Penile Cancer – Causes, Signs, and Symptoms.

Description

Penile cancer is a disease in which malignant (cancer) cells form in the tissues of the penis. It is the male sex organ that passes sperm and urine from the body. The most common type of penile cancer is squamous cell carcinoma (cancer that begins in flat cells in the top layer of the skin). It usually forms on or under the foreskin (the loose skin covering the head of the penis). Signs of penile cancer include sores or other skin changes, discharge, and bleeding. Human papillomavirus (HPV) causes about one-third of penile cancer cases. Circumcision (removal of the foreskin) may help prevent HPV and decrease the risk of penile cancer. When found early, penile cancer can usually be cured.

 

Types of penile cancer

There are several types of penile cancer:

• Epidermoid/squamous cell carcinoma. Ninety-five percent (95%) of penile cancer is epidermoid, or squamous cell, carcinoma. This means that the cells look like the tissues that make up skin when seen through a microscope. Squamous cell carcinoma can begin anywhere on the penis. But it usually develops on or under the foreskin. When found at an early stage, epidermoid carcinoma can usually be cured.
• Basal cell carcinoma. Basal cells can sometimes become cancerous. These are round cells located under the squamous cells in a layer of skin called the lower epidermis. Basal cell carcinoma is a type of non-melanoma skin cancer. Less than 2% of penile cancers are basal cell cancers.
• Melanoma. The deepest layer of the epidermis contains scattered cells called melanocytes. These cells make the melanin that gives skin color. Melanoma starts in melanocytes. It is the most serious type of skin cancer. This type of cancer sometimes occurs on the surface of the penis. Learn more about melanoma.
• Sarcoma. About 1% of penile cancers are sarcomas. Sarcomas develop in the tissues that support and connect the body, such as blood vessels, muscle, and fat. Learn more about sarcoma.

This section covers cancer that begins in or on the penis. Learn about cancer that starts in the testicles in a separate section of this website.

Pathophysiology

Penile cancers usually begin as small lesions on the glans or prepuce. They range from white-grey, irregular exophytic to reddish flat and ulcerated endophytic masses. They gradually grow laterally along the surface and can cover the entire glans and prepuce before invading the corpora and shaft of the penis. The more extensive the lesion, the greater the possibility of local invasion and nodal metastasis. Penile cancers may be papillary and exophytic or flat and ulcerative. Untreated, penile autoamputation can occur.

The growth rates of the papillary and ulcerative lesions are similar, but the flat ulcerative lesions tend to metastasize to the lymph nodes earlier and are therefore associated with a lower 5-year survival rate. Cancers larger than 5 cm and those involving more than 75% of the shaft are associated with a high prevalence of nodal metastases and a lower survival rate, but a consistent relationship among the size of the cancer, the presence of inguinal node metastases, and survival has not been identified.

Main causes of penile cancer

Roughly half of all penile cancers are caused by certain types of a virus called human papillomavirus (HPV).

There are different types of HPV and some affect the genital area.

You can get HPV from:

• any skin-to-skin contact of the genital area
• vaginal, anal or oral sex
• sharing sex toys

Most people affected by HPV will not get penile cancer.

Risk factors

Certain risk factors can increase your chances of getting penile cancer which are as follows:

Men who carry the human papilloma virus (HPV) have an increased risk of developing penile cancer, which is the virus that causes genital warts.

Studies have found that almost 5 out of 10 men (47%) with penile cancer also have an HPV infection.

Age is also a risk factor for cancer of the penis. The condition rarely affects men under 40 years of age, and most commonly occurs in men aged over 60.

Smoking is the most significant lifestyle factor associated with penile cancer. Chemicals found in cigarettes can damage cells in the penis, which increases your risk of getting the condition.

Conditions that affect the penis, such as phimosis, which makes the foreskin difficult to retract, increase your chances of developing infections such as balanitis.

Repeated infections are linked to a higher risk of developing some types of penile cancer, because they can weaken your immune system.

Symptoms

The earlier penile cancer is found, the better. If it’s found early, there is a good chance for successful treatment and a cure. If diagnosis is delayed, the disease can get worse. Treatment for more advanced cancer may be less successful and more disfiguring.

