Penile Cancer

     The main structures of the male reproductive system are the testicles, epididymis, seminal vesicles, prostate and penis. The internal parts of the male reproductive system are located in the lower pelvic cavity between the hip bones.

The penis hangs in front of the pouch of skin (scrotum) that contains the testicles.

     The penis is made of different types of tissue, including skin, nerves, smooth muscle and blood vessels. The *shaft* is the main part of the penis. The head of the penis is called the *glans*. The glans are covered by a loose fold of moveable skin called the foreskin (prepuce). Sometimes the foreskin is surgically removed in an operation called circumcision.

The base of the penis within the pelvis is called the root.

The penis is made up of 3 chambers of spongy tissue containing many blood vessels:

  * The corpora cavernosa (singular: corpus /cavernosum/) are the 2 upper chambers of the shaft that make up most of the penis.

  * The corpus spongiosum is the lower chamber of the shaft that surrounds the urethra. Inside the penis is a thin tube called the urethra. The urethra extends from the base of the bladder to the tip of the penis. The opening of the urethra in the glans of the penis is called the meatus. Urine and semen travel through the urethra and leave the body through the meatus.

     Penile cancer starts in or on the penis. It most commonly starts in the skin cells of the penis. A cancerous (malignant) tumour is a group of cancer cells that can grow into and destroy nearby tissue. It can also spread (metastasize) to other parts of the body. Cells in the penis sometimes change and no longer grow or behave normally. These changes may lead to non-cancerous (benign) conditions such as genital warts (also called condylomata).  Changes to cells of the penis can also cause precancerous conditions.   This means that the abnormal cells are not yet cancer, but there is a chance that they may become cancer if they aren’t treated. The most common precancerous condition of the penis is penile intraepithelial neoplasia (PeIN).

     However, in some cases, changes to the cells of the penis can cause cancer. Most often, penile cancer starts in flat, thin cells called squamous cells. These cells are in the skin of the penis and the head of the penis (called the glans). This type of cancer is called squamous cell carcinoma (SCC) of the penis. SCC can develop anywhere on the penis, but it develops most often on the foreskin (in uncircumcised men) or the glans.

Signs and Symptoms of Penile Cancer

     The signs and symptoms below don’t always mean a man has penile cancer. In fact, many are more likely to be caused by other conditions. Still, if you have any of them, see a doctor right away so their cause can be found and treated, if needed. The sooner a diagnosis is made, the sooner you can start treatment and the better it is likely to work.

Skin changes:     The first sign of penile cancer is most often a change in the skin of the penis. This is most likely to be on the glans (tip) of the penis or on the foreskin (in uncircumcised men), but it can also be on the shaft.

These changes may include:

  * An area of skin becoming thicker

  * Changes in the skin colour

  * A rash or small crusty bumps on your penis; it can look like an unhealed scab.

  * A lump

  * An ulcer (sore) that might bleed

  * A reddish, velvety rash under the foreskin

  * Small, crusty bumps

  * Flat, bluish-brown growths

  * Smelly discharge (fluid) or bleeding under the foreskin

 

Sores or lumps from penile cancer usually don't hurt, but they might.

You should see a doctor if you find any kind of new growth or other abnormality on your penis, even if it's not painful. Any change that doesn't get better in about 4 weeks, or gets worse, should be checked by a doctor.

  

  Swelling:  Swelling at the end of the penis, especially when the foreskin is constricted, is another possible sign of penile

   cancer. It may be harder to draw back the foreskin.

    Lumps under the skin in the groin area If the cancer spreads from the penis, it most often travels first to lymph nodes in the groin. This can make those lymph nodes swell. Lymph nodes are collections of immune system cells. Normally, they are bean-sized and can barely be felt at all. If they're swollen, the lymph nodes may feel like smooth lumps under the skin.  But swollen lymph nodes don’t always mean that cancer has spread there.

More commonly, lymph nodes swell in response to an infection.

    The skin in and around penile cancer can often become infected, which might cause the nearby lymph nodes to swell, even if cancer hasn’t reached them.

What are the types of penile cancer?

  * 95% (95 out of 100) of penile cancers are squamous cell carcinomas.  These cancers start in the squamous cells, which 

    are in the skin of the penis and the head of the penis.

  * Rare types of penile cancers include melanomas and sarcomas.

* *Sarcoma * These cancers form in tissues like blood vessels, muscle, and fat.

  * *Melanoma*  This is cancer that starts in the cells that give your skin color.

