Penile Cancer

What is Penile Cancer?

Penile cancer is a rare type of cancer that develops as a result of the uncontrolled growth of abnormal cells in the tissue of the penis. It usually begins on the head of the penis (glans) or in the skin covering the shaft, but the cancer can also spread to other parts of the penis. Penile cancer typically becomes evident in its later stages, which is why early diagnosis is crucial.

Types of Penile Cancer

Penile cancer most commonly originates from the flat cells (squamous cells) on the external surface of the penis, although other types can also occur. The main types of penile cancer are:

1. Squamous Cell Carcinoma

• This is the most common type of penile cancer and typically begins in the head (glans) or the shaft.
• In advanced stages, it may spread to surrounding tissues and organs.
• There is a strong association with HPV (Human Papillomavirus) infection.

2. Basal Cell Carcinoma

• Basal cell carcinoma generally grows more slowly and is less likely to invade surrounding tissues.
• It is considered a low-risk type of cancer and is less common in the penis, usually treatable with surgery.

3. Melanoma

• Penile melanoma is a rare form of cancer that develops from the pigment-producing cells (melanocytes) in the skin.
• It can rapidly spread to underlying blood vessels or lymph nodes, making it more dangerous.
• It typically presents as dark-colored lesions or moles on the skin.

4. Adenocarcinoma (Glandular Cell Cancer)

• This type of cancer usually arises from the secretory glands in the urethral area of the penis.
• It is rare and, if not treated early, can lead to serious complications.

5. Sarcoma

• This is a very rare form of penile cancer.
• The cancer develops from connective tissue or vascular cells and typically invades deeply within the penis.
• Treatment usually involves surgery along with other modalities.

6. Lymphoma

• Lymphoma is an extremely rare form of penile cancer.
• It generally originates in the lymphatic system but can also occur in the penis itself.
• Lymphoma is usually diagnosed before it has widely spread.

Causes of Penile Cancer

Penile cancer typically develops as a result of the interaction of various risk factors. Below are the main causes and risk factors that can lead to the development of penile cancer:

1. Human Papillomavirus (HPV) Infection

• HPV is one of the most significant causes of penile cancer. In particular, HPV 16 and HPV 18 have been closely linked to the disease. HPV is a sexually transmitted virus that can cause cells to become cancerous.
• The HPV vaccine is an important step in protecting against these cancers.

2. Lack of Circumcision

• Men who are uncircumcised may have a higher risk of developing penile cancer. The buildup of smegma, cellular debris, and infections under the foreskin can damage the glans and increase cancer risk.
• Circumcision, according to some studies, may reduce the risk of penile cancer.

3. Age

• Penile cancer is more common in men aged 50 and above. As age advances, genetic mutations and cellular damage can accumulate, leading to cancer development.

4. Smoking

• Smoking can increase the risk of penile cancer as it introduces carcinogens into the body that damage cells.

5. Weakened Immune System

• A weakened immune system makes it more likely for cancer cells to develop. Conditions such as HIV infection or immunosuppressive therapies (e.g., post-organ transplant) can elevate the risk of penile cancer.

6. Chronic Skin Infections and Inflammation

• Long-term inflammation or chronic skin infections on the penis, particularly on the glans, may lead to cellular changes that increase cancer risk.

7. Family History of Cancer

• Penile cancer may have a genetic predisposition; individuals with a family history of the disease might be at higher risk.

8. Other Sexually Transmitted Infections

• Other sexually transmitted infections, such as syphilis or herpes, may also contribute to an increased risk by causing harmful cellular changes.

10. Obesity and Diabetes

• Obesity and diabetes negatively affect overall health, potentially weakening the immune system and creating a pro-inflammatory state that may increase cancer risk.

11. Excessive Alcohol Consumption

• Excessive alcohol intake can impair liver function and reduce the body’s ability to eliminate toxins, thereby increasing the risk of cancer over time.

12. Genetic Factors Predisposing to Penile Cancer

• Inherited genetic factors may play a role in the development of penile cancer, sometimes causing the disease to occur at a younger age.

