penile cancer

             Penile cancer is cancer that develops in the skin or tissues of the penis. Symptoms may include abnormal growth, an ulcer or sore on the skin of the penis, and bleeding or foul-smelling discharge.[2]

Carcinoma of the penis
Specialty
Oncology
Frequency
93,850 in 2018 [1]
Deaths
15,138 (2018) [1]

 

Risk factors include phimosis (inability to retract foreskin of the penis), chronic inflammation, smoking, HPV infection, condylomata acuminate, having multiple sexual partners, and early age of sexual intercourse.[3]

Around 95% of penile cancers are squamous cell carcinomas. Other types of penile cancer such as Merkel cell carcinoma, small cell carcinoma, and melanoma are generally rare.[4] In 2018, it occurred in 34,000 men and caused 15,000 deaths.[1]

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Signs and symptoms

     Penile cancer can present as redness and irritation on the penis with a skin thickening on the glans or inner foreskin or an ulcerative, outward growing (exophytic) or “finger-like” (papillary) growth.[5][6] Penile cancer may accompany penile discharge with or without difficulty or burning or tingling while urinating (dysuria) and bleeding from the penis.[5][6]

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Risk factors & Infections
HIV infection—HIV-positive men have eight-fold increased risk of developing penile cancer than HIV-negative men.[7][8]
Human papillomavirus—HPV is a risk factor in the development of penile cancer.[9] According to the Center for Disease Control and Prevention (CDC), HPV is responsible for about 800 (about 40%) of 1,570 cases of penile cancer diagnosed annually in the United States.[10][11] There are more than 120 types of HPV.[12]
Genital warts—Genital or perianal warts increase the risk of invasive penile cancer by about 3.7 times if they occurred more than two years before the reference date.[9] About half of men with penile cancer also have genital warts, which are caused by HPV.[13]
Hygiene and injury.
Poor hygiene—Poor hygiene can increase a man's risk of penile cancer.[14][15]
Smegma—Smegma, a whitish substance that can accumulate beneath the foreskin, is associated with greater risk of penile cancer.[7][16] The American Cancer Society suggests that smegma may not be carcinogenic, but may increase the risk by causing irritation and inflammation of the penis.[7]
Balanitis and penile injury—Inflammation of the foreskin and/or the glans penis (balanitis) is associated with about 3.1 times increased risk of penile cancer.[9] It is usually caused by poor hygiene, allergic reactions to certain soaps, or an underlying health condition such as reactive arthritis, infection, or diabetes.[17] Small tears and abrasions of the penis are associated with about 3.9 times increased risk of cancer.
Phimosis—Phimosis is a medical condition where the foreskin cannot be fully retracted over the glans. It is considered a significant risk factor in the development of penile cancer (odds ratio of 38–65).[9] Phimosis may also be a symptom of penile cancer.[18]
Paraphimosis—Paraphimosis is a medical condition where the foreskin becomes trapped behind the glans. It is considered a risk factor for the development of penile cancer.[7]
Circumcision—Some studies show that circumcision during infancy or in childhood may provide partial protection against penile cancer, but this is not the case when performed in adulthood.[19] It has been suggested that the reduction in risk may be due to reduced risk of phimosis;[7][19] other possible mechanisms include reduction in risk of smegma and HPV infection.[7]
Other
Age—Penile cancer is rarely seen in men under the age of 50. About 4 out of 5 men diagnosed with penile cancer are over the age of 55.[7]
Lichen sclerosus—Lichen sclerosus is a disease causing white patches on the skin. Lichen sclerosus increases the risk of penile cancer.[14][20] As the exact cause of lichen sclerosus is unknown, there is no known way to prevent it.[14]
Tobacco—Chewing or smoking tobacco increases the risk of penile cancer by 1.5–6 times depending on the duration smoking and daily number of cigarettes.[4][9][14]
Ultraviolet light—Men with psoriasis who have been treated using UV light and a drug known as psoralen have an increased risk of penile cancer.[7][14]
Pathogenesis    
Diagnosis    
Prevention
HPV vaccines such as Gardasil or Cervarix may reduce the risk of HPV and, consequently, penile cancer.[4][14]
The use of condoms is thought to be protective against the HPV associated penile cancer.[4]
Good genital hygiene, which involves washing the penis, the scrotum, and the foreskin daily with water, may prevent balanitis and penile cancer. However, soaps with harsh ingredients should be avoided.[citation needed]
Cessation of smoking may reduce the risk of penile cancer.[9]
Circumcision during infancy or in childhood may provide partial protection against penile cancer. Several authors have proposed circumcision as a possible strategy for penile cancer prevention;[4][14][23] however, the American Cancer Society points to the rarity of the disease and notes that neither the American Academy of Pediatrics nor the Canadian Academy of Pediatrics recommend routine neonatal circumcision.[7]
Phimosis can be prevented by practising proper hygiene and by retracting the foreskin on a regular basis.[medical citation needed]
Paraphimosis can be prevented by not leaving the foreskin retracted for prolonged periods of time.[medical citation needed]
Treatment: Treatment of penile cancer will vary depending on the clinical stage of the tumor at the time of diagnosis.[24] There are several treatment options for penile cancer, depending on staging. They include surgery, radiation therapy, chemotherapy, and biological therapy.

The most common treatment is one of five types of surgery:

Wide local excision—the tumor and some surrounding healthy tissue are removed
Microsurgery—surgery performed with a microscope is used to remove the tumor and as little healthy tissue as possible
Laser surgery—laser light is used to burn or cut away cancerous cells
Circumcision—cancerous foreskin is removed
Amputation (penectomy)—a partial or total removal of the penis, and possibly the associated lymph nodes.

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