  * *Basal cell carcinoma:  These cancers start deep in your skin. They grow slowly and aren’t likely to spread to other

     areas of your body.

 

Penile Cancer Causes and Risk Factors

 

Experts don’t know exactly what causes penile cancer. Research shows that it’s more common in men who:

  * Have the human papillomavirus (HPV)/genital warts

  * Being between the ages of 50 and 70 years old.

  * Not being circumcised.

  * Not regularly cleaning under your foreskin (loose skin covering the head of an uncircumcised penis).  * Smoke

  * Have a weakened immune system because of HIV  or AIDS

  * Aren’t circumcised. Fluids and a thick buildup called smegma can collect under your foreskin and might make cancer

     growth more likely.

  * Have a condition called phimosis, which makes your foreskin tight and tough to clean. It can also lead to fluid buildup.

  * Had psoriasis treatment with the drug psoralen and ultraviolet (UV) light

 

What are the stages of penile cancer?

Staging describes cancer. Staging is based on how much cancer is in the body, where it was first diagnosed if cancer has spread and where it has spread to.

The stage of cancer can help your health care team plan your treatment. It can also tell them how your cancer might 

    respond to treatment and the chance that your cancer may come back (recur).

        Penile cancer staging

  * *Stage 0:* Carcinoma in-situ. The cancer is only in the top layers of the skin of the penis.

  * *Stage 1:* cancer has spread to the connective tissue just under the skin of the penis. It has not spread to any lymph nodes or anywhere else in the body.

  * *Stage 2:* cancer has spread to one or more of these places:

      o Blood or lymph vessels 

      o Internal chambers of the penis

      o Urethra (the tube that your pee comes out of).

  *  Cancer has not spread to any lymph nodes or anywhere else in the body.

  * *Stage 3:* cancer has spread to the urethra or prostate (the gland that produces a fluid which makes up a large

       portion of semen).

  * *Stage 4:* cancer has spread to any of the following:

      o Nearby structures, other than the urethra or prostate.

      o Lymph nodes in the groin (inguinal lymph nodes).

      o Lymph nodes in the pelvis (pelvic lymph nodes).

      o Other parts of your body such as the liver or lungs. This is called distant metastasis.

 

 

  Treatment

 

Treatment for penile cancer depends on the stage of cancer.

 

        Stage 0

   * A doctor cuts out the cancer from the penis.

   * In some cases, the cancer can be treated with laser therapy. A laser is used to kill the cancer.

   * Cryotherapy, a procedure that uses an extremely cold liquid or a device to freeze and destroy cancerous tissue

 

        Stage 1 and early Stage 2

  * If the cancer is only in the foreskin, you will need a circumcision.

  *Mohs surgery, in which doctors remove affected skin one layer at a time until they reach healthy tissue

  * Radiation therapy may be an option to preserve your penis. This treatment uses high-energy x-rays that kill or shrink

    the cancer.

  * Brachytherapy (radioactive seeds are implanted near the cancer) may be another option to preserve your penis.

 

        Stage 2 and early Stage 3

  * Partial penectomy or radical penectomy (surgery to remove the whole penis).

  * If you have a medical condition that makes it unsafe for you to have surgery, or you do not wish to have surgery,

    radiation therapy to the pelvis is another treatment option.

 

        Stage 3 and Stage 4

  * Some people may need exenterative surgery. This is a surgery that removes all organs from your pelvic cavity.

  * If surgery is not possible, treatment includes palliative radiation therapy and/or systemic therapy (chemotherapy),

    These treatments are used to help control symptoms but will not cure the cancer.

 

Early detection is very important. It not only ensures better results but there are more treatment options.

 

after treatment

 

  * Follow-up testing and appointments are based on the type and stage of your cancer.

  * These are guidelines written for your doctor, nurse practitioner or specialist. You can look at them to see what

       appointments and tests you might need after treatment.

  * After treatment, you will return to the care of your family doctor or specialist for regular follow-up.

  * For the first year after treatment, you may need to see your doctor once each month.  In the second year after

    treatment, you should see your doctor every 3 months.  In year 3, see your doctor every 6 months. 

    In years 4 and 5 after treatment, see your doctor every 6  months.

Most treatments for early-stage penile cancer don’t affect your ability to have sex, but chemotherapy and radiation might also may make you infertile, Freezing your sperm is an option,  Talk to your doctor about possible side effects.

The following images are what Penile Caner looks like

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