What is Penile Cancer?
Cancer of the penis develops in or on the penis & which begins when cells of this region grow out of control. In order to understand penile cancer, it would immensely help to know the structure & function of penis. Penis is external male sexual organ & which is also a part of the urinary system. Penis is composed of several types of body tissues including blood vessels, nerves, smooth muscle & skin. Main part of penis is known as shaft & the head is called glans. The glans is normally covered by skin called prepuce or foreskin at birth & which is often removed in infant boys by operation called circumcision. There are 3 chambers inside penis which contain soft & spongy network of blood vessels. Two of these are cylinder shaped chambers known as corpora cavernosa& lie on either side of upper part of penis. The third chamber is under the shaft & is known as corpus spongiosum. This chamber widens at the end to form the glans. Corpus spongiosum is a thin tube which starts at the bladder & runs through the penis while surrounding the urethra. Both urine & semen travel through urethra & leave body through the glans. The opening at the glans of penis is known as meatus.
Causes of Penile Cancer & Risk Factors
The exact cause of penile cancer, like most other cancers, is not yet known. But there are a number of risk factors closely associated with developing penile cancer.
Some Most Common Risk Factors for Penile Cancer include -
- Human Papilloma Virus (HPV) - HPV infection is common & passed on from one person to another by sexual contact. However, for most people HPV causes no harm & goes away without any treatment. Nevertheless, it poses increased risk of developing penile cancer. Commonly called 'wart virus' because of its appearance, men with history of genital warts are at increased risk of cancer of the penis.
- Age Factor - While most cases of penile cancer are in men aged over 60 years, it is quite rare for men below 40 years to develop cancer of the penis.
- Smoking - It has been observed that men who smoke are more likely to develop penile cancer. Chemicals like benzyrene in cigarettes are supposed to be the culprit & which damage the DNA of cells in penis thereby increasing risk.
- Weakened Immune System - You face an increased risk of penile cancer with a weakened immune system. HIV, AIDS or drugs to dampen immune system after organ transplants could contribute to cancer of the penis in some men.
- Circumcision - This small operation to remove part or all, of the foreskin also appears to affect risk of penile cancer. This is more evident when men are circumcised in their teens. However, men who are circumcised as babies or in adulthood are less likely to develop penile cancer.
- Build-Up of Secretions Under Foreskin - Secretions & dead skin cells often build-up under foreskin among uncircumcised men. Therefore, they should regularly pull-back foreskin to clean under it. This thick & bad smelling substance called smegma causes irritation & inflammation of the penis. Men with phimosis are at a higher risk of developing penile cancer.
- Psoriasis Treatment - Psoriasis is a chronic skin condition & is sometimes treated with combination of drugs called psoralen& phototherapy. This treatment is called PUVA & can also be applicable for cancer patients. Men treated with PUVA appear to have increased risk of developing cancer of the penis.
Signs & Symptoms of Penile Cancer
Signs & symptoms associated with penile cancer do not necessarily confirm existence of cancer as they are also likely to be caused by other conditions. But then, it would be wiser to see the doctor immediately so that it can be investigated & treated if found. Treating cancer in early stages is essential to successful outcomes.
Some Common Symptoms of Penile Cancer include -
- Skin Changes - First signs of penile cancer happen as changes in the skin of penis. Most often on the glans or foreskin & sometimes on the shaft as well. Other signs & symptoms of penile cancer include skin area of penis becoming thicker and/or changing color, ulcers which bleed, lump on the penis, reddish & velvety rash, small crusty bumps, bluish-brown flat growths & smelly discharge under foreskin. While sores & lumps on penis are usually not painful, they can also be at times.
- Swelling - Swelling at glans penis in cases where foreskin is constricted is a possible sign of cancer of the penis.
- Lumps Under Skin in Groin Area - When cancer spreads from penis, it travels to lymph nodes in groin area. Lymph nodes are normally bean-sized & can barely be felt. But when swollen they can be felt as lumps under skin. However, swollen lymph nodes do not always mean cancer & can also be response to some infection. Skin inside & around penile cancer may cause nearby lymph nodes to swell, even if cancer has not reached them.
How is Penile Cancer Diagnosed?
In case you witness any signs & symptoms of penile cancer, you should visit the doctor who will prescribe some of these tests for diagnosis.
- Medical History & Physical Exam - Doctors will need a complete medical history including details about symptoms & possible risk factors. They will also examine the genital area carefully for possible signs of penile cancer. Since penile lesions affect skin on penis, close examination can often be helpful. They will also look & examine lymph nodes in groin area to see if they are swollen. In case examination results suggest penile cancer, you will need other tests including biopsy & imaging tests.
- Biopsy - Biopsy is important to diagnosing penile cancer. A small piece of tissue is extracted from abnormal area & sent to lab for examination under a microscope. Results are available in a few days, but may at times take longer.
Types of Biopsy for Penile Cancer -
Incisional Biopsy removes only a part of abnormal area. Often done for lesions which are large, ulcerated with top layer of skin missing or appearing as a sore, or appearing to grow deep into penis; this biopsy is usually done with local anesthesia in doctor's office, clinic or outpatient surgical center.
Excisional Biopsy removes the entire lesion. Most often used in case abnormal area is small, like nodules or plaque. In case this is only on the foreskin, doctors may recommend circumcision as form of excisional biopsy. This procedure is usually performed in hospital or outpatient surgical center under local or general anesthesia.
Lymph Node Biopsy is prescribed when penile cancer has invaded deep within penis to nearby lymph nodes. This biopsy is done to help determine stage of cancer after diagnosis. It is checked with fine needle aspiration or surgery in doctor's office or clinic.
