Risk Factors for Penile Cancer (PC)

 

Phimosis

Is a condition, when foreskin becomes tight and difficult to retract, it is associated with poor hygiene and accumulation of smegma (thick substance, that collects under the foreskin). It is strongly associated risk factor, due to the chronic infection

 

HPV infection

Human papilloma viruses, called so, because some cause growth of papillomas. Infection may be spread not only by sexual contact also by skin to skin contact. Some serotypes of HPV have cancerogenic activity. Risk is growing within the groups of early sexual initiation and often changes of sexual partners

 

Psoralene and ultraviolet A phototherapy (PUVA therapy)

Applied as a therapy for psoriasis

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Smoking

Smoking can contribute to or speed up the development of the penile cancer, especially in the men, who are also infected with HPV virus

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Multiple sexual partners, early age of the first intercourse

 

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Prevention

 

Neonathal circumcision

Reduces the risk of invasive penile cancer, however circumcision in adult life does not have any protective effect

 

Hygene

Uncircumcised men should on regular basis retract foreskin and wash out smegma

 

Limiting the number of sex partners

Even use of the condom will not always be enough to prevent HPV infection, that is why sexual “discipline” might be good preventive strategy for the penile cancer

 

Quitting smoking

 

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Possible symptoms of penile cancer

• skin changes (color, thickness, smell, fluid, swelling)

• lymph nodes enlargement in the groin inguinal area

• bleeding

• pain in shaft or tip of the penis

 

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Diagnosis

• physical examination

• ultrasound

• biopsy – is the only way to diagnose if the change is a cancer or no. There are different types of biopsy. Sometimes only part of the change is removed (performed for the big lesions, growing deep into the penis).  In other situation the whole lesion is taken for analysis (possible with the small lesions). Penile biopsy is usually made in the hospital or doctors office under local anesthesia. If general anesthesia is required – procedure has to be performed in the hospital

• sentinel lymph node biopsy – is performed to check if the cancer has spread. There are different possibilities – Fine Needle Aspiration (FNA) – when needle takes tissue and fluid sample from the lymph node, in some cases surgery is needed to remove one or more nodes (see below)

• X-ray

• CT scan or PET CT

• MRI

 

 

Treatment of Penile Cancer

Treatment options depends on tumor size, histology, tumor stage and grade, localization, possible side effects and patient preference. Below please find some methods shortly explained. The type of surgery, recurrence risk, the quality of life after should be considered and discussed with the doctor in details, unfortunately organ sparing procedures are corresponding with the higher risks of the local recurrence and close observation will be needed. The most common treatment options include:

 

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Organ preserving surgery

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Radical circumcision

Performed to remove foreskin and some skin nearby. Also performed before radiotherapy to avoid tightening of the foreskin

 

Excision

Removal of the tumor with the small or large amount of normal tissue around (small or bigger surgical margins) – surgical margins are preserved to avoid recurrence of the disease

 

Mohs Surgery

Removal of the tissue layer after layer and constant control under microscope, when all the layers affected by disease are removed, surgery is finalized

 

Glansectomy

Partial or full removal of the glans, after the surgery glans might be rebuild with tissue grafts (used only for the small tumors on the surface of the penis), shaft of the penis is preserved during this type of surgery

 

Partial Penectomy

Surgical removal of the part of the penis with the aim to leave as much of the healthy tissue as possible

 

Radical Penectomy

Unfortunately the most effective procedure to treat penile cancer is radical penectomy. During this procedure total shaft is removed, including its part in the pelvic cavity. In this case a new opening for urethra will be created in the area between scrotum and anus. Urinating will be possible in the sitting position 

 

Radical inguinal lymphadenectomy

The most common metastasis for the penile cancer is into the inguinal lymph nodes. That is why, once diagnosed – lymph nodes need to be surgically removed (laparoscopically or robotically)

 

Cryoablation

Use of the liquid nitrogen to freeze and kill cancer cells

 

CO2 Laser therapy

Use of powerful beam of light to destroy cancer cells used for early stage penile cancer (disadvantage – difficult to determine cancer spread)

 

Radiotherapy 

 

Chemotherapy

Depending on staging the disease.