What is Penile Cancer?

Penile cancer is a type of cancer that primarily affects the male reproductive organ, the penis. This cancer can develop on the surface of the penis or within its tissues. Typically, penile cancer begins like other cancers or when cells within the organ start to multiply out of control. These cells are oftentimes malignant and will cause uncontrolled growth within that area of the male anatomy. The penis’s tissues are relatively unique in human biology; the penis itself is a cylindrical or rod-shaped organ that is used during reproduction.

Its primary function is sperm delivery and the excretion of urine. The two types of tissues that comprise the penis are two types of spongy erectile tissue, the corpora carvernosa, and the corpus spongiosum. The corpora cavernosa are the parts of the penis that are comprised of erectile tissue. This corpora cavernosa forms the majority of the penile structure.

The second type, the corpus spongiosum, is the type of tissue that forms the soft area around the urethra. This is made of a single column of this type of tissue and is a relatively small part of the penile structure.

This column also widens at the end and forms the glans of the penis, which is also called the head of the penis and is the site of the opening where semen and urine are excreted. Within each of these tissues is the potential for penile cancer.

Here are a few types of cancer that can form due to uncontrolled cell division:

• Squamous Cell Carcinoma: This type of penile cancer can develop in any part of the penis. The squamous cells of the penis are the flat skin cells that cover the organ. This is the most common version of the disease, with a reported 95 percent of the new penile cancer cases happening due to squamous cell carcinoma. This is slow-growing cancer that typically forms on the foreskin of the penis or on the glans. If found early, this type of cancer is very treatable.
• Carcinoma In Situ: When squamous cell carcinoma is just starting to form on the skin of the penis, this is its earliest form. This is why carcinoma in situ is typically found in the very top layers of the penile epidermis. At this stage, cancer hasn’t spread to the deeper tissues of the penis. When carcinoma in situ is found on the glans, it is called erythroplasia of Queyrat. It’s called Bowen disease when it’s on the shaft skin or below.
• Verrucous Carcinoma: Another form of squamous cell carcinoma, verrucous carcinoma is a more uncommon form of cancer. These carcinomas grow slowly and can spread to the surrounding skin tissue but very rarely spread.

Other forms of cancer can also form on the penile structure; the most common are the two types of skin cancers:

• Melanoma: Another type of skin cancer that can occur on the penis, melanoma directly affects the skin’s melanocytes. In the melanocytes, melanin is created to protect the skin from damaging UV rays. Because an overage of sun exposure typically causes melanoma, it’s rarer to develop melanomas on the penile structure.
• Adenocarcinoma: This is another rare condition that can develop in the sweat glands of the penis. Since this is close to the surface of the penile skin, it’s sometimes hard to differentiate from carcinoma in situ.

History

While penile cancer at large has a relatively short history, squamous cell carcinoma has a modern history that dates back to the 1700s. In 1775, squamous cell carcinoma became one of the first types of cancer to be linked to an occupational hazard. Sir John Perrival Pott noticed that chimney sweeps in England were developing this type of carcinoma on their reproductive organs.

Progressing his research, Sir John noted that other tradesmen who worked with coal distillates were also prone to skin cancer. As a result, more stringent personal hygiene was facilitated as well as protective clothing that caused a drop in the incidence of squamous cell carcinoma. Erythroplasia of Queyrat, on the other hand, which is a carcinoma of the glans, was first described in 1891 by Tarnovsky. It was fully acknowledged as a penile condition in 1897 by Fournier and Darier.

Next, Louis Queyrat, a French dermatologist, executed research that recognized that erythroplasia of Queyrat was a separate condition from Bowen’s condition due to its tendency to infect the glans of the penis rather than the shaft. Queyrat described the condition in 1911 as a reddish, velvety lesion that can be ulcerated and papillary. Despite this, both conditions are acknowledged as forms of carcinoma in situ.

In 1977, Persky L. released the research, Epidemiology of Cancer of the Penis, which was an in-depth look at risk factors, hygiene, and other important information about the condition.

Risk Factors

There are several risk factors for penile cancer that can increase the chance of developing the condition. While each risk factor doesn’t necessarily mean that the patient will definitely develop this disease, each does definitely contribute to the possibility of developing the condition. It’s also possible that people without any risk factors can develop penile cancer.

In any situation, here are a few risk factors for penile cancer:

• Human Papilloma Virus (HPV)

This is the number one risk factor for penile cancer. The human papillomavirus classification is actually a group of more than 150 viruses. These viruses are named this way because they cause growths that are called papillomas or warts. Genital warts are a type of human papillomavirus, but all HPV conditions have been strongly linked with certain cancers.

HPVs are typically contracted through intercourse, so limiting exposure to HPV and the resulting papillomas are advised to limit sexual relations with multiple partners.

