Penile cancer

Encyclopedia of Medicine by Maureen Haggerty

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Definition

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

Description

Cancer of the penis is a rare disease. It occurs most often in men who were not circumcised as infants.

Causes & symptoms

The cause of penile cancer is unknown. There does, however, appear to be a connection between development of the disease and lack of personal hygiene. Failing to regularly and thoroughly cleanse the part of the penis covered by the foreskin increases the risk of developing the disease.

The most common symptom of penile cancer is a tender spot, an open sore, or a wart-like lump that originates at the tip of the penis, spreads slowly across the skin, and invades deeper layers of tissue. Pain and bleeding may develop as the cancer continues to grow. A urologist should be consulted about any growths on the penis or abnormal discharge from it.

Untreated penile cancer infiltrates the lymph nodes. Through the lymphatic (infection-fighting) system, it spreads to the groin and other parts of the body.

Diagnosis

The diagnosis of penile cancer is most commonly made by a doctor who specializes in the genitourinary tract (a urologist). The doctor examines the patient's penis for lumps or other abnormalities. A biopsy may be ordered to distinguish malignant changes 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. This process is called staging.

Stages of penile cancer

In Stage I, malignant cells are found only on the surface of the head (glans) of the penis.

In Stage II, the penile cancer has spread to the surface of the glans, tissues beneath the surface, and the shaft of the penis.

In Stage III, malignant cells have spread to lymph nodes in the groin, where they cause swelling.

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.

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.

Treatment

Surgery and radiation therapy

Amputation of all or part of the penis (total or partial penectomy) is the most common and most effective treatment. If the disease is diagnosed early enough, surgeons are often able to preserve enough of the organ for urination and sexual activity.

Wide local excision is a form of surgery that removes only cancer cells and a small amount of normal tissue adjacent to them. 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. Laser surgery uses an intense precisely focused beam of light to dissolve or burn away cancer cells.

Radiation therapy may be administered to enhance the effects of surgery or as an alternative to surgery. External radiation is provided by a machine. Internal radiation involves implanting radioactive elements into the part of the body where malignant cells are located.

Medication

Superficial cancers that are limited to a small area can be treated with fluorouracil (Adrucil, Efudex), a medication that is applied as a cream directly to the skin of the penis.

Chemotherapy

More advanced disease requires systemic treatments with chemotherapy that is administered intravenously or taken by mouth. These drugs enter the bloodstream and kill cancer cells that have spread to any part of the body.

Biological therapy

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.

Prognosis

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

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.

Staging

The evaluation of the progression of cancer or a similar disease.

Further Reading

For Your Information

Other

• NCI/PDQ Patient Statement: Penile Cancer. http://oncolink.upenn/edu/pdq_html/2/engl/201.082.html (17 May 1998).
• Penile Cancer. http://www.noah.cuny./edu.8080/cancer/nci/cancernet/ (18 May 1998).

Gale Encyclopedia of Medicine. Gale Research, 1999.