Penile Cancer
Cancer begins when normal cells change and grows uncontrollably, forming a mass called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous, meaning it can spread to other parts of the body). Penile cancer is a disease in which malignant (cancer) cells form in the tissues of the penis. This is a rare form of cancer that occurs mostly in uncircumcised men (men who have a foreskin, the piece of skin covering the head of their penis).
Types of penile cancer
Ninety-five percent (95%) of penile cancer is epidermoid, or squamous cell, carcinoma. This means that the cells look like the tissues that make up skin when looked at with a microscope. Squamous cell carcinoma can begin anywhere on the penis. The majority of these cancers are found in the foreskin of the penis especially in men who have not been circumcised, and also the cancer can be found in the glans. When found at an early stage, epidermoid carcinoma can usually be cured.
· Verruscous carcinoma is an uncommon type of squamous cell cancer that occurs in the skin in many areas. When a verrucous carcinoma grows on the penis it is known as Buschke-Lowenstein tumor. It tends to grow slowly but it can also get very large. They can invade deeply into surrounding tissue, but they rarely spread to other parts of the body.
· Carcinoma in situ (CIS): In the earliest stage of the squamous cell cancer of the penis and is only found in the top layers of the skin. It has not yet grown into the deeper tissues of the penis. CIS of the glans is sometimes called Erythroplasia of Queyrat, and if it is found in the shaft it is known as Bowen’s disease.
2. Basal cell penile cancer
Another type of skin cancer that may develop on the penis is the basal cell cancer. Under the squamous cells in the lower epidermis (one of the layers of the skin tissues that cover the penis) are round cells called basal cells. These can sometimes become cancerous and also called non-melanoma skin cancer. This type of penile cancer also grows slowly and rarely spreads to other parts of the body. Less than 2% of penile cancers are basal cell cancers.
3. Melanoma:The deepest layer of the epidermis contains scattered cells called melanocytes, which are the cells that make up the brownish color to the skin to help protect from the sun. Melanoma starts in melanocytes, they grow quickly and it is the most serious type of the skin cancer. This cancer sometimes occurs on the surface of the penis. Less than 2% of penile cancers are melanomas.
4. Adenocarcinoma (Paget disease of the penis): This type of penile cancer is very rare and can develop from sweat glands in the skin of the penis. It may be hard to differentiate from carcinoma in situ of the penis. In the beginning the cancer cells spreads within the skin. Then later on these cells can invade, growing into the tissues underneath the skin and further spreading to the lymph nodes.
5. Sarcoma
About 1% of penile cancers are sarcomas, which are cancers that develop in the tissues that support and connect the body, such as blood vessels, smooth muscle, and fat.
Types of penile cancer
- Epidermoid/squamous cell carcinoma
Ninety-five percent (95%) of penile cancer is epidermoid, or squamous cell, carcinoma. This means that the cells look like the tissues that make up skin when looked at with a microscope. Squamous cell carcinoma can begin anywhere on the penis. The majority of these cancers are found in the foreskin of the penis especially in men who have not been circumcised, and also the cancer can be found in the glans. When found at an early stage, epidermoid carcinoma can usually be cured.
· Verruscous carcinoma is an uncommon type of squamous cell cancer that occurs in the skin in many areas. When a verrucous carcinoma grows on the penis it is known as Buschke-Lowenstein tumor. It tends to grow slowly but it can also get very large. They can invade deeply into surrounding tissue, but they rarely spread to other parts of the body.
· Carcinoma in situ (CIS): In the earliest stage of the squamous cell cancer of the penis and is only found in the top layers of the skin. It has not yet grown into the deeper tissues of the penis. CIS of the glans is sometimes called Erythroplasia of Queyrat, and if it is found in the shaft it is known as Bowen’s disease.
2. Basal cell penile cancer
Another type of skin cancer that may develop on the penis is the basal cell cancer. Under the squamous cells in the lower epidermis (one of the layers of the skin tissues that cover the penis) are round cells called basal cells. These can sometimes become cancerous and also called non-melanoma skin cancer. This type of penile cancer also grows slowly and rarely spreads to other parts of the body. Less than 2% of penile cancers are basal cell cancers.
3. Melanoma:The deepest layer of the epidermis contains scattered cells called melanocytes, which are the cells that make up the brownish color to the skin to help protect from the sun. Melanoma starts in melanocytes, they grow quickly and it is the most serious type of the skin cancer. This cancer sometimes occurs on the surface of the penis. Less than 2% of penile cancers are melanomas.
