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Overview
Penile cancer is a condition in which malignant cells form in the tissues of the penis (NHS, 2019). Cancers of the penis are rare in the UK; however, the incidence of these malignancies is higher in parts of South America, Africa, and Asia (European Association of Urology (EAU), 2014).
When the condition has been diagnosed, it can be psychologically devastating to the man (and, if appropriate, his family/friends). Early-stage penile cancer is slow-growing and it rarely interferes with the man's ability to urinate or with his erectile function. Men do not usually complain until they experience pain or there is a discharge from the cancer; at this stage, the cancer has usually progressed from being superficial to invasive.
The type of penile cancer will depend on the type of cell where the cancer began. Knowing this will help the patient and the healthcare provider decide which treatment options are available.
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Risk factors
The exact cause of penile cancer is unknown, but there are several risk factors. A man's risk of developing cancer will depend on a number of factors, including the man's age, genetics and exposure to risk factors (including some potentially avoidable lifestyle factors). Some 63% of penile cancer cases in the UK are preventable (CRUK, 2016).
Age
Old age is the key risk factor for penile cancer. The cancer is more common in men aged over 50 years and is rare in men under 40 years.
Smoking
Those men who smoke may be more likely to develop penile cancer: the chemicals in cigarettes can cause damage to the DNA of cells in the penis, thus increasing the risk of developing cancer. Smoking can put men at a high risk of infection by the human papilloma virus (HPV) infection.
Human papilloma virus
Human
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Symptoms
Penile carcinoma almost always presents with an abnormality of the skin or a palpable lesion on the man's penis. A growth or a sore on the penis that does not heal within 4 weeks—this can look like a wart, ulcer or blister and it might not be painful—may be a sign.
Bleeding, including from under the foreskin in the uncircumcised man, can be a sign of cancer. If there is a malodourous discharge, this can be the result of infection or irritation of the penile skin. The man may find it difficult to draw back the foreskin due to phimosis.
A rash can develop on the penis; the man may also report changes to the colour of his penis or foreskin. It is important for the man to be aware of what is normal for him and report any changes to the practice nurse, GP or doctor.
These are the
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Diagnosis
A detailed history is essential and a physical examination must be undertaken. In order to make a definitive diagnosis, a biopsy is taken from any lesion or abnormal areas on the penis, glans or foreskin. The biopsy can be performed under a local or general anaesthetic, the biopsies are then sent for histological assessment. If the biopsy demonstrates cancer, then there is a need to undertake other investigations and tests to determine if there is any evidence of metastatic spread (Horenblas, 2012). Blood will also be taken for tumour markers and a full blood count. The results of the tests and investigations will help decide on the best type of treatment.
Local staging can be undertaken using magnetic resonance imaging (MRI). Ultrasound of the glans penis may also be used to identify if there is any involvement of the corpus cavernosum. Methods for lymph node staging will include clinical examination,
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Treatment
Around half of presenting patients often have had the lesion for six months or longer (Arya et al, 2013). The delay may be the result of embarrassment, guilt, fear, or ignorance, as well as personal neglect. The man may try to treat himself using a number of over-the-counter skin creams and lotions.
The cause of delay may also be attributed to the nurse or doctor, as they may be unaware of the potential of penile cancer and can make an incorrect differential diagnosis (for example, sexually transmitted infection): the patient may be prescribed antibiotics prior to any referral being made. A delay in diagnosis and treatment will impact on the prospect of survival; it will also reduce the ability to retain a functioning and cosmetically satisfactory result (EAU, 2014).
Penile squamous cell carcinoma (EAU, 2014) behaves in a similar way to squamous cell carcinoma occurring on other parts of the
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Key Points
I would like to thank Mrs Frances Cohen for her help and support.
Glossary
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Brachytherapy |
The treatment of cancer by the insertion of radioactive implants directly into the tissue |
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Cytology |
The scientific study of cells |
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Fibromuscular |
Relating to or containing fibrous and muscular tissues |
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Histology |
The microscopic study of the structure of tissues |
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Immunocompromised |
Having an impaired immune system |
| Inguinal |
Related to the groin |
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Lesion |
An area of tissue damaged through injury or disease |
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Lymphadenectomy |
Surgical removal of the lymph nodes |
| Lymphadenopathy |
Disease or enlargement of the lymph nodes |
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Penectomy |
Surgical removal of the penis |
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Phimosis |
Occurs when the foreskin becomes tight and is difficult to retract |
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Smegma |
A substance made up of dead skin cells that can build up under a tight foreskin |
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Sub-epithelial |
Occurring beneath an epithelial layer |
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Os |
Opening |
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Vaccine |
Vaccines produce antibodies to fight disease without actually causing infection. If the vaccinated person comes into contact |
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