Penile Cancer is a disease in which the tissues and the skin of the penis are affected by malignancy (cancer). The penis is a rod-shaped male reproductive organ that ejaculates sperm and urine from a man’s body. It consists of two tissues of erectile, spongy tissues with blood vessels that fill with blood to help erection:

Corpora cavernosa: Two columns of erectile tissues that form most of the penis.

Corpus spongiosum: Single column of erectile tissue (surrounding urethra) that forms a small portion of the penis.

A Squamous cell carcinoma commonly originating in the glands or foreskin is the most common type, found in 9 out of 10 cases. This type of cancer (Penile cancer) is very rare in Europe and North America. Report reveals that only 0.2% of cancers and 0.1% of deaths from cancer amongst males in the United States where as in some parts of Africa and South America it accounts for up to 10% of cancers in men. Although penile cancer is rare, it is psychologically devastating to the patient if diagnosed. It also throws a challenge to the urologist. It is important to differentiate among benign, pre malignant and malignant conditions. Penile squamous cell carcinoma, the most common penile cancer, behaves similarly to  that occurs in other parts of the skin. Metastasis, possible with this type of carcinoma, is often fatal.

Patients having carcinoma of the penis often tend to delay seeking medical treatments for more than one year from onset as they go through a critical stage and often feel embarrassed. The percentage ranges from A sense of guilt, fear and personal neglect also work in them and compel them to delay further. By this time, men prefer to treat themselves and apply various skin creams and lotion which can not provide permanent cure but only delay the prognosis.

Types and Symptoms of Penile Cancer

Types of penile cancer:

1. Squamous cell carcinoma
2. Adenocarcinoma
3. Melanomas
4. Basal cell penile cancer
5. Sarcomas.

Symptoms of Penile cancer:

Penile cancer is seen first on the glands or head of the penis and spreads thereafter. In some cases, obvious symptoms may be identified at early stages, while in many cases the symptoms remain latent until the disease has spread. It may not be the sign of cancer; therefore any abnormalities of the penis should be reported to your general physician without delaying as it may give some serious trouble in the long run.

Men who have retained their foreskin need to examine the area underneath the foreskin on regular basis and should pay heed to keep the area clean to lower the risk. The symptoms of penile cancer may include:

• A wart-like growth or lesion
• An open sore that won’t heal
• A reddish rash
• Persistent, smelly discharge under the foreskin.

Causes of Penile Cancer:

Some abnormalities that can cause penile cancer are listed below:

Infection of HPV:

HPV is a very common virus, transmitted during sexual intercourse. It does not always prevent symptoms. Infection of HPV is also the leading cause of cervical cancer in women.

Smoking increases your risk factor for penile cancer:

Smoking increases your risk of being afflicted by various types of cancer not just the penile cancer. Smoking transmits harmful chemicals and substances when you smoke and causes damage to cells’ DNA. These carcinogens can also affect the cells in the penis, thus causing penile cancer. Smoking also decreases your immunity to fight an HPV infection.

Age and Gender:

The risk factor is high among men age over 60.

Being infected with AIDS virus:

The risk is high among men having AIDS as it lowers down the immune system of an HIV positive.

Personal hygiene:

Personal hygiene in the genital area is essential. Oily secretions, dead skin and bacteria can crop up under the foreskin. This is called smegma which may have a foul odor and may indicate penile cancer.

Treatment options:

Different types of treatments are available for patients with penile cancer. While some treatments are standard, some are being tested in clinical trials. Before seeking treatment, patients may wish to rethink and decide whether they wish to undergo a clinical trial- a research meant to improve current treatments or obtain information on new treatments for cancer patients. When clinical trials approve that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Surgery:

Surgery is the most commonly adapted treatment which is useful to remove the cancer for all stages of penile cancer following the operations mentioned below:

* Mohs microsurgery: In this operation, the tumor is cut from the skin in thin layers. During the surgery, the edges of the tumor and each layer of tumor are removed and examined under a microscope to detect the malignant cells. Layers are removed until no more cancer cells are viewed. This type of surgery is useful to remove as little normal tissue as possible and is also used to remove cancer on the skin. It is also known as Mohs surgery.
* Laser surgery: A laser beam (a narrow beam of intense light) is used as a knife to perform bloodless operation in tissue or to remove a surface lesion such as a tumor.
* Cryosurgery: In this type of surgery an instrument is used to freeze and destroy abnormal tissues. This type of treatment is known as cryotherapy.
* Circumcision: This surgery is performed to remove a portion or the entire foreskin of the penis.
* C:It removes only the cancer cells and some normal tissues around it.
* Amputation of the penis: In this process a part or an entire penis is removed. If a part of the penis is removed, it is a called partial penectomy. If the entire penis is removed, it is termed as total penectomy. Lymph nodes in the groing may be taken out during this surgical treatment.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may have to undergo chemotherapy or radiation therapy after surgery to destroy any cancer cells that are left. Treatment offered after a surgery, to increase the chances of a cure, is called adjuvant therapy.
* Radiation therapy: High-energy x-rays or other types of radiation are allowed to enter the body to destroy cancer cells or prevent them from advancing. There are two types of radiation therapy.

External radiation therapy: In this process a machine is used outside the body to send radiation toward the cancer.

Internal radiation therapy: In this method a radioactive substance, sealed in needles, seeds, wires, or catheters is placed directly into or near the cancer. The selection of radiation therapy depends on the type and stage of the cancer.
* Chemotherapy: Chemotherapy is a medical treatment designed to kill cancer cells. Drugs are applied to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is received by mouth or injected into a vein or muscle, drugs flow through the bloodstream and can reach cancer cells throughout the body. This is called systemic chemotherapy. When chemotherapy is applied 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 done depends on the type and stage of the cancer being treated. Topical chemotherapy is adapted to treat stage 0 penile cancers.

New types of treatment are also coming in way. These include:

Biologic therapy: Biologic therapy makes use of 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 immunity against cancer. This type of cancer treatment is called biotherapy or immunotherapy. Topical biologic therapy may be followed to diagnose stage 0 penile cancer.

Radio sensitizers:
Radio sensitizers are drugs that turn tumor cells more sensitive to radiation therapy. Radiation therapy along with radio sensitizers helps destroying large number of tumor cells.

Stage by stage treatment:

Stage 0 (carcinoma in situ)

Treatment of stage 0 follows:

• Mohs microsurgery.
• Topical chemotherapy.
• Topical biologic therapy.
• Laser surgery.
• Cryosurgery.

Stage I penile cancer: If the cancer is present only in the foreskin, wide local excision and circumcision may be followed. 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.

Stage II penile cancer:

Treatment of stage II penile cancer may be carried on following these methods:

• Surgery (partial or total penectomy, with or without removal of lymph nodes in the groing).
• 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.

Stage III penile cancer:

Possible treatments for stage III penile cancer:

• Surgery (penectomy and removal of lymph nodes in the groin) with or without radiation therapy.)
• A clinical trial of sentinel lymph node biopsy followed by surgery.
• A clinical trial of radio sensitizers.
• A clinical trial of chemotherapy before or after surgery.

Stage IV penile cancer:

• Surgery (wide local excision and removal of lymph nodes in the groin).
• Radiation therapy.
• A clinical trial of chemotherapy before or after surgery.

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