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Penile Cancer

Overview

Cancer of the penis, which is relatively common in many parts of the world, is rare in the United States, possibly due to Americans' careful personal hygiene and the widespread practice of male circumcision. The American Cancer Society estimates that about 1,200 new cases of penile cancer will be diagnosed in the United States this year, occurring in about 1 man out of 100,000.

The penis has several types of tissue that contain cells that can develop cancer. The majority of penile cancers develop from skin cells called squamous cells - a nonmelanoma form of skin cancer. When detected early, this type of cancer can be cured. While squamous cell cancers can develop anywhere on the penis, most appear on the foreskin in men who have not been circumcised or on the glans - the head of the penis. Verrucous carcinoma is an uncommon form of squamous cell cancer that can develop on male or female genitals. While it can spread into surrounding tissues, it rarely metastasizes. Adenocarcinoma is a very rare type of penile cancer developing in the sweat glands in the skin of the penis but it can spread to the lymph nodes.

Causes and Risk Factors

The exact cause of most penile cancer is unknown. While many men who develop penile cancer have no known risk factors, it may be associated with the following:

  • Human papillomarvirus (HPV) infection - considered the most important avoidable risk factor for penile cancer because the virus can cause warts which are passed along during sexual contact
  • Having unprotected sexual relations with multiple partners, which increases risk of contracting HPV
  • Smoking - thought to damage the DNA of cells in the penis and contribute to the development of penile cancer, especially in men with HPV infection
  • Psoriasis treatment - men who have been treated for psoriasis with a combination of a drug called psoralen and exposure to ultraviolet light have a higher rate of penile cancer
  • Poor hygiene - oily secretions from the skin and dead skin cells, which accumulate under the foreskin, can result in a substance called smegma. While not proven, it has been suggested that smegma may contain cancer-causing substances.

It had been believed that men who are circumcised have a lower risk of developing penile cancer, however, this has not been proven.

Warning Signs

Early symptoms of penile cancer include the appearance of a painless nodule, a warty growth or ulcer on the penis, especially on the glans or foreskin, or swelling at the end of the penis. Any abnormality of the penis, including warts, blisters, sores, ulcers, white patches, rash or bumps, should be evaluated by a physician. Most penile cancers do not cause pain, but can cause ulceration and bleeding in later stages. A number of benign conditions, such as genital warts or infections, can have similar symptoms, but it is important to discuss these with a physician promptly since penile cancer detected and treated in early stages can be curable.

Screening and Diagnosis

In order to determine if an abnormality on the penis is cancer, a biopsy is needed in which a sample of skin tissues is removed for laboratory testing. If cancer is confirmed, tests to determine the extent of the cancer will be recommended, including:

Fine needle aspiration. A type of biopsy in which cells are removed through a thin needle that has been placed directly into the mass.

Ultrasound. This procedure uses sound waves to help determine how deeply a tumor has invaded into the penis.

CT Scan or MRI. A CT scan or MRI may reveal the presence of enlarged lymph nodes - an indication that the cancer has spread.

Lymph node dissection or sentinel lymph node biopsy. These procedures are used to surgically remove lymph nodes in the groin to determine if the cancer has spread. Sentinel lymph node biopsy uses a radioactive tracer to find the first lymph node that may be cancerous. This minimizes the number of lymph nodes that need to be removed for analysis and therefore minimizes side effects of the lymph node dissection.

Treatment

When treated in its early stages, penile cancer can be cured in nearly all patients. Surgery is the most common treatment, particularly for small superficial tumors. Effective approaches to treating squamous cell tumors include Mohs surgery, which enables the surgeon to minimize damage to healthy tissue by progressively removing as little tissue as possible for analysis thereby helping to maintain penile appearance and function. Cryosurgery - a method using liquid nitrogen to freeze and destroy abnormal cells, and laser surgery - an approach which uses a beam of laser light to vaporize cancer cells, can also be used for squamous and basal cell skin cancer.

More invasive cancers may require extensive surgery, including removal of part of or the entire penis. Extensive surgery to remove the lymph nodes that are toward the penis is often necessary. This is one of the rare circumstances in which metastatic cancer can be cured by surgery alone.

Radiation therapy may be recommended as an alternative to surgery for treatment of penile cancer and may help avoid partial or complete removal of the penis. Radiation therapy may be used to target affected lymph nodes in the groin and pelvic area or used following surgery to reduce the risk of the cancer recurring.

Chemotherapy may be used topically, which means the medication is placed directly on the skin, or systemically, with drugs given by injection or mouth. Topical chemotherapy reaches cancer cells near the skin?s surface, but does not reach those that have spread.

Prevention

It is thought that penile cancer is a preventable disease since there are wide variations in the incidence of this cancer around the world. In general, it is best to avoid the known risk factors mentioned previously. Reducing the chance of developing penile cancer includes avoiding sexual practices that are likely to result in human papillomavirus infection, limiting the number of sexual partners, and quitting smoking. In addition, practicing good genital hygiene by retracting the foreskin (in uncircumcised men) and cleaning the entire penis is important since some, but not all, studies suggest that a substance called smegma could contain cancer-causing elements.

It is still questionable whether circumcision reduces the risk of developing penile cancer; especially since penile cancer risk is low in some uncircumcised populations.

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