Penile Cancer: Etiology, Diagnosis, and Treatment Options

Penile cancer develops when malignant cells in your penis grow out of control. Your penis is a rod-shaped reproductive organ that allows you to pee and have sex. Its main parts include the rod-like part (shaft) that extends from your low belly to the tip of your penis, called the head, or glans. If you’re uncircumcised, a layer of skin called the foreskin covers the head. If you’re not circumcised, the head of your penis is exposed. Cancer can form anywhere in your penis, but it most commonly starts on the head or foreskin (if you’re uncircumcised). Ninety-five percent of penile cancers are squamous cell carcinoma (SCC).

Symptoms

Penile cancer usually causes your penis to look different. The skin on your penis may become discolored, and you may notice a lump.

Signs and symptoms of penile cancer include:

A painless lump or sore (that may bleed).
Swelling and irritation, especially in the head of your penis (balanitis).
Skin thickening or changing skin color.
Flat growths that look blueish-brown.
Foul-smelling fluid underneath your foreskin.
Small, crusty bumps.
Rash.

Etiology

The exact cause of penile cancer is not fully understood, but several risk factors have been identified:

Not being circumcised - increased risk of infection and inflammation beneath your foreskin, which both may increase your cancer risk.
Human papillomavirus (HPV) - The HPV associated with cervical and penile cancer is a sexually transmitted virus.
HIV - It’s possible that the sexual behaviors that increase a person’s risk of HPV (for example, unprotected sex, multiple partners, etc.) also increase the risk of HIV infection and subsequently penile cancer.
Tobacco - Smoking cigarettes, chewing tobacco, or using snuff increases your penile cancer risk.
Lichen sclerosis - Lichen sclerosis (LS) is an inflammatory disorder that may cause the head of your penis or your foreskin to feel painful, irritated, or itchy. If you have LS, you’re at an increased risk of penile cancer.
Poor hygiene - Not washing your penis frequently or thoroughly may increase your risk of smegma. Smegma is a build-up of fluids your body secretes naturally. If you’re uncircumcised, smegma can collect beneath your foreskin and become thick and smelly. It’s more likely that smegma leads to irritation and inflammation that may increase cancer risk.

Diagnosis

The diagnosis of penile cancer typically involves several steps:

Physical Examination: Initial assessment involves a thorough examination of the penile head and/or penile shaft for lumps, swelling, or tenderness.
Imaging: You may need imaging to see how much the cancer’s spread. Depending on your cancer, your healthcare provider may order a CT scan, MRI, ultrasound, PET scan, or chest X-ray.
Biopsy: A biopsy is the only way to confirm a cancer diagnosis. During the procedure, your healthcare provider removes suspicious-looking cells or tissues. A specialist who works in a lab (pathologist) views the cells under a microscope to check for signs of cancer.

Treatment Options

Your treatment will depend on the size of the tumor, whether it’s spread, and how likely it is that the cancer will return (recur) after treatment. Treatment may involve a care team that includes your primary care provider, a cancer specialist (oncologist), a urinary tract specialist (urologist), and a skin specialist (dermatologist).

For cancer that’s in earlier stages, your healthcare provider may recommend one or a combination of the following treatments:

Medicated creams: Your healthcare provider may recommend a cream that you regularly apply to your penis. Common medicines include fluorouracil and imiquimod.
Circumcision: If the cancer is only on your foreskin, your healthcare provider may remove the tissue.
Laser ablation: This procedure uses lasers that create extreme heat to destroy the tumor.
Cryotherapy: This procedure uses extreme cold to destroy the tumor.
Mohs surgery: During this procedure, your healthcare provider removes cancerous skin layer by layer until arriving at the healthy tissue underneath.
Excision: Your healthcare provider may cut the cancer cells or tumor from your penis.
Radiation therapy: Your healthcare provider may use energy beams, like X-rays, to destroy cancer cells or shrink a tumor before surgery.

For cancer that’s more advanced, your healthcare provider may recommend:

Penectomy: A partial penectomy removes part of your penis. A total penectomy removes your entire penis. For a total penectomy, your healthcare provider will create an opening in your abdomen or the skin between your anus and scrotum (perineum) so you can pee.
Lymphadenectomy: Your healthcare provider may remove your lymph nodes (most commonly in your groin area) if the cancer’s spread there.

Your healthcare provider may use radiation, chemotherapy, or both to shrink cancer cells before performing surgery.

Conclusion

Penile cancer, though rare, is a highly treatable and often curable disease when detected early. Advances in surgical techniques, radiation, and chemotherapy have significantly improved survival rates. Awareness of risk factors and prompt evaluation of penile abnormalities are crucial for early diagnosis. With ongoing research and new treatment strategies, the prognosis for penile cancer continues to improve, offering hope and effective management for affected individuals. Regular follow-up care is essential to monitor for recurrence and manage any long-term effects of treatment.