HEALTH: PENILE CANCER (CANCER OF THE PENIS) SYMPTOMS
What is Penile Cancer?
Penile cancer is a rare form of cancer that occurs mostly in uncircumcised men (men with the foreskin, a piece of skin covering the head of their penis, intact). Cancer of the penis can occur anywhere along the penile shaft, but most are on the foreskin or head (glans). It is usually a slow- growing cancer and is curable if discovered early.Cancer of the penis is rare in the U. S., affecting only one or two men in 100,000. It is almost never seen in those who have been circumcised as babies, which is a major argument in favor of newborn circumcision. Unfortunately, some men do not seek medical attention until after it has spread.
Nearly all penile malignancies are cancers of the skin, the most common being squamous cell carcinoma, similar to squamous cell carcinomas on other parts of the skin such as the face or hands. Some penile cancers are melanomas, which appear as blue-brown flat growths and tend to spread more rapidly and more widely. Occasionally, the deep tissues of the penis develop cancer, typically sarcomas. The cancer spreads gradually becoming larger in the area of the skin where it first develops.
Ultimately, it spreads to deep tissues inside the body of the penis and to lymph nodes in the groin (inguinal area) or pelvis.When the cancer is in the penis itself (local) and involves no more than a few nearby inguinal lymph nodes, it can be cured, but cure rates fall rapidly once it spreads to the pelvic lymph nodes. Once cancer of the penis is found, more tests will be done to determine whether the cancer has spread from the penis to other parts of the body.
The penis is a rod-shaped male reproductive organ of a man that passes sperm and urine from the body. The penis of a man consists of three chambers of spongy erectile tissue containing multiple blood vessels, nerves, and smooth muscle.
It contains two types of erectile tissue (spongy tissue with blood vessels that fill with blood to make an erection):
- Corpora cavernosa: The two columns of erectile tissue that form most of the penis. The corpora cavernosa make up two of the chambers and are located on both sides of the upper part of the penis. At the tip of the penis, the corpora cavernosa expands to form the “helmet”, or glans.
- Corpus spongiosum: The single column of erectile tissue that forms a
small portion of the penis. The corpus
spongiosum is located below the corpora cavernosa and surrounds the
urethra, the tube through which urine and semen exit the body at an
opening called the meatus.
The erectile tissue is
wrapped in connective tissue and covered with skin. The glans (head of the
penis) is covered with loose skin called the foreskin.
There are several types of penile cancer, including:
Epidermoid/squamous cell carcinoma. Ninety-five percent (95%) of penile cancer is epidermoid, or squamous cell, carcinoma. This means that, under a microscope, the cells resemble the tissues that make up skin. When cancer begins in squamous cells, it is called non-melanoma skin cancer and it can develop anywhere on the penis; most develop on or under the foreskin. When found at an early stage, epidermoid carcinoma can usually be cured.
Basal cell penile cancer. Under the squamous cells in the lower epidermis (one of the layers of the skin tissues that cover the penis) are round cells known as basal cells. These can occasionally become cancerous. This is also called non-melanoma skin cancer. Less than 2% of penile cancers are basal cell cancers.
Melanoma. The deepest layer of the epidermis contains scattered cells called melanocytes, which produce the melanin that gives skin color. Melanoma starts in melanocytes, and it is the most serious of the skin cancer types. This cancer occasionally occurs on the surface of the penis.
Sarcoma. About 1% of penile cancers are sarcomas, which are cancers that develop in the tissues that support and connect the body, such as blood vessels, smooth muscle, and fat.
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Anything that increases your chance of getting a disease is called a risk factor.
Circumcision may help prevent infection with the human papillomavirus (HPV). A circumcision is an operation in which the doctor removes part or all of the foreskin from the penis. Many boys are circumcised shortly after birth. Men who were not circumcised at birth may have a higher risk of developing penile cancer.
Human papillomavirus (HPV) infection. The most important risk factor for penile cancer is infection with this virus. HPV is passed from one person to another during sexual intercourse. Reduce your risk of HPV infection by limiting the number of sex partners, because having many partners increases the risk of HPV infection. Using a condom cannot fully protect you from HPV during sex.
Smoking. Smoking may contribute to the development of penile cancer, especially in men who are also infected with HPV.
Age. Most cases of penile cancer occur in men over age 50, but occur in men younger than 40 about 20% of the time.
Smegma. Smegma is a thick substance that can accumulate under the foreskin and is caused by dead skin cells, bacteria, and oily secretions from the skin. Smegma may contain small amounts of cancer-causing substances. Uncircumcised men should retract the foreskin and thoroughly wash the penis on a regular basis, in order to make sure that smegma does not cause irritation of the penis.
Phimosis. Phimosis occurs when the foreskin becomes tight or constricted and is difficult to retract, therefore causing a buildup of smegma. Men with phimosis are less likely to be able to thoroughly clean the penis.
HIV/AIDS infection. Infection with human immunodeficiency virus (HIV), the virus that causes acquired immune deficiency syndrome (AIDS), is also a risk factor. When a person is HIV-positive, their immune system is less able to fight off early-stage cancer.
