Penile cancer

Definition

Penile cancer is the growth of malignant cells on the external skin and in the tissues of the penis.

Description

Penile cancer is a disease in which cancerous cells appear on the penis. If left untreated, this cancer can grow and spread from the penis to the lymph nodes in the groin and eventually to other parts of the body.

Demographics

Penile cancer is a rare form of cancer that develops in about one out of 100, 000 men per year in the United States. Penile cancer is more common in other parts of the world, particularly Africa and Asia. In Uganda, penile cancer is the most common form of cancer for men.

Causes and symptoms

The cause of penile cancer is unknown. The most common symptoms of penile cancer are:

• A tender spot, an open sore, or a wart-like lump on the penis.
• unusual liquid discharges from the penis.
• Pain or bleeding in the genital area.

Diagnosis

In order to diagnose penile cancer, the doctor examines the patient's penis for lumps or other abnormalities. A tissue sample, or biopsy , may be ordered to distinguish cancerous cells from syphilis and penile warts. If the results confirm a diagnosis of cancer, additional tests are done to determine whether the disease has spread to other parts of the body.

Treatment team

A doctor who specializes in the genitourinary tract (urologist) is usually the first point of contact for the patient and makes the diagnosis of penile cancer. Once a diagnosis of cancer is made, a specialist in cancer (oncologist) will become involved to determine the stage of the cancer and recommend appropriate treatments.

Clinical staging, treatments, and prognosis

In Stage I penile cancer, malignant cells are found only on the surface of the head (glans) and on the foreskin of the penis. If the cancer is limited to the foreskin, treatment may involve wide local excision and circumcision. Wide local excision is a form of surgery that removes only cancer cells and a small amount of normal tissue adjacent to them. Circumcision is removal of the foreskin.

If the Stage I cancer is only on the glans, treatment may involve the use of a fluorouracil cream (Adrucil, Efudex), and/or microsurgery. Microsurgery removes cancerous tissue and the smallest possible amount of normal tissue. During microsurgery, the doctor uses a special instrument that provides a comprehensive view of the area where cancer cells are located and makes it possible to determine that all malignant cells have been removed.

In Stage II, the penile cancer has spread to the surface of the glans, tissues beneath the surface, and the shaft of the penis. The treatment recommended may be amputation of all or part of the penis (total or partial penectomy). If the disease is diagnosed early enough, surgeons are often able to preserve enough of the organ for urination and sexual activity. Treatment may also include microsurgery and external radiation therapy , in which a machine provides radiation to the affected area. Laser surgery is an experimental treatment for Stage II cancers. Laser surgery uses an intense precisely focused beam of light to dissolve or burn away cancer cells.

In Stage III, malignant cells have spread to lymph nodes in the groin, where they cause swelling. The recommended treatment may include amputation of the penis and removal of the lymph nodes on both sides. Radiation therapy may also be suggested. More advanced disease requires systemic treatments using drugs (chemotherapy ). In chemotherapy, medicines are administered intravenously or taken by mouth. These drugs enter the bloodstream and kill cancer cells that have spread to any part of the body.

In Stage IV, the disease has spread throughout the penis and lymph nodes in the groin, or has traveled to other parts of the body. Treatments are similar to that for Stage III cancer.

Recurrent penile cancer is disease that recurs in the penis or develops in another part of the body after treatment has eradicated the original cancer cells.

Cure rates are high for cancers diagnosed in Stage I or II, but much lower for Stages III and IV, by which time cancer cells have spread to the lymph nodes.

Alternative and complementary therapies

In addition to the treatments previously described, biological therapy is another treatment that is currently being studied. Biological therapy is a type of treatment that is sometimes called biological response modifier (BRM) therapy. It uses natural or artificial substances to boost, focus, or reinforce the body's disease-fighting resources.

Coping with cancer treatment

Medical side effects of treatment include constipation, fatigue , and sleep disorders. These effects may be managed through a combination of diet and environment as well as supplemental drug treatments. The patient should seek support resources for the psychological effects that treatment for penile cancer may cause, such as depression , decreased sexuality , anxiety, or feelings of grief.

KEY TERMS

Circumcision

—Surgical removal of the foreskin of the penis. It is usually performed shortly after birth.

Fluorouracil

—A cell-killing (cytotoxic) medication that can be applied in cream form to treat cancer of the penis.

Clinical trials

New treatments for penile cancer that are in clinical trials as of 2001 include chemotherapy with the drugs methotrexate , bleomycin , interferon, or cisplatin .

Prevention

Conditions which increase a person's chance of getting penile cancer include:

• infection with genital warts (human papillomavirus , or HPV)
• a skin disease called psoriasis
• a condition called phimosis, in which the foreskin becomes difficult to retract
• other conditions that result in repeated irritation of the penis
• a history of smoking

There appears to be a connection between development of the disease and lack of personal hygiene. Failure to regularly and thoroughly cleanse the part of the penis covered by the foreskin increases the risk of developing the disease. Penile cancer is also more common in uncircumcised men.

Special concerns

The treatment or amputation of the penis may have a significant psychological impact on the patient. Thorough patient education and appropriate counseling or support resources are a must.

See Also Testicular cancer

Resources

BOOKS

Ernstoff, Marc S., John A. Heaney, and Richard E. Peschel, eds. Testicular and Penile Cancer. Oxford: Blackwell Sci ence Limited, 1998.

PERIODICALS

Lindegaard, J., et al. "A Retrospective Analysis of 82 Cases of Cancer of the Penis." British Journal of Urology (June 1996): 883-90.

