What Is Penile Cancer?

    Cancer of the penis, or penile cancer, is a relatively rare form of cancer that affects the skin and tissues of the penis. According to OncoLink, a publication of the University of Pennsylvania, there are only about 1,300 case of penis cancer diagnosed every year in the U.S. (Wood, 2011).

    Penile cancer can affect different parts or layers of the penis. Cancer can spread through tissue, the lymph nodes, and the blood. Uncircumcised men are at greater risk for developing penis cancer.

    Who Is at Risk for Contracting Penile Cancer?

    Men living in Asia, Africa, and South America have an increased chance of developing penile cancer, with 10 to 20 men per 100,000 being diagnosed per year (Wood, 2011).

    Uncircumcised men are three times more likely to develop this form of cancer than men who are circumcised. In addition, men who have an unretractable foreskin are 10 times more likely than other men to develop penile cancer.

    Other risk factors include:

    • poor hygiene
    • age 60 or older
    • poor personal hygiene, especially in uncircumcised men who fail to remove the buildup of skin, moisture, and oil (smegma) that collects underneath the fold of skin
    • prior diagnosis with a sexually transmitted infection such as HPV
    • smoking
    • multiple sexual partners

    Recognizing Potential Signs of Penile Cancer

    The first noticeable symptom of penile cancer is usually a lump, mass, or ulcer, which can be a small, insignificant bump or a large, infected sore. Penile cancers usually are located on the head and/or foreskin instead of the shaft. Other symptoms include:

    • itching and burning
    • raised, wart-like, flat, or inflamed sores
    • discharge
    • bleeding
    • redness
    • irritation
    • swollen lymph nodes in the groin

    Diagnosing Penile Cancer

    The earlier a diagnosis takes place, the better the chances are for a full recovery. Unfortunately, because penile cancer occurs so rarely, doctors often do not catch it at the early stages.

    Doctors will normally conduct a physical examination, taking a look at the penis and any lesions or sores that are present.

    If cancer is suspected, your doctor will normally take a biopsy of the skin or tissue from the penis. A pathologist examines the tissue to see what types of cells are present. If they are cancerous, your doctor may want to check if the cancer has spread. This is completed via cystoscopy. This procedure includes inserting a small camera into the penis opening and sending it all the way to the bladder. In addition, an MRI (imaging test) of the penis is sometimes conducted to ensure that tumors have not invaded the deeper tissues of the penis.

    Stages of Penile Cancer

    There are six stages of penile cancer. When the doctor diagnoses your cancer, he or she will be able to determine which stage you are currently in. The symptoms of each stage are located in the chart below:

    STAGE

    SYMPTOMS

    Stage 0

    • tumor nor cancer cells have spread to any other tissue
    • tumor involves only the cells in which it began

    Stage 1

    • tumor has invaded the connective tissue below the first layer of skin
    • the cancer has not spread to any glands, lymph nodes, or other parts of the body

    Stage 2

    • tumor has invaded the connective tissue below the skin, the erectile tissues, or the urethra
    • the cancer has not spread to any glands, lymph nodes, or other parts of the body

    Stage 3a

    • tumor has invaded the connective tissue below the skin, the erectile tissues, or the urethra
    • cancer has spread to a single gland or lymph node in the groin
    • cancer has not spread to any other parts of the body

    Stage 3b

    • tumor has invaded the connective tissue below the skin, the erectile tissues, or the urethra
    • cancer has spread to more than one shallow gland or lymph node in the groin
    • cancer has not spread to any other parts of the body

    Stage 4

    • tumor has invaded other structures, such as

    pelvic bones, prostate glands

    • cancer has spread to deep glands or lymph nodes
    • cancer has spread to other areas and organs of the body

    How Is Penile Cancer Treated?

    There are two main types of penile cancer: invasive and noninvasive. Noninvasive cancers are where the cancer has not spread to deeper parts of the penis tissue. Invasive cancers are where the cancer has moved deep into the penis tissue and surrounding lymph nodes.

    Noninvasive Treatment

    Some of the main treatments for noninvasive penile cancer include:

    • local treatments­­—topical chemotherapy in which medicine is placed directly on the skin lesion
    • circumcision
    • local excision—cancer tissue on skin surface is removed
    • laser surgery—laser removes surface lesions
    • topical chemotherapy
    • radiation therapy—high energy x-rays pointed at tumor area
    • cryosurgery—tumor is frozen, then destroyed

    Invasive Treatment—Types of Surgery

    Surgery can include removing the tumor and foreskin, the entire penis, and/or groin and pelvis lymph nodes.

    Excisional surgery involves numbing the area to be removed with local anesthesia and removing the entire area, leaving a border of healthy tissue. The skin is closed with stitches, and the tissue is sent to a laboratory to make sure that all the cancer was removed.

    Moh’s surgery is a very detailed surgery where the doctor attempts to remove the absolute least amount of tissue while still getting rid of all the cancerous cells. He or she will remove a thin layer of the tumor and then look at it under a microscope to see if it contains cancer cells. This process is repeated until there are no cancer cells present in the layers removed.

    Partial penectomy is a surgery in which part of the penis is removed. This will only work if the tumor is less than 2 centimeters. For tumors larger than 2 centimeters, the entire penis will have to be removed. Full removal is called a penectomy.

    Following Up After Surgery

    After surgery, you should follow up about every two to four months during the first year, especially if lymph nodes were not removed. The most important thing you can do to increase your chances of remaining cancer-free is to stick with any follow-up treatment suggested by your doctor.

    For cases where the entire penis is removed, your cancer will have to be in full remission for two years or more before you can be a candidate for penis reconstructive surgery.

    Clinical Trials for New Treatment Methods

    The following treatments are being studied in clinical trials, but are not being used as common treatments:

    Biologic Therapy

    This form of therapy uses a patient’s immune system to fight cancer. Substances created by the body or made in a lab are injected to stimulate the body’s natural immune response.

    Radio Sensitizers

    Drugs can make tumor cells more sensitive to radiation therapy. This treatment combined with radiation therapy is believed to kill more tumor cells.

    Sentinel Lymph Node Biopsy Followed By Surgery

    Blue dye is injected into a blood vessel near the penis. Dye will flow into the closest lymph nodes. The lymph nodes with the dye will be removed and checked for the presence of cancer cells.

    Long-Term Outlook for Penile Cancer

    Your level of recovery will depend on what stage of cancer you were diagnosed with. If your tumors were at superficial levels of tissue or shallow lymph node glands, then your prognosis is most likely very good. Tumors that never spread to glands or lymph nodes have cure rates between 80 and 100 percent. However, if the cancer reaches the deep lymph nodes in the groin, the survival rate drops to below 50 percent within a five-year period (Wood, 2011).