Psoriasis treatment. Men who have been treated with the drug psoralen combined with ultraviolet (UV) light have a higher risk of developing penile cancer.
Circumcision status. Circumcision is a procedure to remove the foreskin of the penis and may provide some protection from penile cancer due to improved hygiene. Epidermoid/squamous cell carcinoma of the penis almost never occurs in men who are circumcised. However, it is important to note that circumcision alone cannot prevent penile cancer.
Personal hygiene. Men who carefully and completely clean under the foreskin on a regular basis can reduce their risk of developing penile cancer.
While it is not possible to completely prevent penile cancer, a man can reduce his risk by avoiding smoking, avoiding sexual practices that could lead to HPV or HIV/AIDS infection, and practicing good hygiene.
Health: Symptoms of Penile Cancer (Penis - Cancer)
Men with penile cancer may experience the following symptoms. Sometimes, men with penile cancer do not show any of these symptoms. Or, these symptoms may be caused by a health condition that is not cancer. If you are concerned about symptoms on this list, consult your doctor or health care provider.
- A growth or ulcer on the penis, especially on the glans or foreskin, but can also occur on the shaft
- Changes in color of the penis
- Skin thickening on the penis
- Persistent discharge with foul odor beneath the foreskin
- Blood coming from the tip of the penis or under the foreskin
- Unexplained pain in the shaft or tip of the penis
- Irregular or growing bluish-brown flat lesions or marks beneath the foreskin or on the body of the penis
- Reddish, velvety rash beneath the foreskin
- Small, crusty bumps beneath the foreskin
- Swollen groin lymph nodes
- Irregular swelling at the end of the penis
Health: Diagnosis of Penile Cancer (Penis - Cancer)
The following tests may be used to diagnose penile cancer:
Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease).
Fine needle aspiration/biopsy. A fine needle aspiration is a specific type of biopsy. A local anesthetic to numb the area may be injected into the skin near the nodule (tumor) prior to the biopsy; prior to doing this, the skin is often made numb with an anesthetic cream. The doctor will insert a thin needle into the nodule and extract (take out) cells and some fluid. The procedure may be repeated two or three times to obtain samples from different areas of the nodule. The pathologist will determine if the cells are cancerous (called positive for cancer), non-cancerous (called negative for cancer), or undetermined (unclear).
Sentinel lymph node biopsy. This is another type of biopsy. It is important to know if cancer cells have spread to other areas beyond the penis. In this technique, the doctor removes one or a few sentinel lymph nodes, the first node(s) into which the lymph system drains near to the nodule, to check for cancer cells. In the case of penile cancer, the sentinel lymph nodes are located just under the skin in the groin. If cancer cells are detected, it means that the disease may have spread to other lymph nodes in the region or beyond through the blood and lymph vessels.
X-ray. An x-ray is a picture of the inside of the body. For instance, a chest x-ray can help doctors determine if the cancer has spread to the lungs.
Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail. This is particularly useful in looking to see if the cancer has spread to lymph nodes within the groin, pelvis, and in the abdominal cavity and also allows imaging of the lungs, liver, and other tissues.
Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium may be injected into a patient’s vein to create a clearer picture.
Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body and absorbed by the organs or tissues being studied. This substance gives off energy that is detected by a scanner, which produces the images. Some doctors will use PET scans to look for evidence of spread of penile cancer, although it has not specifically been approved for this use. It is known to be useful in staging squamous cancer of the lung and of the esophagus, and as experience increases it may eventually become a more standard tool in diagnosing penile cancer.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
- The stage of the cancer.
- The location and size of the tumor.
- Whether the cancer has just been diagnosed or has recurred (come back).
Tests and stages of penile cancer (penis cancer):
After penile cancer has been diagnosed, tests are done to find out if cancer cells have spread within the penis or to other parts of the body.
The process used to find out if cancer has spread within the penis or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
- MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
The following stages are used for penile cancer:
Stage 0 (carcinoma in situ)
In stage 0, abnormal cells are found on the surface of the skin of the penis. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
Stage I
In stage I, cancer has formed and spread to connective tissue just under the skin of the penis.
Stage II
In stage II, cancer has spread to:
- connective tissue just under the skin of the penis and to one lymph node in the groin; or
- erectile tissue (spongy tissue that fills with blood to make an erection) and may have spread to one lymph node in the groin.
Stage III
In stage III, cancer has spread to:
- connective tissue or erectile tissue of the penis and to more than one lymph node on one or both sides of the groin; or
- the urethra or prostate, and may have spread to one or more lymph nodes on one or both sides of the groin.
Stage IV
In stage IV, cancer has spread:
- to tissues near the penis and may have spread to lymph nodes in the groin or pelvis; or
- anywhere in or near the penis and to one or more lymph nodes deep in the pelvis or groin; or
- to distant parts of the body.
Recurrent penile cancer (penis cancer)
Recurrent penile cancer is cancer that has recurred (come back) after it has
been treated. The cancer may come back in the penis or in other parts of the
body.
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Natural Alternative Treatment Option: NATURAL CANCER TREATMENT
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Health: Conventional Treatment for Penile Cancer (Penis - Cancer)
There are different types of treatment for patients with penile cancer.
