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Penile Cancer (Cancer of the Penis)

cancer penis


Penile cancer is a cancer that develops on the penis. Penile cancer is rare . Most cases develop in men over the age of 50. The cause is not clear. There is a good chance of a cure if it is diagnosed and treated in an early stage (as many cases are). In general, the more advanced the cancer (the more it has grown and spread), the less chance that treatment will be curative.

What causes it?

A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply 'out of control'. In most cases, the reason why penile cancer develops is not known. However, there are factors which are known to alter the risk of penile cancer developing. These include:

Age. Penile cancer is more common in men over the age of 50.
Many cases of penile cancer are associated with an infection with certain types of human papillomavirus (see below).
Phimosis in adults and poor hygiene around the foreskin can increase the risk of penile cancer. Phimosis is when the foreskin remains unusually tight and cannot be drawn back from the head of the penis.
Having a circumcision as a baby or child seems to protect against penile cancer.

Human papilloma virus (HPV) and penile cancer

There are many strains of HPV. Two types, HPV 16 and 18, are involved in the development of many cases of penile cancer. The strains of HPV associated with penile cancer are nearly always passed on by having sex with an infected person. An infection with one of these strains of HPV does not usually cause symptoms. So, you cannot tell if you or the person you have sex with are infected with one of these strains of HPV.

What are the symptoms of penile cancer?

Almost all penile cancers first develop on the glans (head) of the penis or on the underside skin of the foreskin (if you are not circumcised). It is rare to develop penile cancer on the main shaft of the penis. Therefore, you may only notice an early cancer if you pull back your foreskin.

Typically, the first symptom is a change in colour of the skin of the affected part of the glans or foreskin of the penis.

The affected skin can also become thickened or appear like a small red rash.

The affected area of skin may then gradually develop into a small flat growth (often bluish-brown in colour) or a growth or sore which may bleed.

It does not usually cause pain. In some cases the early cancer develops as small crusty bumps.

Left untreated, the cancer typically grows to involve the entire surface of the glans and/or foreskin. It then eventually spreads further to deeper parts of the penis and to other areas of the body to cause various other symptoms.

How is penile cancer diagnosed and assessed?

Anyone who has an abnormal growth or sore on their penis will have a thorough examination by their doctor. This will usually include feeling for any enlarged lymph glands in the groin. You will then be referred to see a specialist in the hospital.

It is likely that further tests would be required. These may include:

A biopsy. This is where a small piece of tissue is taken from the cancer and sent to the laboratory. Sometimes biopsies are also taken from the lymph glands in the groin. Results of a biopsy can take two weeks.
An MRI of the penis may be performed to assess the size of the cancer.
A CT scan of the chest, abdomen and pelvis may be performed. These scans can provide detail on the structure of the internal organs. (See separate leaflets called 'CT Scan' and 'MRI Scan' for more details.)

Stages of penile cancer range from stage 1 (where the cancer is confined to the skin of the penis) to stage 4 (where there is spread to lymph nodes deep in the pelvis or to other parts of the body).

Grading of the cancer cells

If a biopsy of the cancer is taken then the cells can assessed. By looking at certain features of the cells under the microscope the cancer can be 'graded'.
Grade 1 -low grade.
Grade 2 - middle grade.
Grade 3 - more 'aggressive'.
Finding out the stage and grade of the cancer helps doctors to advise on the best treatment options. It also gives a reasonable indication of prognosis (outlook).

What are the treatment options for penile cancer?

Treatment options may include surgery, chemotherapy and radiotherapy. The treatment advised for each case depends on various factors such as the stage and grade of the cancer, and your general health.

Surgery

An operation is advised in most cases. The type of operation depends upon the size of the cancer and its position on the penis. If the cancer is small and only on the skin of the penis then the cancer and a small amount of normal tissue can be removed. However, if the cancer is larger then either part of the penis or even the entire penis is removed.
Reconstructive surgery is an option for many men. Your surgeon will be able to discuss the different types of reconstructive surgery with you in more detail. The lymph glands in the groin are often also removed during the operation.

Chemotherapy

Chemotherapy is a treatment of cancer by using anti-cancer drugs which kill cancer cells or stop them from multiplying. Sometimes chemotherapy is given before surgery to reduce the size of the cancer. This may make surgery easier and more likely to be successful.
Chemotherapy may be given after having an operation. This aims to kill any cancer cells that have been left behind following the operation.

Radiotherapy

Radiotherapy is a treatment that uses high energy beams of radiation which kills cancer cells or stops cancer cells from multiplying. Radiotherapy is sometimes used for smaller cancers in people who do not need an operation. This is less common though.

Other treatments

If the cancer is at an early stage and is only on the glans (the head of the penis), sometimes doctors prescribe a cytotoxic (cell-killing) cream that can be used on the cancer.

What is the prognosis (outlook)?

There is a good chance of a cure if penile cancer is diagnosed and treated when it is at an early stage In general, the later the stage and the higher the grade of the cancer, the poorer the outlook. Even if a cure is not possible, treatment can often slow down the progression of the cancer.

The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information about outlook given above is very general. The specialist who knows your case can give more accurate information about your particular outlook, and how well your stage and grade of cancer is likely to respond to treatment.

Most treatments for penile cancer will not affect your ability to have sex, even if you need an operation


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