Penile cancer is a rare type of cancer that occurs on the skin of the penis or within the penis. It most commonly starts in the skin cells of the penis and can develop into different types of cancer depending on the cells affected. Penile cancer is more common in men over the age of 50, but it can occur at any age.

Types of Penile Cancer

1. Squamous Cell Carcinoma (SCC):

   • The most common type of penile cancer, accounting for about 95% of cases.

   • Usually begins in the glans (head) or foreskin of the penis.

   • Often slow-growing, but it can spread to other parts of the body if not treated.

2. Verrucous Carcinoma:

   • A subtype of squamous cell carcinoma.

   • A slow-growing, wart-like tumor that rarely spreads.

3. Basal Cell Carcinoma:

   • A rare type of penile cancer that starts in the basal cells of the skin.

   • Tends to grow slowly and rarely spreads.

4. Melanoma:

   • A rare and aggressive type of cancer that begins in the pigment-producing cells of the skin (melanocytes).

   • Can develop on the penis, though this is extremely rare.

5. Adenocarcinoma:

   • A rare form of penile cancer that begins in the glandular cells of the penis, often in the sweat glands.

6. Sarcoma:

   • A very rare type that develops in the connective tissues of the penis, such as blood vessels, smooth muscle, or fat.

Symptoms of Penile Cancer

• Changes in Skin Color or Thickness:

  • The skin of the penis may change color or become thicker in certain areas.

• A Lump or Mass:

  • A growth or sore that might be painless but does not heal.

• Ulceration:

  • An open sore that does not heal, often located on the glans or foreskin.

• Redness or Rash:

  • Persistent redness, irritation, or a rash on the penis.

• Bleeding or Discharge:

  • Bleeding from the penis or an abnormal discharge can be signs of advanced cancer.

• Pain or Swelling:

  • Pain in the penis or swelling, particularly at the tip.

• Enlarged Lymph Nodes:

  • Swelling of the lymph nodes in the groin, indicating that cancer may have spread.

Risk Factors

• Human Papillomavirus (HPV) Infection:

  • HPV, particularly types 16 and 18, is a major risk factor for penile cancer.

• Smoking:

  • Smoking increases the risk of penile cancer, especially when combined with HPV infection.

• Phimosis:

  • A condition where the foreskin cannot be fully retracted over the glans, leading to poor hygiene and increased risk of infection and cancer.

• Age:

  • The risk increases with age, particularly in men over 50.

• Poor Hygiene:

  • Lack of proper cleaning, particularly in uncircumcised men, can increase the risk of penile cancer.

• Uncircumcision:

  • Men who are uncircumcised may have a higher risk, especially if they do not practice good hygiene.

• Multiple Sexual Partners:

  • Increases the risk of HPV infection and consequently penile cancer.

Diagnosis

Diagnosis typically involves several steps:

1. Physical Examination:

   • A doctor will examine the penis for any abnormalities, such as lumps, sores, or changes in skin texture.

2. Biopsy:

   • A small sample of tissue is taken from the suspicious area and examined under a microscope to determine if cancer cells are present.

3. Imaging Tests:

   • Ultrasound, MRI, or CT scans may be used to assess the extent of cancer and whether it has spread to lymph nodes or other parts of the body.

4. Sentinel Lymph Node Biopsy:

   • This test may be done to check if cancer has spread to the lymph nodes in the groin.

Staging

Penile cancer is staged based on how far it has spread:

• Stage 0: Cancer is only in the top layer of skin on the penis (carcinoma in situ).

• Stage I: Cancer has grown into the connective tissue just beneath the skin but has not spread to lymph nodes or other parts of the body.

• Stage II: Cancer has grown into the deeper tissues of the penis or spread to nearby lymph nodes.

• Stage III: Cancer has spread to more distant lymph nodes or deeper tissues within the penis.

• Stage IV: Cancer has spread to distant parts of the body, such as the lungs, liver, or bones.

Treatment Options

Treatment depends on the stage and location of the cancer, as well as the patient’s overall health:

1. Surgery:

   • Circumcision: Removal of the foreskin if cancer is confined to that area.

   • Wide Local Excision: Removal of the tumor and some surrounding healthy tissue.

   • Partial or Total Penectomy: Removal of part or all of the penis, depending on the extent of cancer. This is typically done for more advanced cancers.

   • Lymph Node Dissection: Removal of lymph nodes in the groin if cancer has spread.

2. Radiation Therapy:

   • High-energy rays are used to target and kill cancer cells, often used in combination with surgery or for patients who cannot undergo surgery.

3. Chemotherapy:

   • Can be applied topically (for surface cancers) or systemically (for advanced cancers) to kill cancer cells.

   • Topical Chemotherapy: Applied directly to the skin for very early-stage cancers.

   • Systemic Chemotherapy: Used for more advanced stages or when cancer has spread.

4. Laser Therapy:

   • Uses a focused beam of light to destroy cancerous tissues, typically for very early-stage cancers.

5. Cryotherapy:

   • Involves freezing cancer cells with liquid nitrogen. Used for small, early-stage tumors.

6. Immunotherapy:

   • Drugs that help the immune system recognize and attack cancer cells. Used in some cases, especially for advanced cancers.

Prognosis

The prognosis for penile cancer depends on the stage at diagnosis. Early-stage penile cancer that has not spread beyond the penis is often highly treatable with a good chance of a cure. However, advanced penile cancer that has spread to lymph nodes or other organs can be more challenging to treat and may have a less favorable prognosis.

Follow-Up Care

Regular follow-up care is essential for monitoring for recurrence, managing side effects of treatment, and ensuring overall health. This typically includes periodic physical exams, imaging studies, and patient education on self-examination.

Prevention

• HPV Vaccination: Vaccination against HPV can reduce the risk of HPV-related penile cancers.

• Circumcision: May reduce the risk of penile cancer, particularly when performed shortly after birth.

• Good Hygiene: Regular washing, particularly under the foreskin in uncircumcised men, is important.

• Safe Sexual Practices: Limiting the number of sexual partners and using condoms can reduce the risk of HPV infection.

• Quitting Smoking: Reduces the risk of developing penile cancer.

If you or someone you know is dealing with penile cancer, it's important to consult with a healthcare team to discuss the best treatment options and follow-up care.