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Cancer (Oncology)

Penile Cancer

Cancer of the penis can develop in several different kinds of cells, although almost all penile cancers start in the skin cells of the penis. Where it starts will determine the cancer's severity and treatment. Penile cancer is extremely rare in North America and Europe, but much more common in some parts of Asia, Africa, and South America, where it accounts for up to 10 percent of cancers in men.

About 95 percent of penile cancers develop in the squamous cells, usually occurring on the foreskin or on the glans (head of the penis). Squamous cell tumors grow slowly and are curable if found at an early stage. Less common forms of penile cancer include: melanoma, basal cell cancer, adenocarcoma (Paget Disease), and sarcoma (which develops in the penis's blood vessels, smooth muscle or other connective tissue cells).

Risk Factors

Age is a primary risk factor for penile cancer, with 80 percent of cases diagnosed in men over 55. Men with AIDS, smokers, and men who have been treated with PUVA (ultraviolet light) therapy – during treatment for psoriasis – are at increased risk.

Uncircumcised men are also at increased risk of developing penile cancer, likely because they are prone to developing phimosis – a condition where the foreskin becomes tight and difficult to retract. They can also accumulate smegma, secretions which build up underneath the foreskin. Both conditions increase the risk of penile cancer. Uncircumcised men are also more likely to become infected with human papilloma virus (HPV), a virus which causes genital warts. Some types of HPV can lead to cancer. About half of penile cancer cases show HPV infection.

Screening and Prevention

The exact cause of most penile cancers is unknown and they are therefore difficult to prevent. However, certain precautions can guard against the known risk factors. Most important among these is practicing good genital hygiene, including retracting and cleaning the foreskin (if you are uncircumcised) and entire penis. Men can reduce the risk of HPV infection by limiting their number of sexual partners, using condoms, and getting vaccinated for HPV before becoming sexually active. Refraining from smoking is another way to reduce risk. It is important to note that circumcision offers protection, but only if it occurs shortly after birth. Most doctors do not recommend circumcision solely as a method of preventing penile cancer.

Symptoms and Diagnosis

There are no screening tests available for penile cancer, but it is often possible to find the disease early by noticing changes on the skin of the penis. Changes in color, skin thickening and tissue build-up should be examined. Ulcers or lumps, a reddish rash, small crusty bumps, or flat, dark growths that develop on the glans, foreskin, or shaft are also cause for concern. Swelling at the tip of the penis or in the lymph nodes, a malodorous discharge, blisters and white patches might also indicate the beginning of cancer. All of those symptoms are more likely caused by something other than cancer, but they warrant attention by a doctor. As with most diseases, early treatment usually results in little or no damage to the penis. Waiting until the condition worsens can lead to removal of part or all of the penis.

Treatment

Surgery is the main method of treatment for penile cancer, sometimes combined with radiation. Chemotherapy may be used for cancers that are too large to easily remove or metastasized or spread.

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