Since you see and touch your penis when you urinate, you can help spot the disease early. Men who aren’t circumcised are at greater risk for penile cancer. But every man should be on the lookout for penile lesions.

You should see your health care provider if you notice any of these on the foreskin, or the shaft or head of your penis:

• An area of skin becoming thicker and/or changing color
• A lump on the penis
• An ulcer (sore) that might bleed
• A reddish, velvety rash
• Small, crusty bumps
• Flat, bluish-brown growths
• Smelly discharge (fluid) under the foreskin
• Swelling

Most of these signs may be from a bacterial or fungal infection, or even an allergic reaction. All of these will respond to antibacterial or antifungal ointments and creams. But growths that return or sores that don’t heal must be thought of as cancer until it’s proven they’re not.

Penile cancer is often, unfortunately, ignored until it is advanced. Patients are reluctant or embarrassed to talk about their genitals. Or, they may be afraid of treatment or surgery on the penis. If you notice any of these signs, it’s important to have them checked by a health care provider as soon as you can.

Possible Complications

Untreated, penile cancer can spread to other parts of the body (metastasize) early in the disease.

Diagnosis and Tests for Penile Cancer

If you have possible symptoms of penile cancer you should go to a doctor. A physical exam will be done and you might also need some tests to find out what’s causing your symptoms.

Medical history and physical exam

The doctor will talk to you about your medical history and the details of your symptoms, like when they started and if they’ve changed. You’ll also discuss any possible risk factors you have.

The doctor will also look at your genital area carefully for possible signs of penile cancer or other health problems. Penile lesions (sores) usually affect the skin on the penis, so a doctor often can find cancers and other problems by looking closely at the penis. The doctor may look at and feel the lymph nodes in your groin to see if they are swollen.

If symptoms and/or the exam suggest you might have penile cancer, other tests will be needed. These might include a biopsy and imaging tests.

Biopsy

A biopsy is the only sure way to know if a change is penile cancer. To do this, a small piece of tissue is taken from the changed area and sent to a lab. There, it’s looked at with a microscope to see if it contains cancer cells. The results are usually available in a few days, but may take longer in some cases There are many ways a biopsy can be done:

Incisional biopsy

For an incisional biopsy only a part of the changed area is removed. This type of biopsy is often done for lesions that are big, ulcerated (the top layer of skin is missing or the lesion appears as a sore), or that appear to grow deeply into the penis.

These biopsies are usually done with local anesthesia (numbing medicine) in a doctor’s office, clinic, or outpatient surgical center.

Excisional biopsy

In an excisional biopsy, the entire lesion is removed. This type of biopsy is most often used if the lesion is small, such as a nodule (lump) or plaque (raised, flat area).

These biopsies are usually done in a hospital or outpatient surgical center. Local anesthesia (numbing medicine) or general anesthesia (where you are asleep) may be used.

Lymph node biopsy

If the cancer has spread deep within the penis, nearby lymph nodes usually will need to be checked for cancer spread. This is done to help find the stage (extent) of the cancer after the diagnosis. These lymph nodes can be checked either with fine needle aspiration or by doing surgery to remove them.

Fine needle aspiration (FNA): To do this type of biopsy, the doctor puts a thin, hollow needle right into the lymph node and uses a syringe to pull out cells and a few drops of fluid. Local anesthesia may be put into the skin over the node to numb the area first.

If the enlarged lymph node is deep inside your body and the doctor can’t feel it, imaging methods such as ultrasound or CT scans can be used to guide the needle into the node.

This type of biopsy is often done to see if enlarged lymph nodes contain cancer. It’s not used to sample lesions on the penis itself. This procedure can be done in a doctor’s office or clinic.

Surgical biopsy: In some cases, the lymph nodes are not checked with FNA, but instead surgery is done to remove one or more lymph nodes. These surgical lymph node biopsies, which include sentinel lymph node biopsy and lymphadenectomy.

Imaging tests

Imaging tests use x-rays, magnetic fields, or sound waves to create pictures of the inside of your body. If the doctor thinks the cancer has spread, then one or more of these tests may be used to help find the stage of the cancer.

Computed tomography (CT)

A CT scan uses x-rays to make detailed cross-sectional images of your body. It can show how big the tumor is and can also help see if the cancer has spread to lymph nodes or other parts of the body.

