Penile Cancer
What Is The Penile Cancer?
Penile cancer is a malignant growth found on skin or in tissues of the penis. Around 95% of penile cancers are squamous cell carcinoma, other type of penile cancers are rare. Benign, precancerous, cancerous conditions must be differentiated.
This is a slow growing cancer in its early stage, and because it seldom interferes with voiding or erectile function, patient do not complains until pain or discharge from cancer occurs. By this time, the cancer has usually progressed from being superficial to invasive.
Why Delay Occurs In Penile Cancer?
This delay is attributed to embarrassment, guilt, fear, ignorance, and personal neglect.
Patients often try to treat themselves with skin creams and lotions. This may be appears to be effective for time which further delays the diagnosis and worsens the prognosis. A delay in diagnosis and therapy not only affects the likelihood of survival but also limits the ability
to retain a functioning and cosmetically satisfactory result.
What Are The Symptoms?
Symptoms include redness, rashes, occasionally pain on the penis, foul smelling discharge or bleeding from the penis. Growth or sore on the penis that doesn’t heal within four weeks, sometime only change in colour of the penis.
So, any non healing ulcer, boil or lesion over the penis must be reported and investigated by the urologist.
What Are The Risk Factors?
- Includes infections (HIV /AIDS, HPV , genital warts ),
- Poor hygiene-increases a man’s risk of penile cancer
- Balanitis and penile injury-inflammation of foreskin, and glans penis is associated with three times increased risk of penile cancer
- Phimosis-unable to retract foreskin considered significant risk factor in the development of penile cancer.
- Circumcision – in childhood is associated with reduction in the risk for penis cancer
- Others—Age(rare seen <50yr), Lichen sclerosis, Tobacco, UV etc
What Is The Cause Of Penis Cancer?
Penile cancer arises from precursor lesions, which generally progress from low grade to high grade lesions. Generally in HPV infection this sequence follows Squamous hyperplasia– -> Low grade penile intraepithelial neoplasia (PIN)– ->High grade PIN– > Invasive carcinoma of penis. Poor hygiene is the biggest risk factor.
How To Prevent Penile Cancer?
- HPV vaccines such as Gardasil or Cervarix may reduces the risk of Penile Cancers
- Use of condoms is thought to be protective against HPV associated penile cancers
- Good genital Hygiene, which involves washing the penis, the scrotum, and foreskin, daily with water, may prevent balanitis and penile cancer.
- Cessation of smoking may reduce the risk of penile cancer.
- Circumcision during infancy or in childhood may provide partial protection against penile cancer.
- Phimosis->can be prevented by practicing proper hygiene
What Is The Treatment?
Several treatment options include surgery, radiation, chemotherapy, biological therapy.
- Wide local excision—the tumor and some surrounding healthy tissue removed
- Microsurgery—surgery performed with a microscope is used to remove the tumor and as little healthy tissue
- Laser surgery—laser light is used to burn or cut away cancerous cells in the early stage.
- Circumcision—Cancerous foreskin is removed
- Amputation is (Penectomy)—a partial or total removal of the penis, and possibly the associated lymph nodes.
- Radiation therapy—usually used adjuvant with surgery to reduce the risk of recurrence.
- With earlier stages of penile cancer, a combination of topical chemotherapy and less invasive surgery may be used.
Lymphnode (Ingoinal/Groin) Dissection Or Removal
After the penis surgery, groins to be examined regularly for any lymphnodes enlargement. These lymphnodes harbour tumour and needs removal to cure the cancers completely.
Now a day this operation is done with the help of robots or laparoscopy to decrease morbidity and complications. Healing is also faster and patient is discharged earlier.
What Is The Prognosis?
Generally earlier the cancer is diagnosed, the better the prognosis. After the penis surgery, groin lymphnode removal will improve the chances of survival. In advance stages, one may need chemotherapy.
The overall 5 yr survival rate for all stages of penile cancer is about 50%.
