Penile cancer, one of the rare male genital area cancers, is seen in men over the age of 50 who do not keep the area under the foreskin clean. In the early stages of cancer, small wart-like formations are seen in the area close to the tip of the penis and are painless. However, as the condition progresses, pain and bleeding may occur.
“What is penile cancer?” The answer to the question is that it usually is a rare type of cancer in the head of the penis and on the foreskin. This type of cancer develops as a result of the uncontrolled proliferation of skin or cells in the penis. Its incidence is very low in Europe, the United States and developed countries. The incidence is more common in parts of Africa, South America, and some Asian regions. The incidence is higher in individuals that are smoking, who lack personal hygiene, patients with phimosis (reduced foreskin tip), HPV infected patients, men with AIDS and groups over 60 years of age. If diagnosed early, treatment is possible.
Risk factor for penile cancer can be anything that is generally known to be related to cancer development. However, each type of cancer has different risk factors. Some of these are factors that can be influenced by making changes in your habits, and some are factors that cannot be influenced. For example, while the age of the person and the hereditary characteristics from the family cannot be changed, factors such as smoking and sun exposure are among the risk factors that the person can control. In addition, having one or more risk factors does not always mean that you will get the disease. On the other hand, when some penile cancers are observed, it has been observed that men who do not show any risk factors also get this disease. Some risk factors that increase a man's likelihood of developing penile cancer are as follows:
- HPV virus: It is one of the most important risk factors for penile cancer. Human Papillomavirus occurs in more than 150 virus types and each has its own characteristics. HPV causes very different clinical lesions in the skin and mucous membranes. Different types of HPV cause different types of warts on various parts of the body. HPV can be transmitted through sexual contact. It can be passed from one person to another during contact with the infected area during sexual activity, including vaginal, anal, oral. HPV infection can spread from one region to another. For example, it can start from the penis and then spread to the anus area. About half of penile cancers are HPV positive.
- Not being circumcised
- Smegma: It is a substance that forms when dead skin, bacteria and natural oils collect under the foreskin. If the necessary hygienic measures are not followed and cleaned well in this region, smegma will develop and this may cause inflammation.
- Phimosis: It is the condition where the fold called foreskin of uncircumcised men is quite narrow and cannot be pulled backwards. In this case, inflammation and the development of smegma increase the risk of penile cancer.
- Smoking and other tobacco use: As with many cancers, tobacco use is among the most common risk factors as it exposes the body to various heavy chemicals.
- Age: The risk of penile cancer increases with age, with the average age being over 60.
- UV exposure: Men with psoriasis sometimes receive UV light therapy along with drugs called psoralen. It has been found that the development of this cancer is nine to ten times more common in men treated with PUVA. For this reason, men's genitals are closed during treatment.
- AIDS: Men with AIDS may be more prone to penile cancer as a result of weakened immunity.
- Poor hygiene
Although there is no guaranteed way to prevent cancer, some measures can help reduce risk factors. These factors can be listed as follows:
- To be circumcised, or to apply appropriate genital hygiene measures in case of not being circumcised.
- Safe sex methods such as use of condoms.
- Obtaining necessary support for decreasing or completely quitting tobacco products.
Penile cancer symptoms can often be noticed in the early stages. Therefore, early diagnosis and awareness are of great importance. However, the symptoms of penile cancer do not always indicate a cancerous formation and similar findings of other diseases can be seen. These symptoms can often be a sign of an infection or an allergic reaction. It is necessary to determine the source of the symptoms and make a differential diagnosis under the guidance of a specialist.
The most important symptoms of penile cancer are as follows:
- Thickening and change of color of the skin of the penis
- Apparent swelling
- Wart, sore or mass formation on the penis
- Bleeding of the foreskin
- Foul smelling discharge
- Irritation and crusting
- Presence of red spot and rash
Many penile cancers begin in the skin cells of the penis. 95% of this type of cancer occurs in squamous cells, which are skin cells. These cancers usually occur in the foreskin or glans area (head) of the penis. Other less common forms of cancer are as follows:
- Melanoma: An aggressive type of skin cancer which originates from melanocytes.
- Basal cell carcinoma: It is a slow-growing, rarely invasive type of skin cancer that mostly occurs on sun-exposed areas of the body.
- Adenocarcinoma: It is a rare type of cancer that forms from the sweat glands of the penis.
- Sarcoma: This type of cancer can form from the smooth muscles of the penis, from the penile vessels or from other connective tissue of the penis.
STAGE 0: It is the first stage of penile cancer. At this stage, the tumor is only superficial in the upper layer of the skin and has not spread further. It does not spread to nearby lymph nodes or more distant parts of the body.
STAGE 1: The tumor has reached the underlying tissue from the upper layer of the skin. It is not involved in nearby blood vessels, lymphatic vessels, or nerves and is not high-grade.
STAGE 2: At this stage, cancer cells begin to develop. It can involve the blood and lymph vessels, as well as the inner chambers of the penis and the urethra. The cancer has still not spread to the lymph nodes or distant parts of the body.
STAGE 3A: The tumor has grown in the tissue under the upper layer of the skin and there may be an enlargement of the corpus spongiosum or the corpus cavernosum. Cancer can spread to lymph nodes on the same side of the body. It does not spread to distant parts of the body.
STAGE 3B: In addition to stage 3A, it spreads to the lymph nodes in the inguinal region. It does not spread to distant parts of the body.
STAGE 4: It may have spread to tissues near the penis and lymph nodes in the groin or pelvis, and may spread to distant parts of the body.
The diagnosis of penile tumor is made as a result of a physical examination by a specialist physician, in addition to a biopsy that confirms the presence of cancer cells. Considering the stage of the disease after the diagnosis, the necessary road map is drawn and the treatment is planned. Methods such as computed tomography, ultrasound, and magnetic resonance imaging can also be used to detect the spread of cancer.
Treatment of penile cancer varies according to the type and stage of the cancer. In some patients, removal of the affected cancerous tissue part is sufficient, while in some patients it may be necessary to remove the penis completely with a surgical (penectomy) method. Laser therapy can be done to destroy the tumor. It is also possible to use radiotherapy or chemotherapy through topical creams.
Follow-up plan should be followed to prevent recurrence of the disease after penile treatment. Regular check-ups and examinations are important for the long-term health of the patient.