4. Adenocarcinoma (Paget disease of the penis): This type of penile cancer is very rare and can develop from sweat glands in the skin of the penis. It may be hard to differentiate from carcinoma in situ of the penis. In the beginning the cancer cells spreads within the skin. Then later on these cells can invade, growing into the tissues underneath the skin and further spreading to the lymph nodes.
5. Sarcoma
About 1% of penile cancers are sarcomas, which are cancers that develop in the tissues that support and connect the body, such as blood vessels, smooth muscle, and fat.
Risk and Causes of Penile Cancer
Human papilloma virus (HPV)
Human papilloma virus (HPV) is known as a papilloma virus for the reason that some of them cause a type of growth called papilloma. The Papillomas are not classified as cancers, and they are usually called warts. HPV is a common infection which is passed on from person to person by sexual contact. According to the type of HPV will determine different types of wart at various sites of the body. The outer genital organs of the male and female and the anal region can be affected by a certain type of HPV, it appears as raised, bumpy warts. The medical name used for genital warts is condyloma acuminatum; these warts can be hardly seen. Two types of HPV that causes most cases of genital warts are HPV 6 and HPV 11. They are called low-risk types of HPV and are occasionally linked to cancer. Other HPV types are found to be linked to cancer and are known as high-risk types. These types are known as HPV 16, HPV 18, HPV 31 and other types as well. Signs of a high-risk HPV infection are not visible until pre-cancerous changes or when the cancer develops. Researchers have found and believe that HPV infection is an important risk of penile cancer. It is found to be in about half of all penile cancers. Men who have two or more sexual partners before the age of 20 have a 4 to 5 increased risk of penile cancer. This may also be due to HPV infection.
Human papilloma virus (HPV) is known as a papilloma virus for the reason that some of them cause a type of growth called papilloma. The Papillomas are not classified as cancers, and they are usually called warts. HPV is a common infection which is passed on from person to person by sexual contact. According to the type of HPV will determine different types of wart at various sites of the body. The outer genital organs of the male and female and the anal region can be affected by a certain type of HPV, it appears as raised, bumpy warts. The medical name used for genital warts is condyloma acuminatum; these warts can be hardly seen. Two types of HPV that causes most cases of genital warts are HPV 6 and HPV 11. They are called low-risk types of HPV and are occasionally linked to cancer. Other HPV types are found to be linked to cancer and are known as high-risk types. These types are known as HPV 16, HPV 18, HPV 31 and other types as well. Signs of a high-risk HPV infection are not visible until pre-cancerous changes or when the cancer develops. Researchers have found and believe that HPV infection is an important risk of penile cancer. It is found to be in about half of all penile cancers. Men who have two or more sexual partners before the age of 20 have a 4 to 5 increased risk of penile cancer. This may also be due to HPV infection.
Age
It is uncommon for the case of penile cancer to occur in men under the age of 40. This proves that the risk of penile cancer increases with age. About 4 out of 5 cases of penile cancer are diagnosed in men over the age of 60.
Smoking
Smoking increases the risk of developing penile cancer in men rather than those who do not. It even produces a higher risk when smokers have HPV. Individual who are involved in smoking, are exposing their body to cancer-causing chemicals. These chemicals are absorbed into the blood as it is inhaled into the lungs. As these harmful substances are in the bloodstream they may travel throughout the body that can cause cancer in many different areas. Researchers believe that the substances damage the DNA cells of the penis, which leads to developing penile cancer. The cell that lines the penis known to be Langerhans cells, assist in fighting disease. These cells however do not work well in smokers; therefore they do not fight of viruses as well as they do in non-smokers.
A weakened immune system
A weakened immune system increases the risk of penile cancers as well as other cancers. Men who have AIDS (acquired immunodeficiency syndrome) have an increased chance of penile cancer. This risk is related to their lowered immune response that occurs to the deficiency.
Circumcision
Circumcision is a procedure to remove all or part of the foreskin that is often done in infants but can also be done later in life. The age men are circumcised appears to affect the risk of penile cancer.
· Men who are circumcised as babies appear to be less likely to develop penile cancer.
· Men who are circumcised in their teens seem to have some protection from penile cancer.
· Circumcision in adulthood seems to make no difference to a man’s risk of penile cancer.
It is uncommon for the case of penile cancer to occur in men under the age of 40. This proves that the risk of penile cancer increases with age. About 4 out of 5 cases of penile cancer are diagnosed in men over the age of 60.
