Carolinas HealthCare System

Penile Cancer

Malignant tumors of the penis are extremely rare in the United States. Scientists currently believe that penile tumors are caused by cancer-producing effects of secretions that become trapped within the foreskin if they are not washed away on a regular basis. It is not surprising, therefore, that this particular malignancy is extraordinarily common in South and Central America, and Third World countries, where public health and personal hygiene often are lacking. Also, circumcision, a practice that could improve hygiene, is not regularly performed. In the United States, penile cancer is a relatively unusual cancer, probably due to the country's superior sanitary and hygienic conditions along with commonly practiced circumcision.

However, scientists are currently studying other causes of penile cancer, particularly the role of human papilloma virus (HPV), which already has strong links to cervical cancer. Antibodies to HPV-16, a specific type of papilloma virus also implicated in cervical cancer, have been found in many patients with penile cancer.

Unfortunately, early diagnosis of penile cancer is often missed because it is so rare in the United States that general physicians and even urologists may only see two or three such cancers in their lifetime. In addition, patients may also be reluctant or embarrassed to talk to their doctor if they suspect a problem.

However, like most diseases, early diagnosis improves the chance of a cure. If diagnosis is delayed, and the disease progresses, therapy may be less successful and more disfiguring. So, it is very critical that any skin erosion, ulcer, sore, irritation, discoloration that is noticed on the foreskin, the skin of the shaft of the penis or the surface of the head of the penis be brought to the attention of the physician by the patient and be promptly evaluated.

Chances are good that most such lesions are linked to a bacterial or fungal infection or even an allergic reaction, all of which will respond readily to antibacterial or antifungal ointments and creams. But growths or areas that return or do not heal should receive further evaluation including a biopsy where the tissue is removed for examination under a microscope.

If a precancerous or cancerous condition is found, prompt treatment and systematic, regular follow-up are very important.

How is Penile Cancer Treated?

Early detection and identification of penile cancer are very valuable because the treatments that can provide successful outcome are indeed low risk. If the tumor appears on the skin surface, your urologist may be able to treat the problem with a topical cream that has minimal side effects.

For lesions smaller than a pea, a small local excision or a type of surgery that continues to shave layers of abnormal tissue until normal tissue is reached (Moh's surgery) may be performed. With these procedures, there is essentially no loss of form or function to the penis. However, careful follow-up is critical to identify early recurrence. In the removal of these small lesions, it is very unlikely that cancer has spread to lymph nodes and, therefore, removal of the lymph nodes is usually not necessary.

With larger lesions, it is necessary to remove greater amounts of tissue and also to consider removal of the draining lymph nodes in the groin in order to achieve a cure. In these circumstances, a combination of surgery, radiation and chemotherapy may be necessary.

It is also important to note that external beam radiation is an alternative therapy, specifically for small lesions. Again, the critical importance of early detection not only ensures a better outcome for the treatment supplied but also provides more treatment options that can be applied.

What Can Be Expected After Treatment for Penile Cancer?

Your post-treatment experience will be directly tied to the stage of your cancer when it is diagnosed. Cure is almost certainly ensured when lesions are detected early. But it is less certain as the tumor becomes more advanced. Treatment is also increasingly more debilitating.

Men, especially men who are not circumcised, should report any lesions or changes in appearance to their physician promptly. While patients at greatest risk are those who are not circumcised, every man should be on the lookout for penile lesions as they need prompt attention.

How to Reduce Your Risk

Until recently, the general consensus was that penile cancer was caused by chemical irritation and there was no concern about transmitting it. But recent data have shown that HPV increases incidence in both penile and cervical cancers. There appears to be increased incidence of these cancers in the spouses of people with this sexually transmitted disease. Thus, while penile cancer is not directly transmissible, if you or your partner has HPV, you need to use protection during intercourse, be aware of any lesions, and, if you are the woman, have frequent cervical examinations. Not only are efforts to eliminate or minimize the infection important but so are discussions with a urologist or other specialist about its link to penile cancer.

Should all Male Children be Circumcised Soon After Birth to Prevent Penile Tumors?

This question creates much debate. Some experts believe that sexual sensation is diminished after circumcision, even though evidence points to a lower incidence of urinary tract infections and penile cancer in men who have had the procedure. Parents should discuss the risks and benefits of circumcision with the child's doctor.

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