Unfortunately, condoms aren’t 100 percent effective in limiting exposure to HPV, though there are vaccine options for treatment and protection.

• Hygiene

In 1775, it was discovered by Sir John Perrival Potts that chimney sweeps were contracting squamous carcinoma as a result of both personal hygiene and exposure to coal.

Hygiene is an important aspect to consider in the prevention of penile cancers; in fact, males that regularly clean under their foreskin can drastically reduce the chance of contracting penile cancer.

• Smegma

Smegma is a whitish substance that can form underneath the foreskin of uncircumcised individuals if hygiene isn’t maintained.

This material is comprised of dead skin cells, oils from the penis, bacteria that flourish in the moist and warm conditions of the penis foreskin, and even some trace amounts of cancer-causing substances.

Because of the dangers of smegma, men without circumcision need to pull back the foreskin daily and clean the penis with water. This will also reduce the irritation that smegma can cause on the skin of the penis.

• Age

There’s a tendency for penile cancer to develop in men that are over 50. However, the average age of people with penile cancer is 68. This means that older gentlemen should consider regular checkups so that penile cancer can be diagnosed early if it forms.

• Lack of Circumcision in Childhood

Men that are circumcised have a lower incidence of penile cancer. Circumcision removes a part of the foreskin and is traditionally done in infancy. While there are situations where adults undergo this procedure, men who have had this procedure at a later stage actually have a slightly higher chance of developing penile cancer than those circumcised at a young age.

• Phimosis

Sometimes, with uncircumcised men, a condition called phimosis can occur. Phimosis is a condition that causes the foreskin to become tight and unable to retract. As a result, individuals with phimosis have a more difficult time cleaning the foreskin area.

As a result, smegma can build up, which can cause infection and provide the conditions for penile cancer to develop.

• Sunlight and UV exposure

Too much UV sunlight on any area of exposed skin can cause melanoma. While melanoma of the penis is rarer than other penile cancers, it’s worth noting that it can occur in individuals that don’t employ adequate UV protection. Additionally, people with psoriasis can be treated with drugs called psoralens. These drugs are activated using UVA as a light source.

This PUVA therapy is effective for psoriasis treatment but can cause an uptick in the chance of developing penile cancer.

• Smoking

Smoking is a major cause of cancer in general because cigarettes are loaded with various cancer-causing chemicals. Also, since cancer directly affects immune function, it’s believed that those that smoke is more likely to become infected with HPV, which is a major risk factor for penile cancer.

• AIDS

AIDS is an immunodeficiency condition that increases the risk of penile cancer because the compromised immune system has a harder time fighting off conditions like HPV.

Additionally, penile infections caused by smegma are also more likely to lead to penile cancer.

Screening

While penile cancer can be found early, no processes are developed specifically for the condition that serves as an early screening procedure.

That being said, several preexisting procedures can help screen for the condition.

Fortunately, most penile cancers start out on the skin and then move to the underlying structures like the corpora carvernosa and the corpus spongiosum, so their development can be tracked if caught early.

Unfortunately, most penile cancers can also be mistaken for other conditions that have been sexually transmitted or have developed as a result of poor hygiene.

Also, since penile cancer is relatively rare, especially in men under the age of 50, there hasn’t been a dedicated screening program developed for the condition. That being said, there are ways to screen for the condition.

These include:

• Lymph Node Dissection or Biopsy

This can include lymph node dissection or sentinel lymph node biopsy. During these procedures, lymph nodes are removed from the penis through a surgical process. This helps determine if cancer has spread into the deeper tissues of the penis.

To reduce the number of needed lymph nodes, the surgeon can also elect to use a radioactive tracer to locate the first cancerous lymph node.

• Fine Needle Aspiration

This is another form of biopsy that utilizes a thin needle to biopsy targeted cells. In this procedure, the needle is typically inserted into swellings or lumps that are located under the penile skin. While the lump isn’t always visible externally, it may be identified using CT scan or ultrasound techniques. Fine needle aspiration is typically considered a safe procedure that requires fewer cells than more invasive cell biopsies.

• An MRI or CT Scan

Magnetic resonance imaging and computed tomography scans are both great ways to detect abnormal growth that could be cancerous. An MRI uses powerful magnetic fields and radio pulses to create detailed images of the internal organs. Every component is displayed, including the bones, the muscles, and the soft tissues.

MRIs typically provide a clearer picture of what’s going on internally than what is available in a CT scan. Still, since there are only a few types of tissue material in the penile structure, both are viable. A CT scan, on the other hand, uses X-ray beams. These beams are used throughout the area in an arcing pattern while taking several pictures. These provide a fairly clear image of the area of the body that may be inflamed, enlarged, or damaged. The chief advantage is that CT scans are more comfortable and faster for the patient.

• Ultrasound

An ultrasound scan uses high-frequency sound waves and a special gel solution to determine if cancerous tissues have invaded the penile structure.