Different types of treatments are available for men with penile cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for men with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.
Three types of standard treatment are used:
Surgery
Surgery is the most common treatment for all stages of penile cancer. A doctor may remove the cancer using one of the following operations:
- Mohs microsurgery: A procedure in which the tumor is cut from the skin in thin layers. During the surgery, the edges of the tumor and each layer of tumor removed are viewed through a microscope to check for cancer cells. Layers continue to be removed until no more cancer cells are seen. This type of surgery removes as little normal tissue as possible and is often used to remove cancer on the skin. It is also called Mohs surgery.
- Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor.
- Cryosurgery: A treatment that uses an instrument to freeze and destroy abnormal tissue. This type of treatment is also called crysotherapy.
- Circumcision: Surgery to remove part or all of the foreskin of the penis.
- Wide local excision: Surgery to remove only the cancer and some normal tissue around it.
- Amputation of the penis: Surgery to remove part or all of the penis. If part of the penis is removed, it is a partial penectomy. If all of the penis is removed, it is a total penectomy.
Lymph nodes in the groin may be taken out during surgery.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly onto the skin (topical chemotherapy) or into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Topical chemotherapy may be used to treat stage 0 penis cancer.
New types of treatment are being tested in clinical trials. These include the following:
Biologic therapy
Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy. Topical biologic therapy may be used to treat stage 0 penis cancer.
Radiosensitizers
Radiosensitizers are drugs that make tumor cells more sensitive to radiation
therapy. Combining radiation therapy with radiosensitizers helps kill more tumor
cells.
Laser therapy
A narrow beam of high-intensity light can remove or destroy cancer confined to the outermost layer of the skin of the penis.
Sentinel lymph node biopsy followed by surgery
Sentinel lymph node biopsy is the removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. It is the first lymph node the cancer is likely to spread to from the tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes. After the sentinel lymph node biopsy, the surgeon removes the cancer.
This summary section refers to specific treatments under study in clinical
trials, but it may not mention every new treatment being studied. Information
about ongoing clinical trials is available from the NCI Web site.
Stage 0 (carcinoma in situ)
Treatment of stage 0 may be one of the following:
- Mohs microsurgery.
- Topical chemotherapy.
- Topical biologic therapy.
- Laser surgery.
- Cryosurgery.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage 0 penile cancer.
Stage I penile cancer
If the cancer is only in the foreskin, wide local excision and circumcision may be the only treatment needed.
Treatment of stage I penile cancer may include the following:
- Surgery (partial or total penectomy with or without removal of lymph nodes in the groin.
- External or internal radiation therapy.
- Mohs microsurgery.
- A clinical trial of laser therapy.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I penile cancer.
Stage II penile cancer
Treatment of stage II penile cancer may include the following:
- Surgery (partial or total penectomy, with or without removal of lymph nodes in the groin).
- External or internal radiation therapy followed by surgery.
- A clinical trial of sentinel lymph node biopsy followed by surgery.
- A clinical trial of laser surgery.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage II penile cancer.
Stage III penile cancer
Treatment of stage III penile cancer may include the following:
- Surgery (penectomy and removal of lymph nodes in the groin) with or without radiation therapy.
- Radiation therapy.
- A clinical trial of sentinel lymph node biopsy followed by surgery.
- A clinical trial of radiosensitizers.
- A clinical trial of chemotherapy before or after surgery.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III penile cancer.
Stage IV penile cancer
Treatment of stage IV penile cancer is usually palliative (to relieve symptoms and improve the quality of life). Treatment may include the following:
- Surgery (wide local excision and removal of lymph nodes in the groin).
- Radiation therapy.
- A clinical trial of chemotherapy before or after surgery.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IV penile cancer.
Treatment options for recurrent penile cancer (penis cancer)
Treatment of recurrent penile cancer may include the following:
- Surgery (penectomy).
- Radiation therapy.
- A clinical trial of biologic therapy.
- A clinical trial of chemotherapy.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that
are now accepting patients with recurrent penis cancer.
Health: Prevention of Penile Cancer (Penis - Cancer)
Circumcision may decrease the risk. Men who are not circumcised should be taught at an early age the importance of cleaning beneath the foreskin as part of their personal hygiene.
Good personal hygiene and safer sexual practices, such as abstinence, limiting the number of sexual partners, and use of condoms to prevent HPV infection, may decrease the risk of developing penile cancer.
Call your health care provider if symptoms of penis cancer develop.
_______________________________________________________________________________________________________Disclaimer: This information is not presented by a medical practitioner. Therefore any content of this site is strictly intended for educational and informational purpose only. Any access to this site is strictly on a voluntary basis and at the sole discretion of the user. No content of this site is intended as a substitute for medical advice, diagnosis or treatment, nor constitute the practice of any medical profession or health care provider. The information provided on this site is here to educate visitors on health issues that may affect their lives. Otherwise, always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition. And never disregard professional medical advice or delay in seeking it because of something you have read.
Sources: NIH News In Health/National Institutes of Health/National Library of Medicine/Dept of Health and Human Services_______________________________________________________________________________________________________
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