Symptoms of Penile Cancer

Penile cancer may not show symptoms in its early stages, but over time the following signs can develop. These symptoms may vary depending on the type and stage of the cancer:

1. Ulcer or Lesion on the Penis

• The most common symptom is a non-healing ulcer, sore, or lesion on the head (glans) or shaft of the penis.
• The sore is generally painless, though it can occasionally cause discomfort.

2. Swelling or a Lump on the Penis

• A swelling or a firm lump may develop on the head or shaft of the penis, which can be noticeable in the early stages of the cancer.

3. Bleeding

• Bleeding from the penis, either from the glans or the lesion site, can be another symptom. This bleeding is typically painless but may become painful if infection or advanced cancer develops.

4. White or Reddish Patches on the Glans

• Penile cancer can sometimes present with white, red, or dark patches on the surface of the penis, especially on the glans.

5. Pain or Discomfort

• In more advanced stages, pain or discomfort may be experienced in the penis, particularly where lesions are present.

6. Persistent Inflammation or Redness

• Chronic inflammation and persistent redness of the penis may occur, which can be a sign of infection or advanced cancer.

7. Swollen Lymph Nodes

• Penile cancer can spread to the lymph nodes in the groin area, causing them to swell and sometimes become painful—indicating that the cancer may be metastasizing.

8. Difficulty Urinating

• If the cancer spreads to the urethra, it may cause difficulty, burning, or pain during urination due to pressure on the urinary channel.

9. Sexual Dysfunction

• Lesions on the glans or shaft may cause pain during intercourse and problems with achieving or maintaining an erection.

10. Foul Odor or Discharge

• An unpleasant odor or abnormal discharge from the lesion may occur, which can be a sign of infection or cancer.

Diagnosis of Penile Cancer

The diagnosis of penile cancer is a critical early step when symptoms are present or risk factors are identified. The diagnostic process begins with a comprehensive evaluation by a physician and may include several tests. The main diagnostic methods used for penile cancer are:

1. Physical Examination

• A physical examination is the first step in diagnosing penile cancer. The doctor will inspect the penis for abnormal signs such as sores, swellings, ulcers, or firm lumps and will also check the groin lymph nodes to determine if the cancer has spread.

2. Biopsy

• A biopsy is the most important test to confirm the diagnosis of penile cancer. During the biopsy, a small tissue sample is taken from the abnormal area and examined in the laboratory to determine the presence of cancer cells. A skin biopsy or tissue sample from a lump may be performed.
• The biopsy also provides information about the type and stage of the cancer.

3. Ultrasonography

• Ultrasonography is another key imaging test used to detect any mass, swelling, or abnormal tissue within or around the penis. It can also help evaluate the enlargement of lymph nodes and assess whether the cancer has spread.

4. Magnetic Resonance Imaging (MRI)

• MRI provides a more detailed examination of penile cancer, revealing whether the cancer has invaded surrounding tissues and its impact on key areas such as the glans and urethra.
• It can also determine if there is spread to the pelvic lymph nodes.

5. Computed Tomography (CT)

• A CT scan is used to check if the cancer has spread to surrounding tissues, lymph nodes, or distant organs. It is also used to assess whether the cancer has metastasized to organs such as the liver or lungs.

6. Blood Tests

• Blood tests are generally not used to directly detect penile cancer, but they can provide information about the overall condition of the patient, such as evidence of metastasis or assessments of liver and kidney function.
• They may also offer insight into hormone levels and markers of inflammation.

7. Endoscopic Examination (Urethroscopy)

• If there is suspicion that the cancer has spread to the urethra, an endoscopic examination (urethroscopy) may be performed. This test involves inserting an endoscope into the urethra to inspect its inner lining for signs of cancer.

8. HPV Testing

• An HPV test can be used to detect the presence of Human Papillomavirus, which is closely associated with penile cancer, especially types HPV 16 and HPV 18. This test can provide insight into one of the potential causes of the cancer.

9. Lymph Node Biopsy

• If there is suspicion of spread to the lymph nodes, a biopsy of these nodes can be performed to help determine the stage of the cancer and guide the treatment plan.