Penile Cancer & Treatment

What is Penile Cancer?

Penile cancer is rare in the United States and there are only about 1,300 new cases diagnosed annually. This translates into an occurrence of about 1 per 100,000 men in North America. In Asia, Africa, and South America, it is much more common with an incidence as high as 10 to 20 per 100,000 men. Circumcision just after birth, a procedure in which the covering of the tip of the penis is removed, appears to protect men from developing the disease. The risk of penile cancer is about 3 times higher for men who are uncircumcised, or are circumcised later in life. Phimosis, or an unretractable foreskin, has also been associated with up to a 10-fold increase in the risk of penile cancer. Possible mechanisms by which circumcision may decrease the incidence of penile cancer include avoiding the development of phimosis and preventing the retention of smegma (skin that has been shed combined with moisture and oil from skin). Poor hygiene, chronic retention of smegma, and having a sexually transmitted disease (such as HPV or human papilloma virus 16 or 18) may also increase a man's risk of developing cancer of the penis. Recent scientific advancements have produced human papilloma virus vaccines that may potentially play a role in the prevention of penile cancer, though the area remains controversial. Similar to anal, gynecologic, and other genital cancers, HPV infection has a strong association with penile cancer. Nearly 50% of patients that develop penile cancer have been found to have the HPV infection. The impact of HPV on prognosis has yet to be determined. In 2009, the FDA approved the use of the HPV vaccine in males aged 9 through 26 years. Although this vaccine is intended to reduce the rate of genital warts, vaccinating prior to initiation of sexual activity may have an effect on penile cancer. This topic remains on the forefront of active research. Smoking also appears to be associated with penile cancers and the incidence of penile cancer is approximately eight-fold higher in HIV-infected men. Most cancers of the penis are squamous cell carcinomas, which arise from the skin of the penis. Although rare, it is possible to get metastasis (tumors which have spread from other areas) to the penis.

 

Symptoms of Penile Cancer
The symptoms of penile cancer can be seen on the skin of the penis. It is important to be aware of what is normal for you and report any changes to your doctor. Penile cancer symptoms may include

• A growth or sore on the penis that doesn’t heal within 4 weeks - it can look like a  wart, ulcer or blister and is not always painful 
• Bleeding from the penis or from under the foreskin 
• A foul smelling discharge 
• Difficulty in drawing back the foreskin (phimosis) 
• A rash on the penis 
• A change in the colour of the penis or foreskin

These symptoms do not always mean you have penile cancer. They may be symptoms of other medical conditions, such as sexually transmitted diseases. But it is important that you see your doctor if you have any of these symptoms. All men should examine their testicles once a month to check for testicular cancer. This is a good time to look for any changes on and around your penis too.

Penile Cancer Causes
This page tells you about the risks and causes of penile cancer. We don’t know exactly what causes penile cancer. But there are some known risk factors. There is information below about

•     A quick guide to what's on this page
•     How common penile cancer is
•     Human papilloma virus (HPV)
•     Age
•     Smoking
•     Having a weakened immune system
•     Circumcision
•     Build up of secretions under the foreskin
•     Painful erection (priapism)
•     Psoriasis treatment
•     Family history

Types of Penile Cancer 

 
Squamous cell cancer of the penis
This is by far the most common type of penile cancer. Over 9 out of 10 penile cancers (90%) are this type. Squamous cell cancers can develop anywhere on the penis, but the most common sites are the

•     Head of the penis (glans)
•     Foreskin (in uncircumcised men)

Squamous cells are flat, skin like cells that cover the surface of the penis. This type of cancer generally grows slowly over many years. But occasionally it can grow quite rapidly. Before squamous cell cancer develops, the cells may go through pre cancerous changes.
Squamous cell cancers that are found early are usually curable.
Verrucous carcinoma is a rare type of squamous cell penile cancer. It looks like a large wart and is a slow growing tumour that rarely spreads to other parts of the body. Verrucous carcinoma is usually curable with surgery.

Adenocarcinoma
Adenocarcinoma means that the cancer started in the glandular cells that produce sweat in the skin of the penis. This type is much rarer than squamous cell penile cancer. Only about 5 in 100 penile cancers (5%) are adenocarcinomas.

Melanoma of the penis
Melanomas develop from the cells in the skin that give the skin its colour. Although melanomas usually develop on areas of the body that are exposed to the sun, a few develop in places that are not generally directly in the sun. Only about 2 out of every 100 penile cancers (2%) are melanomas.

Basal cell cancer of the penis
This type of cancer develops from basal cells, which are found in the deepest layer of the skin. Basal cell cancers develop mostly in areas exposed to the sun, but can develop in other places. This type of cancer is very slow growing and very rarely spreads to other parts of the body. They make up about 2 out of every 100 penile cancers (2%).

Sarcoma of the penis
Sarcomas are cancers that start in the body’s connective tissues. Connective tissues are the tissues that form the structure of the body, such as bone, muscle, fat and cartilage. Sarcomas of the penis are extremely rare and account for only about 1 out of every 100 penile cancers (1%). Sarcomas tend to grow more quickly than other types of penile cancer.

Treatment of Penile Cancer

In recent years, much progress has been made in treating penile cancer. New medicines or ways to use medicines have been developed. Surgical methods involving microscopic techniques and lasers have been refined, and more is known about the best way to use radiation.

