Penile cancera disease where abnormal cells split without control and spread to other nearby body tissue and/or organs is a rare type of malignancy that develops in the penis. The penis is the male sex organ comprised of four main parts: the head of the penis (glans), body/shaft, foreskin (moveable layer of skin covering the glans), and the frenulum (small tag of skin under the penis between the foreskin and the shaft).
The penis has functions in both the urinary and reproductive systems. In the urinary system, the penis contains the urethrathe tube that carries urine from the bladder to outside of the body, which is a thin tube that carries urine from the bladdera hollow, muscular sac in the pelvis that stores urine to the outside of the body. In the reproductive system, bloodthe red bodily fluid that transports oxygen and other nutrients around the body flows to the penis during sexual arousal to make it erect, allowing for sexual intercourse and the passage of sperm from the testicles to the outside of the body.
Penile cancers are generally diagnosed in men over 50, however, it can affect anyone with a penis – including men, teenagers, transgender women, non-binary individuals, and intersex people – at any age.
Types of Penile Cancer
There are several types of penile cancer, that are categorised by which types of cellsthe basic structural and functional unit of all living things the cancer develops from.
Squamous Cell Carcinoma (SCC)
Squamous cell carcinoma’s (SCCs) are the most common type of penile cancer. This type of cancer develops from the squamous cells that cover the surface of the penis. SCC penile cancer often develops in the foreskin of uncircumcised men or in the glans, but can develop in the skin of the shaft as well. While this type of cancer can be aggressive, it can have a good prognosisto predict how a disease/condition may progress and what the outcome might be when caught early.
Carcinoma in situ (CIS)/penile intraepithelial neoplasia (PeIN)
Carcinoma in situpre-cancerous condition where abnormal cells haven't spread beyond the place they developed (CIS), also known as penile intraepithelial neoplasia (PeIN), is the earliest stage of penile SCC. It is the most common precancerous condition of the penis, and only appears in the very top layer of skin cells.
Basal Cell Carcinoma (BCC)
Basal cell carcinomacancer arising from tissues that line organs (BCC) of the penis is a rare subtype of penile cancer, that is often classified as a type of skin cancer. They develop from the basal cells in the skin, which are located under the squamous cells. BCCs are not usually aggressive, are slow growing, and usually have a good prognosis.
Adenocarcinoma
A penile adenocarcinomacancer arising from mucus-producing glands in organs is a very rare subtype of penile cancer that develops from the sweat glands in the penis. Due to the rarity of the disease, there has been limited research done into the prognosis of this disease.
Melanoma
Penile melanomas are a rare subtype of penile cancer that develop from melanocytes, which are the cells that give skin its pigmentation or colour. While melanomas generally develop in areas exposed to the sun, they can rarely develop in areas not exposed to the skin. Penile melanomas can be aggressive, but the prognosis can be good when caught early.
Penile Sarcoma
Penile sarcomas are the rarest subtype of penile cancer. They often develop in deeper tissues of the penis, such as blood vessels, muscle, fat, or connective tissuea group of cells that work together to perform a function, and can be very aggressive. Due to the rarity of this subtype, there has been limited research done into the prognosis of this disease.
Treatment
If penile cancer is detected, it will be staged and graded based on size, metastasiswhen the cancer has spread to other parts of the body, also known as mets, and how the cancer cells look under the microscope. Stagingthe process of determining how big the cancer is, where it started and if it has spread to other areas and grading helps your doctors determine the best treatment for you.
Cancers can be staged using the TNM staging system:
- T (tumoura tissue mass that forms from groups of unhealthy cells) indicates the size and depth of the tumour.
- N (nodea small lump or mass of tissue in your body) indicates whether the cancer has spread to nearby lymph nodessmall bean-shaped structures that filters harmful substances from lymph fluid.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0-IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissue.
- Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and had not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localisedaffecting only one area of body cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also known as localised cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advancedat a late stage, far along or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Gradea description of how abnormal cancer cells and tissue look under a microscope when compared to healthy cells I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
- Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testinga procedure that analyses DNA to identify changes in genes, chromosomes and proteins, which can be used to analyse tumour DNA to help determine which treatment has the greatest chance of success, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment is dependent on several factors, including location, stage of disease and overall health.