- Imaging Tests - generally use X-rays, magnetic fields or sound waves so as to create pictures from inside the body. When doctors think cancer has advanced & spread, then one or more of these imaging tests may be prescribed to help determine stage of penile cancer.
Types of Imaging for Penile Cancer -
Computed Tomography (CT): Scans use X-ray so as to make detailed cross-section images of body tissue instead of a single picture. While the CT scanner takes several pictures rotating around you, the computer combines them into images of slices of parts of body. While CT scans take longer than X-rays, patients may also be asked to drink 1 - 2 pints of oral contrast dye liquid before test or get an IV injection to help better outline abnormal areas in body.
Magnetic Resonance Imaging (MRI): Scans provide detailed images of soft tissues in body. These use strong magnets & radio waves to create images. As with CT scans, contrast material may also be injected at times for MRI scans. Pictures of penile tumors with MRI scans are better when penis is erect & for this purpose doctors may inject prostaglandin into penis before scan. MRI scans often take up to an hour & therefore are a little uncomfortable.
Ultrasound: uses sound waves to make pictures of internal organs. Often useful for determining deep cancers that have penetrated into penis, it can also effectively reveal enlarged lymph nodes in groin. A small microphone like instrument called transducer emits sound waves & picks up echoes as they bounce off body tissues & which are subsequently converted by computer into images. This test is free of radiation & any kind of pain. The skin is lubricated with gel first for ultrasound, after which the technician moves transducer over skin of the body part which is to be examined.
Prognosis & Treatment of Penile Cancer
Treatment & prognosis of penile cancer depend on the following factors.
- Stage of penile cancer.
- Location & size of tumor.
- Whether penile cancer is newly diagnosed or recurred.
Different types of treatment options are available for penile cancer. Some of these are standard while others are going through clinical trials. While quite a few patients might want to take part in clinical trials, many trials are only open to patients who have yet not started treatment.
Four Types of Standard Treatments are presently available -
- Surgery - This is the most common therapy for penile cancer of all stages. Doctors may remove the cancer using the following methods -
- Mohs Microsurgery
- Laser Surgery
- Wide Local Excision
- Amputation of Penis
Lymph nodes within the groin area may also be taken out during surgery. Even though entire cancer has been removed through surgery, doctors may additionally recommend chemotherapy or radiation therapy to kill any cancer cells left behind. Adjuvant therapy is also prescribed in some cases to prevent risk of cancer coming back.
- Radiation Therapy - This penile cancer treatment uses high-energy X-rays or other types of radiation to destroy cancer cells or to prevent them from growing. Two types of radiation which are commonly employed include External radiation which uses a machine outside body send radiation towards cancer & Internal radiation which uses radioactive substances sealed in catheters, wires, seeds or needles & which are directly placed in or near cancer. However, application of radiation therapy depends on stage & type of cancer under treatment.
- Chemotherapy - This treatment procedure uses drugs to stop growth of cancer. It can be taken orally or administered through injections into veins or muscles. Known as systemic chemotherapy, drugs in this procedure enter bloodstream & reach cancer cells throughout the body. In topical chemotherapy, drugs are placed directly on skin while regional chemotherapy places them into cerebrospinal fluid, into the organ or body cavity like abdomen, depending upon the type & stage of cancer. Topical chemotherapy can be an ideal option sor treating Stage 0 of Penile Cancer.
- Biologic Therapy - This treatment procedure enables the patient's immune system to fight cancer. Substances made in a laboratory or the body is used to direct, restore or boost body's natural defenses against cancer. Also known as Immunotherapy or Biotherapy, topical biologic therapy with imiquimod may be effectively used to treat Stage 0 of Penile Cancer.
Types of Treatments under Clinical Trials
- Radiosensitizers - These are drugs which make cancer cells more sensitive to radiation therapy. Combining radiosensitizers with radiation therapy helps effectively destroy tumor cells.
- Sentinel Lymph Node Biopsy following Surgery - This is removal of the sentinel lymph node during surgery & which is the first lymph node receiving lymphatic drainage from tumor.
Determining Penile Cancer Stages
Tests are typically done after diagnosing penile cancer so as to evaluate if cancer cells have spread within penis or to other parts of the body.
- Stages of Penile Cancer
- Stage 0 - Carcinoma in Situ
When growths or abnormal cells look like warts & are found on the surface of skin of penis. These growths may eventually become cancerous & spread into adjoining normal tissue.
- Stage I - Cancer has formed & spread to connective tissue under skin of penis. However, it has not spread to blood vessels or lymph vessels. Moreover, tumor cells still look like normal cells under microscope.
- Stage II - Cancer has spread to connective tissue under skin of penis, & has also crawled into blood vessels & lymph vessels. Tumor cells look very different from normal cells under microscope. Cancer has moved through connective tissue to erectile spongy tissue or beyond erectile tissue to urethra.
- Stage III - This stage is divided into Stage IIIa& Stage IIIb
- Stage IIIa - When cancer has spread to one lymph node in groin. It has also spread to connective tissue under skin of penis& may have spread to blood vessels & lymph vessels. Cancer has crawled through connective tissue to erectile spongy tissue or beyond to urethra. Tumor cells look very different from normal cells under microscope.
- Stage IIIb - When cancer has spread to more than one lymph node on one or both sides of the groin. It has also moved to connective tissue under the skin of penis & to blood vessels & lymph vessels. Or cancer may have moved through connective tissue to erectile spongy tissue or beyond to the urethra. Tumor cells also look very different from normal cells under microscope.
- Stage IV - Penile cancer is in Stage IV when cancer has spread to nearby tissues like prostate & to lymph nodes in the groin or pelvis; Or it has also spread to one or more lymph nodes in pelvis; Or spread from lymph nodes to tissues surrounding lymph nodes; Or to distant parts within the body.
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