Smoking
Smoking increases the risk of developing penile cancer in men rather than those who do not. It even produces a higher risk when smokers have HPV. Individual who are involved in smoking, are exposing their body to cancer-causing chemicals. These chemicals are absorbed into the blood as it is inhaled into the lungs. As these harmful substances are in the bloodstream they may travel throughout the body that can cause cancer in many different areas. Researchers believe that the substances damage the DNA cells of the penis, which leads to developing penile cancer. The cell that lines the penis known to be Langerhans cells, assist in fighting disease. These cells however do not work well in smokers; therefore they do not fight of viruses as well as they do in non-smokers.
A weakened immune system
A weakened immune system increases the risk of penile cancers as well as other cancers. Men who have AIDS (acquired immunodeficiency syndrome) have an increased chance of penile cancer. This risk is related to their lowered immune response that occurs to the deficiency.
Circumcision
Circumcision is a procedure to remove all or part of the foreskin that is often done in infants but can also be done later in life. The age men are circumcised appears to affect the risk of penile cancer.
· Men who are circumcised as babies appear to be less likely to develop penile cancer.
· Men who are circumcised in their teens seem to have some protection from penile cancer.
· Circumcision in adulthood seems to make no difference to a man’s risk of penile cancer.
Phimosis and smegma: Uncircumcised men with certain conditions may be at higher risk for penile cancer.
Phimosis
The foreskin can sometimes become tight and difficult to retract in men who are not circumcised. Penile cancer is common in men who have phimosis, this reason is not clear. Phimosis can often be prevented by retracting the foreskin of the penis and washing the penis.
Smegma
There can be buildup of secretions underneath the intact foreskin, and if the area is not cleaned the secretions it can become smegma. Smegma is a thick smelly substance that is found under the foreskin. It is made up from oily secretions from the skin, together with dead skin cells and bacteria. It is more common in men with phimosis, but can occur in anyone with a foreskin, if the foreskin is not regularly retracted to clean the head of the penis.
UV light treatment of psoriasis
Psoriasis is referred to a chronic skin condition; men who have this disease are treated with a drug called psoralens. This drug is given along with ultra-violet A (UVA) light source. This therapy is known as PUVA therapy, men who use this therapy are at a higher risk of penile. Because of this risk, men being treated with PUVA now have their genitals covered during treatment.
Phimosis
The foreskin can sometimes become tight and difficult to retract in men who are not circumcised. Penile cancer is common in men who have phimosis, this reason is not clear. Phimosis can often be prevented by retracting the foreskin of the penis and washing the penis.
Smegma
There can be buildup of secretions underneath the intact foreskin, and if the area is not cleaned the secretions it can become smegma. Smegma is a thick smelly substance that is found under the foreskin. It is made up from oily secretions from the skin, together with dead skin cells and bacteria. It is more common in men with phimosis, but can occur in anyone with a foreskin, if the foreskin is not regularly retracted to clean the head of the penis.
UV light treatment of psoriasis
Psoriasis is referred to a chronic skin condition; men who have this disease are treated with a drug called psoralens. This drug is given along with ultra-violet A (UVA) light source. This therapy is known as PUVA therapy, men who use this therapy are at a higher risk of penile. Because of this risk, men being treated with PUVA now have their genitals covered during treatment.
Signs and Symptoms
- Sores on the penis
- Penis pain and bleeding from the penis (may occur with advanced disease)
Detection and Diagnosis
The health care provider will perform a physical exam, which may reveal a non-tender lesion that looks like a pimple or wart. This growth is typically near the end of the penis.
A biopsy of the growth is needed to determine if it is cancer.
Treatment
The health care provider will perform a physical exam, which may reveal a non-tender lesion that looks like a pimple or wart. This growth is typically near the end of the penis.
A biopsy of the growth is needed to determine if it is cancer.
Treatment
- Surgery - Cutting out and removing the cancer.
- Chemotherapy -- The use of medicines to kill cancer cells; Also, this therapy may be used along with surgery.
- Radiation -- The use high powered x-rays to kill cancer cells. Also, radiation therapy is often recommended in combination with surgery. A type of radiation therapy called external beam therapy is often used. This method delivers radiation to the penis from outside the body. External beam radiation therapy is usually performed five (5) days a week for 6 - 8 weeks.
References:
Detailed Guide. (n.d.).American Cancer Society | Information and Resources for Cancer: Breast, Colon, Lung, Prostate, Skin. Retrieved June 18, 2013, from http://www.cancer.org/cancer/penilecancer/detailedguide/index
National Comprehensive Cancer Network.NationalComprehensive Cancer Network Clinical Practice Guidelines in Oncology: Penile cancer. 2012. Version 1.2012.
Pettaway CA, Lance RS, Davis JW.Tumors of the penis.In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011: chap 34.
http://www.medscape.com/viewarticle/563167_11