Surgery

Surgery is the most common, and elective, treatment for penile cancer is surgery. The cancer is removed from the penis using one of the following methods:

• Laser surgery, which uses a narrow beam of light to kill the cancer cells.
• Microsurgery to remove the penile cancer and as little normal tissue as possible. During this surgery, the doctor uses a microscope to look at the cancerous area to make sure all the cancer cells are removed.
• Circumcision to remove the foreskin if the penile tumor is confined to this area.
• Wide local excision, which removes only the penile cancer and some normal tissue on either side.
• Surgery to remove part or all of the penis. In a partial penectomy, the surgeon removes a portion of the penis without altering normal urinary function. In a total penectomy, the majority of the penis is removed. This then requires diversion of the urinary stream by creating a perineal urethrostomy so the bladder can be emptied without the need for a tube to drain it. Additionally, lymph nodes in the groin may be removed in an attempt to stage and cure the patient of the disease.

Radiation Therapy
Radiation involves the use of high energy x-rays aimed at the tumor or the area from where the tumor was removed. Radiation can offer the advantage of penis preservation by avoiding a penectomy in some cases. Both external radiation (radiation that comes from a machine rotating around the patient) and brachytherapy (a procedure in which radioactive seeds are inserted directly into the tumor) can be used. Radiation therapy can be used alone for some T1 lesions and T2 lesions that are low grade, or it can be used with or without chemotherapy following surgery in patients who have advanced disease. Prior to the initiation of radiation, a circumcision should be performed. In advanced disease, poorly differentiated tumors, and when lymph nodes are involved, chemotherapy and radiation together is used to treat the pelvis and groin in order to help prevent the cancer from returning in the pelvis, groin, or penis. The radiation and chemotherapy are given after the lymph nodes in the groin have been removed by the surgeon.

 
Chemotherapy
Topical medications are occasionally used to treat non-invasive penile cancers. 5- Fluorouracil (5-FU) is a type of chemotherapy often used intravenously for other types of cancer; however, it is also approved for topical use. The 5-FU cream is applied to the area twice daily for several weeks. Imiquimod is also an approved topical medication. This cream, which is thought to work by stimulating the immune system, is applied to the tumor five times a week for 6 weeks.

Chemotherapy is most commonly used in patients whose cancer has spread throughout the body to distant sites, and who need systemic therapy (therapy that reaches all parts of the body). Chemotherapy can be used in conjunction with radiation when the tumor involves the lymph nodes. This is based on its effectiveness in similar genital cancers. Once the cancer has spread to other organs, chemotherapy is used to try to stop symptoms and extend survival, but does not generally cure the cancer. Chemotherapy can also be used before surgery when patients present with more advanced disease, such as spread to the lymph nodes in the groin or pelvis. Drugs such as bleomycin, cisplatin, and methotrexate have been reported as achieving modest tumor responses in selected patients. 


Lifestyle changes after Pancreatic Cancer
You can't change the fact that you have had cancer. What you can change is how you live the rest of your life -- making choices to help you stay healthy and feel as well as you can. This can be a time to look at your life in new ways. Maybe you are thinking about how to improve your health over the long term. Some people even start during cancer treatment.

Making healthier choices
For many people, a diagnosis of cancer helps them focus on their health in ways they may not have thought much about in the past. Are there things you could do that might make you healthier? Maybe you could try to eat better or get more exercise. Maybe you could cut down on the alcohol, or give up tobacco. Even things like keeping your stress level under control may help. Now is a good time to think about making changes that can have positive effects for the rest of your life. You will feel better and you will also be healthier.

Eating better
If treatment caused weight changes or eating or taste problems, do the best you can and keep in mind that these problems usually get better over time. You may find it helps to eat small portions every 2 to 3 hours until you feel better. You may also want to ask your cancer team about seeing a dietitian, an expert in nutrition who can give you ideas on how to deal with these treatment side effects.

One of the best things you can do after cancer treatment is put healthy eating habits into place. You may be surprised at the long-term benefits of some simple changes, like increasing the variety of healthy foods you eat. Getting to and staying at a healthy weight, eating a healthy diet, and limiting your alcohol intake may lower your risk for a number of types of cancer, as well as having many other health benefits.

Rest, fatigue, and exercise
If you were sick and not very active during treatment, it is normal for your fitness, endurance, and muscle strength to decline. Any plan for physical activity should fit your own situation. An older person who has never exercised will not be able to take on the same amount of exercise as a 20-year-old who plays tennis twice a week. If you haven't exercised in a few years, you will have to start slowly – maybe just by taking short walks.

If you are very tired, you will need to balance activity with rest. It is OK to rest when you need to. Sometimes it's really hard for people to allow themselves to rest when they are used to working all day or taking care of a household, but this is not the time to push yourself too hard. Listen to your body and rest when you need to. (For more information on dealing with fatigue, please see Fatigue in People With Cancer and Anemia in People With Cancer.)

Keep in mind exercise can improve your physical and emotional health.

•     It improves your cardiovascular (heart and circulation) fitness.
•     Along with a good diet, it will help you get to and stay at a healthy weight.
•     It makes your muscles stronger.
•     It reduces fatigue and helps you have more energy.
•     It can help lower anxiety and depression.
•     It can make you feel happier.
•     It helps you feel better about yourself.