Treatment options for penile cancer may include:
- Surgerytreatment involving removal of cancerous tissue and/or tumours and a margin of healthy tissue around it to reduce recurrence, potentially including:
- Circumcisionremoval of the foreskin of the penis.
- Wide local excisionremoval of cancerous tissue and a margin of healthy tissue around it to prevent cancer recurrence.
- Glans resurfacingremoval of the top layer of tissue on the glans portion of the penis, a skin graft may also be required to replace tissue taken.
- Glansectomycomplete of partial removal of the glans portion of the penis.
- Penectomycomplete or partial removal of the penis.
- Lymphadenectomysurgical removal of lymph node(s).
- Chemotherapya cancer treatment that uses drugs to kill or slow the growth of cancer cells, while minimising damage to healthy cells, potentially including topical chemotherapy.
- Radiation therapya treatment that uses controlled doses of radiation to damage or kill cancer cells, potentially including:
- External beam radiation therapy (ERBT).
- Brachytherapya type of internal radiation therapy where radioactive material is placed inside or near a tumor to deliver targeted radiation.
- Laser therapya procedure that uses an infrared laser to raise the temperature of the tumour to shrink and damage cancer cells.
- Photodynamic therapya procedure that involves inserting a light-sensitive drug (photosensitiser) to shrink and damage cancer cells when exposed to a light source.
- Cryotherapythe process of freezing off cancerous tumours and/or lesions using liquid nitrogen.
- Clinical trialsresearch studies performed to test new treatments, tests or procedures and evaluate their effectiveness on various diseases.
- Palliative carea variety of practices and exercises used to provide pain relief and improve quality of life without curing the disease.
Risk factors
While the causes of penile cancer remain unknown, the following factors may increase your riskthe possibility that something bad will happen of developing the disease:
- Being infected with the Human papillomavirus (HPV).
- Not being circumcised.
- Having a history of smoking.
- Having a weakened immune system.
- Being over 50 years old.
- Certain skin conditions, such as:
- Psoriasis.
- Lichen Sclerosis.
- Phimosis.
- Being infected with the human immunodeficiency virus (HIV).
- Being infected with the acquired immunodeficiency syndrome (AIDS).
- Having precancerous lesions, such as CIS and/or PeIN.
- Previous exposure to ultraviolet (UV) radiation.
Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Symptoms
Early symptoms of penile cancer may include:
- A growth or sore on any area of the penis that doesn’t go away after a few weeks.
- Unusual bleeding from the penis and/or under the foreskin.
- Foul-smelling discharge from under the foreskin.
- A lump on any area of the penis.
- Changes in colour of penile skin/foreskin.
- Thickening of penile skin/foreskin.
- Unexplained pain in any area of the penis.
- Swelling of the tip of the penis.
- Persistent rash on any area of the penis.
- Unexplained lumps in the groinarea between the abdomen and thighs region.
Not everyone with the symptoms above will have cancer, but see your general practitioner (GP) if you are concerned.
Diagnosis
If your doctor suspects you have penile cancer, they may order the following tests to confirm the diagnosisthe process of identifying a disease based on signs and symptoms, patient history and medical test results and refer you to a specialist for treatment:
- Physical examinationan examination of your current symptoms, affected area(s) and overall medical history.
- Imagingtests that create detailed images of areas inside the body tests, potentially including:
- Ultrasounda type of medical imaging that uses soundwaves to create detailed images of the body .
- CT (computed tomography) scana type of medical imaging that uses x-rays and computer technology to create detailed images of the body.
- MRI (magnetic resonance imaging)a type of medical imaging that uses radiowaves, a strong magnet and computer technology to create detailed images of the body.
- PET (positron emission tomography) scana type of medical imaging that uses radioactive tracers to create detailed images of the body.
- Blood teststesting done to measure the levels of certain substances in the blood.
- Biopsyremoval of a section of tissue to analyse for cancer cells.