Typically, an ultrasound procedure is much cheaper and doesn’t expose the patient to radiation. However, ultrasounds don’t work as well for bony structures, which is why these are good for detecting cancerous growths within the soft and spongy materials inside the penile structure.

Symptoms

The biggest issue with finding symptoms for penile cancer is that the condition can be mistaken for other penile diseases. As a result of this similarity, the signs and symptoms that are experienced don’t always mean that the person has the condition.

Conversely, many men are embarrassed and don’t immediately see a doctor once symptoms start to manifest. It’s important to understand that when any type of symptom starts to manifest, it’s important to seek out a physician immediately so that the cause can be found and treated expediently.

Here are some of the most common symptoms that potentially indicate penile cancer:

• Lumps Under the Groin Area: This is a clear indication of cancerous structures forming around the lymph nodes. When the cancer is spreading from the penis, the lymph nodes in the groin area are the first structures outside of the penile area to be infected. Typically, lymph nodes are bean-shaped, but they start to enlarge and can be felt under the skin when they swell. At the same time, these can swell due to any infection; as with all of these symptoms, it’s worthwhile to consult with a physician.
• Swelling: Any type of swelling in the penile area is worth consulting a physician about. A chief indicator of penile cancer is swelling at and around the glans of the penis. This is especially true when the glans are constricted.
• Small Bumps: If a patient experiences small crusty bumps on the skin of the penis, this is an indication that this could be caused by penile cancer. If it is cancerous and left untreated, the bumps will spread and grow to cover most of the skin on the penis. Finally, it will start to spread to the soft tissues and other body areas like the groin lymph nodes.
• Bluish-brown Growths: These are flat growths and are usually a bluish-brown color.
• Discharge from Under the Foreskin: This will be a smelly fluid that is typically the result of a potentially cancerous infection. Additionally, this discharge may be blood as well.
• Red Velvety Rash: Typically, when this appears on the glans, this is a sign of erythroplasia of Queyrat, which is a form of penile cancer. This erythroplasia is typically flat and will look very irritated. In addition, this condition is a squamous cell carcinoma that can also appear on the shaft, which is known as Bowen disease. Both of these conditions fall under the umbrella of squamous carcinoma or carcinoma in situ.
• Lumps on the Penis Itself: This can indicate that penile cancer has infected the spongy tissue beneath the skin. While this isn’t always penile cancer, it’s important to speak to a physician to rule the condition out.
• Thickening of the Skin: If the glans or foreskin of the penis starts to thicken, this is a key indicator that something is happening in the tissues of the penis. Typically, this thickening is a precursor to the formation of carcinoma in situ on the surface of the penis itself. Therefore, if thickening occurs, it’s important to consult a doctor immediately.
• Color Changes: Color changes are another precursor condition that can indicate that carcinoma is forming.

Diagnosis and Stages

To diagnose penile cancer, a doctor may at first ask about the medical history so that any potential genetic risk factors can be ascertained. Next, the physician will feel the groin area for enlarged lymph nodes and penile lesions.

Since penile cancer typically begins as a skin condition that can eventually spread to other parts of the body, the doctor will also take a visual examination of the penile structure to determine if cancerous growths have taken hold.

If there is a visible or tactile indication that there may be cancer, the physician will then most likely recommend other tests before a diagnosis is reached. These include up to four types of biopsy and scans.

Here are the types of procedures:

• Standard Biopsy: For this procedure, a small amount of tissue is removed from the abdomen and sent to a lab where tests are run that will detect cancerous cells. This will take a few days to gather results.
• Incisional Biopsy: When there is a larger lesion, part of the penile area will be removed. Typically, this incisional biopsy will include the top layer of the skin and usually captures ulcerated and sore tissues. With this procedure, the area of the penis is numbed with local anesthesia before the procedure.
• Excisional Biopsy: Excisional biopsies are used for smaller areas where the legion can be safely removed for testing. This is typically used for smaller lumps and nodules or even for smaller erythroplasia of Queyrat carcinomas. Additionally, complete circumcision may be recommended by a physician, which is a form of excisional biopsy. For this type of procedure, local or general anesthesia may be used.
• Lymph Node Biopsy; This primarily consists of fine-needle aspiration, which is a procedure that uses a very thin needle to gather potentially cancerous lymph nodes and bodily fluid for testing. These lymph nodes are typically gathered from the groin, not the penis itself, and are a good way to determine if cancer has spread.

Additionally, there are also scanning techniques that can be used to diagnose penile cancer.

