What is Penile Cancer?
Penile cancer is a disease in which malignant (cancer) cells form in the tissues of the penis. The penis is a rod-shaped male reproductive organ that passes sperm and urine from the body.
The main part of the penis is known as the shaft, and the head of the penis is called the glans. At birth, the glans is covered by a piece of skin called the foreskin, or prepuce. The foreskin is often removed in infant boys in an operation called a circumcision.
The penis contains two types of erectile tissue (spongy tissue with blood vessels that fill with blood to make an erection):
- Corpora Cavernosa - The two columns of erectile tissue that form most of the penis. They lie on either side of the upper part of the organ.
- Corpus Spongiosum - The single column of erectile tissue that forms a small portion of the penis. This chamber widens at its end to form the glans and surrounds the urethra (the thin tube that starts at the bladder and runs through the penis. Urine and semen travel through the urethra to pass from the body).
Sometimes, growths can develop on the penis that are abnormal but are not cancers (they are benign). These lesions can look like warts or irritated patches of skin. Like penile cancer, they are most often found on the glans or on the foreskin, but they can also occur along the shaft of the penis.
- Condylomas - These are wart-like growths that look like tiny cauliflowers. Some are so small that they can only be seen when the skin is looked at under a magnifying lens. Others may be as large as an inch or more across. Condylomas are caused by infection with human papilloma virus (HPV).
- Bowenoid Papulosis - In this condition, abnormal cells are seen only in the surface layer of the penile skin. This condition tends to occur in younger men and is seen as small, reddish, pimple-like patches on the shaft of the penis. Bowenoid papulosis can be mistaken for early-stage cancer called carcinoma in situ (CIS), but most doctors agree it is not cancer or a pre-cancerous condition.
Symptoms and Diagnosis
Research is increasing regarding what we know about penile cancer. Scientists are learning more about its causes.
Human papillomavirus (HPV) infection may increase the risk of developing penile cancer.
Circumcision may help prevent infection with the HPV. A circumcision is an operation in which the doctor removes part or all of the foreskin from the penis. Many boys are circumcised shortly after birth. Men who were not circumcised at birth may have a higher risk of developing penile cancer.
Other risk factors for penile cancer include:
- Age - Being age 60 or older
- Phimosis - A condition in which the foreskin cannot be pulled back over the glans of the penis
- Hygiene - Having poor personal hygiene
- Sex - Having many sexual partners
- Tobacco - Using tobacco products
Signs and Symptoms
These and other symptoms may be caused by penile cancer. Other conditions may cause the same symptoms. A doctor should be consulted if you experience redness, irritation, or a sore on the penis, or a lump on the penis.
If a patient has symptoms that could be penile cancer, the doctor will test for fever and high blood pressure and check general signs of health. The patient will likely have one or more of the following tests:
- Physical Exam - An exam of the body to check general signs of health, including checking the penis for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Biopsy - The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer.
If penile cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has spread, and if so, to what parts of the body.
These are the main features of each stage of the disease:
Stage 0 (Carcinoma in Situ)
In stage 0, abnormal cells that look like warts are found on the surface of the skin of the penis. Stage 0 is also called carcinoma in situ.
In stage I, cancer has formed and spread to connective tissue just under the skin of the penis. Cancer has not spread to lymph vessels or blood vessels.
In stage II, cancer has spread to connective tissue just under the skin of the penis, through connective tissue to erectile tissue or beyond erectile tissue to the urethra.
Stage III is divided into stage IIIa and stage IIIb: In stage IIIa, cancer has spread to one lymph node in the groin. It has also spread to connective tissue just under the skin of the penis, through connective tissue to erectile tissue or beyond erectile tissue to the urethra. In stage IIIb, cancer has spread to more than one lymph node on one side of the groin or to lymph nodes on both sides of the groin. It has also spread to connective tissue just under the skin of the penis, through connective tissue to erectile tissue or beyond erectile tissue to the urethra.
In stage IV, cancer has spread to tissues near the penis such as the prostate and may have spread to lymph nodes in the groin or pelvis. It may have also spread to one or more lymph nodes in the pelvis, from the lymph nodes to the tissues around the lymph nodes or to distant parts of the body. Knowing the stage assists the doctor in determining a prognosis. It also better helps you understand the care and treatment that will be required.
Surgery to Remove Lymph Nodes
Patients with cancers that have invaded deep within the penis (stage T2 or higher) usually need to have nearby lymph nodes removed. The surgeon drains the tumor from the first lymph node (sentinel node) and removes it. If the sentinel node contains cancer, a more extensive operation, known as a lymph node dissection or inguinal lymphadenectomy, is performed. If the sentinel node does not have cancer cells, the surgeon doesn't have to remove any more lymph nodes.
Not all doctors agree on how useful this type of operation is for penile cancer, and some prefer to remove more lymph nodes up front with an inguinal lymphadenectomy. Discuss the procedure with your doctor.
Treatment and Side Effects Management
Generally, treatment for penile cancer varies according to the stage and progression of the disease. In all cases, treatment should be individualized for you. Although cancers are classified into particular stages, each person is unique.
Stage 0 (Carcinoma in Situ)
Treatment of stage 0 may be one of the following:
- Mohs Microsurgery
- Topical Chemotherapy
- Topical Biologic Therapy
- Laser Surgery
If the cancer is only in the foreskin, wide local excision and circumcision may be the only treatment needed. Treatment of stage I may include the following:
- Surgery (partial or total penectomy with or without removal of lymph nodes in the groin) External or internal radiation therapy
- Mohs Microsurgery
- A clinical trial of laser therapy
Treatment of stage II may include the following:
- Surgery (partial or total penectomy with or without removal of lymph nodes in the groin) External or internal radiation therapy followed by surgery
- A clinical trial of sentinel lymph node biopsy followed by surgery
- A clinical trial of laser surgery
Treatment of stage III may include the following:
- Surgery (penectomy and removal of lymph nodes in the groin) with or without radiation therapy
- Radiation Therapy
- A clinical trial of one of the following: Sentinal Lymph Node Biopsy, Radiosensitizers, Chemotherapy
Treatment of stage IV penile cancer is usually Palliative (to relieve symptoms and improve the quality of life). Treatment may include the following:
- Surgery (wide local excision and removal of lymph nodes in the groin)
- Radiation Therapy
- A clinical trial of chemotherapy before or after surgery
It helps to learn more about the side effects from your treatment(s) before you begin, so you will know what to expect. When you know more, you can work with your health care team to manage your quality of life during and after treatment. There are effective and readily available medications to address traditional side effects from cancer treatment (such as nausea, diarrhea, constipation and mouth sores.)
As newer targeted therapies become available, they tend to leave people with fewer traditional side effects. Keep in mind that everyone reacts differently to treatment and experiences side effects differently. There are coping mechanisms and strategies that can help.
Side Effects from Penile Treatments Surgery
The lymph nodes are part of the system that normally helps excess fluid drain out of the legs and back into the bloodstream. Removing many lymph nodes in an area can lead to abnormal swelling from problems with fluid drainage. This condition is called lymphedema. Lymphedema can occur even when only one lymph node or the lymph nodes from only one groin area are removed.
Possible side effects of radiation to the pelvic area and groin lymph nodes include tiredness, nausea, or diarrhea.
Chemotherapy has different side effects depending on the type and dose of drugs given and the length of time they are taken. These side effects can include hair loss, mouth sores, loss of appetite, nausea and vomiting, diarrhea, increased chance of infections (due to low white blood cell counts), easy bruising or bleeding (due to low blood platelet counts) and fatigue (due to low red blood cell counts.)