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Penile Cancer (Cancer of the Penis)

penile cancer

Penile cancer is a cancer that develops on the penis. A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear.

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
  • Some skin conditions of the foreskin are can increase the risk of having penile cancer in the future. These include a condition called erythroplasia of Queyrat and balanitis xerotica obliterans. These are both rare conditions.
  • Phimosis in adults and poor hygiene around the foreskin can increase the risk of penile cancer.

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.

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). 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. 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?
  1. 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.
  2. 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.
  3. An MRI of the penis may be performed to assess the size of the cancer.
  4. A CT scan of the chest, abdomen and pelvis may be performed. These scans can provide detail on the structure of the internal organs.
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) - the cells look reasonably similar to normal cells. The cancer cells are said to be 'well differentiated'. The cancer cells tend to grow and multiply quite slowly and are not so 'aggressive'.
  • Grade 2 (middle grade) - is a middle grade.
  • Grade 3 (high grade) - the cells look very abnormal and are said to be 'poorly differentiated'. The cancer cells tend to grow and multiply quite quickly and are more 'aggressive'.
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. 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. Chemotherapy may be given after having an operation. This aims to kill any cancer cells that have been left behind following the operation. Sometimes chemotherapy is given before surgery to reduce the size of the cancer.

Radiotherapy

Radiotherapy is a treatment that uses high energy beams of radiation which are focused on cancerous tissue. 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- podophyllin- 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 (confined to the penis and has not spread to the lymph glands). 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.


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