These include:

• Magnetic Resonance Imaging (MRI): Patients are placed into a cylindrical machine that uses radio waves and strong magnets to get a precise image of the penis’s underlying tissues. Typically MRIs are the clearest and most accurate tests of this type.
• Computed Tomography Scans (CT Scans): This uses arcing X-rays to create an image of the penis’s structures. Many pictures are taken during this procedure in a cross-sectional orientation. While this is not as accurate as an MRI, CT scans are quicker and more convenient for the patient.
• Ultrasound: Ultrasound uses high-intensity sound waves to create a picture of the penis’s structures. Usually, bones are a weakness of this procedure, but since the penis has no bone structure, it remains a good procedure for diagnosis.

Penile cancer, like other cancers, typically falls into five stage groupings:

• Stage Zero: As might be expected, this is the least serious stage. At this point, the cancer is only in the topmost layers of skin. At this stage, there is no lymph node infection.
• Stage I: When cancer has spread into the adjoining tissues under the skin, it’s stage I.
• Stage II: At stage II, cancer has spread into the tissue under the skin or has grown into blood vessels or lymph vessels, though it hasn’t reached the lymph nodes yet.
• Stage III: Once the corpus spongiosum, the corpus cavernosum, or the urethra starts to manifest cancer cells, the cancer is stage III. Cancer also may have spread into a single groin lymph node at this stage.
• Stage IV: When cancer has spread into the nearby structures of the penis, it has reached stage IV. This includes the prostate or the groin lymph nodes.

Treatments and Drugs

There are several surgical options for penile cancer. While the most extreme of these options is a partial or complete penectomy, which removes penis tissue, several treatment surgeries can be used if the condition is caught early.

Here’s a list of a few options:

• Cryotherapy: This procedure uses liquid nitrogen to freeze carcinomas. The frozen cells are killed and can be removed. Typically, this procedure may leave some scarring.
• Laser Therapy: Lasers are focused energy that can be directed to destroy cancer cells. This is a good option for men in the condition’s early stages.
• Excision: If the cancer is only in the foreskin, a physician may suggest a circumcision, which is a form of excision surgery. If it’s in a larger area, then a larger excision may be an option. This simply surgically removes the cancerous growth from the tissues of the penis. This type of surgery may require a skin graft afterward.
• Lymph Node Dissection: To prevent cancer from spreading past the lymph nodes into the body at large, sometimes a physician will remove the lymph nodes on the left and right sides of the groin. This can get rid of cancer, giving it no place to spread. However, for the most part, the deeper lymph nodes are left intact.
• Mohs Surgery: This surgery excises the cancer cells that are located on the surface of the penis. Additionally, a small amount of healthy tissue is also removed to ensure that all cancerous cells are gone from the body. Finally, to ensure the total removal of cancerous material, the excised cells are examined thoroughly for signs of the disease.

Radiation and Chemical Treatments

When it comes to treatments, topical chemotherapy is an option for penile cancer.

This type of chemotherapy works mostly for external skin-related cancers like carcinoma in situ and is used directly on the surface skin of the penis. If topical isn’t an option, several chemotherapy drugs have been found to be effective against penile cancer.

These treatments flow into the bloodstream and attack cancer cells throughout the body. Typically, these systemic drugs weaken the tumors and allow surgery to become an option.

These systemic drugs include:

• Ifosfamide
• Gemcitabine
• Docetaxel
• Cisplatin
• Bleomycin
• Paclitaxel
• Methotrexate

Coping and Support

Penile cancer is cancer that carries with it some heavy emotional weight. Patients will feel upset, especially as this condition can affect sexual health. So it’s perfectly natural to have feelings about a penile cancer diagnosis.

These feelings can include:

• Anger
• Confusion
• Depression
• Embarrassment
• Fear

Many men who have penile cancer may feel less attractive to their partners, which can cause major self-esteem issues. However, the patient needs to remember that they are not alone. There are loved ones who will want to help cope with the diagnosis.

It’s not going to get better all at once, but penile cancer has a survival rate of 85 percent within the first five years, which makes it a very survivable cancer if it’s confined to the penis. Outside of the penis, the survival rate is almost 60 percent, with new technologies and treatments strengthening that rate of survival all of the time.

Additionally, if a patient is seeking out more structured help, then here is a list of options that can offer help in coping with penile cancer:

• Specialist Nurses
• Therapists
• Licensed Counselors
• Support Groups
• Organizations like the American Cancer Society and the Urology Care Foundation

The emotional toll of coping with penile cancer can be extensive, but there is also a physical toll that may need to be addressed as well. When undergoing treatment for penile cancer, there is a chance of hair loss, weight changes, and feelings of weakness. Pain is also something that can occur due to surgeries that are designed to help fight cancer.

If these changes start to become too hard to cope with, a urologist or specialist can help a patient find new support groups, specialists or prescribe medications that will reduce the effect of the treatments.

Sometimes, a partial or complete penectomy is required to remove all traces of penile cancer and save the patient’s life. Unfortunately, this is one of the toughest potential outcomes of penile cancer. Fortunately, support groups, internet communities, and professionals deal with this condition in particular.