CT-guided needle biopsy: CT scans can be used to guide a biopsy needle into an enlarged lymph node or other area that might be cancer spread. To do this, you stay on the CT table while a doctor moves a biopsy needle through your skin and toward the mass. CT scans are repeated until the needle is inside the mass. A biopsy sample is then removed and sent to be checked under a microscope.

Magnetic resonance imaging (MRI)

Like CT scans, MRIs show detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays.

MRI pictures are better if the penis is erect. The doctor might inject a hormone-like substance called prostaglandin into the penis to make it erect.

Ultrasound

Ultrasound uses sound waves to make pictures of internal organs or masses. It can be useful to find out how deeply the cancer has spread into the penis. It can also help find enlarged lymph nodes in the groin.

This test is painless and does not expose you to radiation. For most ultrasound exams, the skin is first lubricated with gel. Then a technician moves the transducer over the skin of the penis.

Chest x-ray

An x-ray might be done to see if the cancer has spread to the lungs.

What are the stages of penile cancer?

The stage of cancer describes the extent and severity of cancer. The treatment and prognosis of cancer depend on the stage of cancer at the time of diagnosis:

• Stage 0: Cancer is limited to the top layer of the skin and had not spread to any other part of the body.
• Stage 1: Cancer spreads into the deeper layer and connective tissue below the skin. It is still limited to just the penis and does not spread to other parts of the body.
• Stage 2: Cancer spreads to the connective tissue below the skin, lymph vessels, and/or blood vessels. It spreads to the urethra and/or erectile tissues. It still doesn’t spread to other parts of the body at this stage.
• Stage 3A: Cancer spreads to one or two lymph nodes in the groin but not to other parts of the body.
• Stage 3B: Cancer spreads to multiple lymph nodes in the groin but not to other parts of the body.
• Stage 4: Cancer spreads to the surrounding areas such as the prostate, scrotum, and pubic bone (hip bone).

How is penile cancer treated?

The two main types of penile cancer are invasive and noninvasive. Noninvasive penile cancer is a condition in which the cancer hasn’t spread to deeper tissues, lymph nodes, or glands.

Invasive penile cancer is a condition in which the cancer has moved deep into the penis tissue and surrounding lymph nodes and glands.

Some of the main treatments for noninvasive penile cancer include:

• Circumcision. The foreskin of the penis is removed.
• Laser therapy. High intensity light is focused to destroy tumors and cancer cells.
• Chemotherapy. An aggressive form of chemical drug therapy helps eliminate cancer cells in the body.
• Immunotherapy. A biological therapy created in a lab boosts, directs, or restores the body’s immune system against cancer cells.
• Radiation therapy. High energy radiation shrinks tumors and kills cancer cells.
• Cryosurgery. Liquid nitrogen freezes tumors and removes them.

Treatment for invasive penile cancer requires major surgery. Surgery may involve the removal of the tumor, entire penis, or lymph nodes in the groin and pelvis.

Surgery

Surgery options include the following:

Excisional surgery

Excisional surgery may be performed to remove the tumor from the penis. You’ll be given a local anesthetic to numb the area so you don’t feel any pain. Your surgeon will then remove the tumor and affected area, leaving a border of healthy tissue and skin. The incision will be closed with stitches.

Moh’s surgery

The goal of Moh’s surgery is to remove the least amount of tissue possible while still getting rid of all the cancer cells.

During this procedure, your surgeon will remove a thin layer of the affected area. They’ll then examine it under a microscope to determine whether it contains cancer cells. This process is repeated until there are no cancer cells present in the tissue samples.

Partial penectomy

A partial penectomy removes part of the penis. This operation works best if the tumor is small. For larger tumors, the entire penis may be removed. Full removal of the penis is called a total penectomy.

Regardless of the type of surgery performed, you’ll need to follow up with your doctor every 2 to 4 months during the first year after your surgery. If your entire penis is removed, you can talk with a doctor about whether penis reconstructive surgery may be an option.

Penile Cancer Prevention

There’s no one way to prevent cancer, but some things can lower your risk:

• Have a circumcision. When you don’t have a foreskin, it’s easier to keep the area clean.
• If you have a foreskin, make sure to carefully clean underneath it.
• Don’t use tobacco.
• Use safe sex practices to avoid HPV and HIV infections.