Early Signs and Symptoms of Penile Cancer

What is penile cancer?

Penile cancer is a relatively rare type of cancer arising from the skin and tissues of the penis. It affects the skin and tissues of the penis. It occurs when normal cells in the penis become cancerous and grow rapidly out of control, forming a tumor. Penile cancer can spread to other parts of the body.

What causes penile cancer?

Certain factors increase the risk of penile cancer:

• Uncircumcised men: Men who are uncircumcised are at a high risk of penile cancer. This is possibly due to the fact that an uncircumcised penis is at a high risk of other conditions such as phimosis (the foreskin becomes tight and difficult to retract) and smegma (a substance formed when dead skin cells and oil accumulate beneath the foreskin).
• Multiple sexual partners increase the risk of penile cancer.
• Chronic balanitis (swelling of the head of the penis) is a risk factor for penile cancer.
• Carcinoma in situ of the penis as seen in erythroplasia of Queyrat and Bowen disease increases the risk of cancer.
• Penile trauma and micro-tears that spread to prepare may increase the risk of cancer in rare cases.
• Men who are aged over 60 years are at high risk.
• Smoking cigarettes increases the risk of penile cancer.
• Men who live in areas of poor hygiene are at an increased risk of penile cancer.
• Poor personal hygiene, especially of the genitals, increases the risk of penile cancer.
• Having sexually transmitted diseases such as human papillomavirus (HPV) is a risk factor for penile cancer.

What are the stages of penile cancer?

The stage of cancer describes the extent and severity of cancer. The treatment and prognosis of cancer depend on the stage of cancer at the time of diagnosis:

• Stage 0: Cancer is limited to the top layer of the skin and had not spread to any other part of the body.
• Stage 1: Cancer spreads into the deeper layer and connective tissue below the skin. It is still limited to just the penis and does not spread to other parts of the body.
• Stage 2: Cancer spreads to the connective tissue below the skin, lymph vessels, and/or blood vessels. It spreads to the urethra and/or erectile tissues. It still doesn’t spread to other parts of the body at this stage.
• Stage 3A: Cancer spreads to one or two lymph nodes in the groin but not to other parts of the body.
• Stage 3B: Cancer spreads to multiple lymph nodes in the groin but not to other parts of the body.
• Stage 4: Cancer spreads to the surrounding areas such as the prostate, scrotum, and pubic bone (hip bone).

How is penile cancer treated?

The treatment of penile cancer depends on the extent of cancer. To decide the treatment plan, penile cancer is categorized into non-invasive (cancer is superficial and limited to the penis) and invasive (cancer spreads deep into the penis tissue and surrounding areas).

Treatment options for non-invasive penile cancer:

• Topical chemotherapy: Intraepithelial neoplasms such as Bowen disease or erythroplasia of Queyrat may be treated with topical 5-fluorouracil or imiquimod. This may be followed by topical imiquimod application.
• Circumcision: The foreskin of the penis is removed if the only prepuce is involved.
• Chemotherapy: Drugs are administered to kill cancer cells in the body.
• Radiation therapy: Radiation such as X-rays are used to kill cancer cells. However, squamous cell cancers are resistant.
• Laser therapy: Laser energy is used to kill cancer cells.
• Cryosurgery: Liquid nitrogen freezes tumors, causing them to fall off.

Treatment options for invasive penile cancer: 

• Excisional surgery: The surgeon only removes the affected area and a rim of healthy tissue surrounding it. 
• Moh’s surgery: In Moh’s surgery, the goal is to remove as little tissue as possible while removing the tumor. The surgeon removes a thin layer of the affected area that is examined under the microscope to check for cancer cells. The process is repeated until there are no cancer cells in the samples.
• Partial or total penectomy: A partial penectomy involves removing part of the penis, whereas total penectomy is the total removal of the penis. The choice of surgery depends on the size of the tumor and the extent of the penis affected. Penis reconstructive surgery may be performed following partial or total penectomy.
• Biological therapy: Certain drugs may be used that only attack the cancer cells and spare normal body cells.

What’s the prognosis of penile cancer?

The prognosis of penile cancer depends on the stage of cancer, age of the patient, overall health, and response to treatment. Early diagnosis and treatment can lead to full recovery. The five-year survival rate for people with tumors that are limited to the penis is approximately 85%. Once the cancer spreads to the surrounding lymph nodes and tissues, the five-year survival rate decreases to around 59%.