ORGANIZATIONS

The Cancer Group Institute. 17620 9th Ave. NE, North Miami Beach, Florida 33162. (305) 493-1980. <http://www.cancergroup.com>.

American Cancer Society. (800) ACS-2345. <http://www.cancer.org/>.

OTHER

Cancer Net: Penile Cancer. 25 Mar. 2001. 28 June 2001 <http://www.cancernet.nci.nih.gov/cancer_types/penile_cancer.shtml>.

Maureen Haggerty

Paul A. Johnson, Ed.M.

QUESTIONS TO ASK THE DOCTOR

• What stage is my cancer?
• What treatment alternatives do I have?
• Do I qualify for an experimental trial of a new treatment?

Penile Cancer

Definition

Penile cancer is the growth of malignant cells on the external skin and in the tissues of the penis.

Description

Penile cancer is a disease in which cancerous cells appear on the penis. If left untreated, this cancer can grow and spread from the penis to the lymph nodes in the groin and eventually to other parts of the body.

Demographics

Penile cancer is a rare form of cancer that develops in about one out of 100,000 men per year in the United States. Penile cancer is more common in other parts of the world, particularly Africa and Asia. In Uganda, penile cancer is the most common form of cancer for men.

Causes and symptoms

The cause of penile cancer is unknown. The most common symptoms of penile cancer are:

• a tender spot, an open sore, or a wart-like lump on the penis
• unusual liquid discharges from the penis
• pain or bleeding in the genital area

Diagnosis

In order to diagnose penile cancer, the doctor examines the patient's penis for lumps or other abnormalities. A tissue sample, or biopsy, may be ordered to distinguish cancerous cells from syphilis and penile warts. If the results confirm a diagnosis of cancer, additional tests are done to determine whether the disease has spread to other parts of the body.

Treatment

In Stage I penile cancer, malignant cells are found only on the surface of the head (glans) and on the foreskin of the penis. If the cancer is limited to the foreskin, treatment may involve wide local excision and circumcision. Wide local excision is a form of surgery that removes only cancer cells and a small amount of normal tissue adjacent to them. Circumcision is removal of the foreskin.

If the Stage I cancer is only on the glans, treatment may involve the use of a fluorouracil cream (Adrucil, Efudex), and/or microsurgery. Microsurgery removes cancerous tissue and the smallest possible amount of normal tissue. During microsurgery, the doctor uses a special instrument that provides a comprehensive view of the area where cancer cells are located and makes it possible to determine that all malignant cells have been removed.

In Stage II, the penile cancer has spread to the surface of the glans, tissues beneath the surface, and the shaft of the penis. The treatment recommended may be amputation of all or part of the penis (total or partial penectomy). If the disease is diagnosed early enough, surgeons are often able to preserve enough of the organ for urination and sexual activity. Treatment may also include microsurgery and external radiation therapy, in which a machine provides radiation to the affected area. Laser surgery is an experimental treatment for Stage II cancers. Laser surgery uses an intense precisely focused beam of light to dissolve or burn away cancer cells.

In Stage III, malignant cells have spread to lymph nodes in the groin, where they cause swelling. The recommended treatment may include amputation of the penis and removal of the lymph nodes on both sides. Radiation therapy may also be suggested. More advanced disease requires systemic treatments using drugs (chemotherapy ). In chemotherapy, medicines are administered intravenously or taken by mouth. These drugs enter the bloodstream and kill cancer cells that have spread to any part of the body.

In Stage IV, the disease has spread throughout the penis and lymph nodes in the groin, or has traveled to other parts of the body. Treatments are similar to that for Stage III cancer.

Recurrent penile cancer is disease that recurs in the penis or develops in another part of the body after treatment has eradicated the original cancer cells.

Cure rates are high for cancers diagnosed in Stage I or II, but much lower for Stages III and IV, by which time cancer cells have spread to the lymph nodes.

Alternative treatment

In addition to the treatments previously described, biological therapy is another treatment that is currently being studied. Biological therapy is a type of treatment that is sometimes called biological response modifier (BRM) therapy. It uses natural or artificial substances to boost, focus, or reinforce the body's disease-fighting resources.

Prevention

Conditions which increase a person's chance of getting penile cancer include:

• infection with genital warts (human papillomavirus, or HPV)
• a skin disease called psoriasis
• a condition called phimosis, in which the foreskin becomes difficult to retract
• other conditions that result in repeated irritation of the penis.
• a history of smoking.

There appears to be a connection between development of the disease and lack of personal hygiene. Failure to regularly and thoroughly cleanse the part of the penis covered by the foreskin increases the risk of developing the disease. Penile cancer is also more common in uncircumcised men.

Resources

ORGANIZATIONS

American Cancer Society. 1599 Clifton Road NE, Atlanta, GA 30329. (800) ACS-2345. 〈http://www.cancer.org〉.

Cancer Group Institute. 17620 9th Ave. NE, North Miami Beach, FL 33162. (305) 493-1980. 〈http://www.cancergroup.com〉.

OTHER

CancerNet: Penile Cancer. March 25, 2001. [cited June 28, 2001]. 〈http://www.cancernet.nci.nih.gov/cancer_types/penile_cancer.shtml〉.

KEY TERMS

Circumcision— Surgical removal of the foreskin of the penis. It is usually performed shortly after birth.

Fluorouracil— A cell-killing (cytotoxic) medication that can be applied in cream form to treat cancer of the penis.