Penile cancer is any carcinoma that first develops on the penis, and it can spread (metastasize) to nearby tissues and other parts of the body. Roughly 95 percent of penile cancer cases begin in the flat skin (squamous) cells, with the tip of the penis (glans) and the foreskin (prepuce) most often affected.
Risk Factors for Penile Cancer
Several things increase a man’s risk of developing penile cancer, including:
- Being uncircumcised: Penile cancer is much less common among men who had their foreskin removed at an early age. Circumcision may protect a man from developing penile cancer by reducing his risk of getting HPV (human papillomavirus).
- Over age 50: Although penile cancer occurs in men under 50 years of age, it is more common in older men. In the U.S., the average age of men with penile cancer is 68 years old.
- Phimosis: In this condition, the foreskin can’t be pulled back over the tip of the penis, making it difficult to see any sores that develop, including those caused by penile cancer.
- Poor hygiene: Researchers don't know why this increases a man's risk of penile cancer, but it may result from dead skin cells and oily secretions collecting under the foreskin.
- Many sexual partners: The more sexual partners a man has, the higher his risk of contracting HPV, a sexually-transmitted virus that can cause penile cancer.
- Tobacco products: Cigarette smokers are 3 to 4.5 times more likely to develop penile cancer.
Symptoms of Penile Cancer
The most common early symptoms of penile cancer include:
- Sores, redness, or irritation on the penis
- Lump on the penis, sometimes looking similar to a wart
- Discharge, bleeding, or foul smell from the penis
If it's not detected and treated early, the cancer can become more advanced and cause additional symptoms, such as:
- Lumps in the lymph nodes (groin or pelvic area)
- Fatigue
- Weight loss
- Bone pain
Diagnosis of Penile Cancer
Physical examination and medical history are the first two tools a physician (urologist) uses to diagnose penile cancer. These include:
- Asking a man about his health habits (such as smoking), past illnesses, and treatments
- Looking for lumps or sores on the penis
- Checking for signs of advanced disease, like swelling in other areas of the body or blockage of the urinary tract--both signs that the cancer cells have traveled from their original location
A biopsy can be used to confirm diagnosis. For this, the doctor removes a small piece of tissue from the affected area and sends it to a pathologist for examination.
Stages of Penile Cancer
Imaging tests such as CT scans, MRI, ultrasound, and x-rays, can help determine how advanced the cancer is and whether it has spread within the penis or to other parts of the body, something collectively referred to as the cancer's stage. Identifying what stage the disease is in allows physicians to determine the best course of treatment.
The stages of penile cancer are:
- Stage 0: Cancer is present only in the top layers of skin.
- Stage I: The cancer has spread deeper into the connective tissues under the skin of the penis.
- Stage II: The cancer has spread locally, such as into nearby blood or lymph vessels, into the middle parts of the penis, or into the urethra (the tube that carries urine out of the body).
- Stage III: The cancer has spread further, such as into the middle parts of the penis or the urethra, and has moved into one or more lymph nodes in the groin.
- Stage IV: The cancer has spread to nearby tissues (such as the prostate gland), one or more lymph nodes in the pelvis, or to distant parts of the body.
After five years, the survival rate for those with early stage disease (stages 0, I, and II) is about 80 to 85 percent. For those with stage IV metastatic disease, that number drops to 18 percent or lower.
Treatment Options for Penile Cancer
There are several penile cancer treatments, depending on the location and size of the tumor, as well as the stage of the cancer. This includes surgery, radiation therapy, or chemotherapy.
References
Letendre J, Saad F, Lattouf JB. (2011). Penile cancer: what's new? Curr Opin Support Palliat Care. 5(3):185-91.
Sharp DS, & Angermeier KW. (2011). Surgery of penile and urethral carcinoma. Campbell-Walsh Urology, 10th. ed.
Barocas DA, & Chang SS. (2010). Penile cancer: Clinical presentation, diagnosis, and staging. Urol Clin of North Am. 37(3):343-352.
Barnholtz-Sloan JS, Maldonado JL, Pow-sang J, & Giuliano AR. (2007). Incidence trends in primary malignant penile cancer. Urol Oncol. 25(5):361-7.
Lynch, DF. (2003). Cancer of the penis. Holland-Frei Cancer Medicine. 6th edition.
