malignant and premalignant lesions of the penis. BMJ. 2013;346:f11491.
2. Sakalis VI, et al. What Is the Most Effective Management of the Primary Tumor in Men with Invasive Penile Cancer: A Systematic Review of the Available Treatment Options and Their Outcomes. Eur Urol Open Sci. 2022;40:582.
3. Xu J, et al. Neoadjuvant docetaxel, cisplatin and ifosfamide (ITP) combination chemotherapy for treating penile squamous cell carcinoma patients with terminal lymph node metastasis. BMC Cancer. 2019;19:6253.
4. Stecca CE, et al. Recent Advances in the Management of Penile Cancer: A Contemporary Review of the Literature. Oncology and Therapy. 2021;9:21–394.
5. Hansen BT, et al. Trends in incidence, mortality and survival of penile squamous cell carcinoma in Norway 1956-2015. Int J Cancer. 2018;142:15865.

Disclaimer: This blog post is intended solely for informational purposes. It is not meant to serve as medical advice. For professional medical guidance, please consult your doctor.