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Penile Cancer

Penile cancer at a glance

  • Penile cancer is the unregulated, malignant growth of cells and tissue of the penis, the male reproductive organ that transports sperm and urine out of the body.
  • Penile cancer is rare in the U.S. and accounts for less than one percent of all cancers.
  • Risk factors of penile cancer include aging, smoking, the presence of human papillomavirus (HPV) and poor personal hygiene.
  • Men with penile cancer may notice a lump or red sores on the outside of the penis, as well as experience abnormal discharge or blood in semen or urine.
  • Surgery is the standard treatment method for penile cancer and numerous methods are available depending on the stage of cancer and overall health of the patient.

What is penile cancer?

Penile cancer forms in the cells and tissue of the penis, the reproductive organ that transports sperm and urine out of the body. It is a rare form of cancer resulting in about 2,000 cases in the U.S. each year. About 400 men die each year as a result of penile cancer.

Penile cancer prognosis (chance of recovery) is difficult to gauge because penile cancer is so rare. Prognosis depends on the stage of the cancer, whether it is recurring or initially diagnosed, and the location and size of the malignant tumor.

Penile cancer is much more common in Asia, Africa and South America compared with North America and Europe. Less than 1 percent of male cancers in the United States are penile. Circumcision at birth (the removal of the foreskin that covers the glans of the penis) appears to reduce a man’s risk of penile cancer, as well as his risk of being infected with HPV.

Causes of penile cancer

Causes of penile cancer, along with causes of most all cancers, are undetermined although several risk factors have been identified. HPV infection may increase a man’s risk for developing penile cancer. Other penile cancer risk factors include being over the age of 60, smoking, having excessive sexual partners and practicing poor genital hygiene.

Symptoms and diagnosis of penile cancer

Symptoms of penile cancer may include sores on the penis, abnormal discharge and bleeding. Men who notice a lump or experience redness, soreness or irritation on the penis should visit a urologist to rule out other conditions or to confirm a penile cancer diagnosis.

A urologist will perform a physical exam to check for general health as well as a penile exam to examine any lumps or unusual features. A biopsy will remove penile cells for study under a microscope to confirm whether cancerous cells exist. Penile cancer biopsies may include:

  • Fine-needle aspiration (FNA) that removes tissue using a thin needle.
  • Excisional, which removes the entire lump or abnormal-looking tissue.
  • Incisional, which removes a portion of the lump or irregular tissue.

Detected penile cancer is classified in stages denoting its extent and progression. In order to stage penile cancer, a urologist may perform a CT scan, MRI or ultrasound, all of which produce internal images of the penis and help determine if the cancer has spread.

Penile cancer stages include:

  • Stage 0 – abnormal cells that resemble warts on the surface of the penis that may turn into cancer (also known as carcinoma in situ).
  • Stage I – cancer is present in the penis and has spread to connective tissue beneath the penis tissue.
  • Stage II – penile cancer that has spread to connective tissue, lymph nodes, blood vessels, erectile tissue or to the urethra.
  • Stage III (IIIa or IIIb) – IIIa penile cancer has spread into the groin area and to one surrounding lymph node; IIIb penile cancer has spread to more than one lymph node.
  • Stage IV – the penile cancer has spread to other organs such as the prostate, as well as to distant areas of the body.

Treatment of penile cancer

Treating penile cancer depends on the overall health of the patient, the stage and size of the tumor, and whether it is recurring or an initial incidence. Standard treatments for penile cancer include surgery to remove the cancerous tissue. The most common types of surgeries to treat and remove penile cancer are:

  • Mohs microsurgery – a surgeon cuts the tumor from the skin in small layers. Each layer is examined under a microscope until no cancer cells are present. This allows for minimal tissue removal.
  • Laser surgery – a laser beam acts as a knife to access the tissue or remove surface cancerous cells.
  • Cyrosurgery – a procedure that kills cancer cells by freezing them.
  • Wide local excision – a traditional surgery that removes the cancer and a layer of normal tissue surrounding the tumor.
  • Penis amputation – may be performed partially or totally in order to ensure the cancer is completely eradicated.

A topical chemotherapy is sometimes used to treat stage 0 penile cancer. Radiation and other chemotherapy methods may also be recommended depending on the stage and severity of the cancer. These are typically performed after a surgery to kill any remaining cancer cells.