Penile cancer
Carcinoma of the penis | |
---|---|
Specialty | Oncology |
Frequency | 36,068 in 2020[1] |
Deaths | 13,211 (2020)[1] |
Penile cancer, or penile carcinoma, is a 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]
Risk factors include
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 2020, it occurred in 36,000 men and caused 13,000 deaths.[1]
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]
Risk factors
Infections
- Human papillomavirus—HPV is a risk factor in the development of penile cancer.[9] According to the Centers 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, 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]
- 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]
- 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]
Pathogenesis
Penile cancer arises from precursor lesions, which generally progress from low-grade to high-grade lesions. For HPV related penile cancers this sequence is as follows:[4]
- Squamous hyperplasia;
- Low-grade penile intraepithelial neoplasia (PIN);
- High-grade PIN (carcinoma in situ—Erythroplasia of Queyrat and bowenoid papulosis(BP));
- Invasive carcinoma of the penis.
However, in some cases non-
In HPV negative cancers the most common precursor lesion is lichen sclerosus (LS).[4]
Diagnosis
The International Society of Urological Pathology (ISUP) recommends the use of p16INK4A immunostaining for the diagnosis and classification of HPV-related penile cancer.[21]
Classification
Around 95% of penile cancers are squamous-cell carcinomas. They are classified into the following types:[22]
- basaloid (4%)
- warty (6%)
- mixed warty-basaloid (17%)
- verrucous (8%)
- papillary (7%)
- other SCC mixed (7%)
- sarcomatoid carcinomas (1%)
- not otherwise specified (49%)
Other types of carcinomas are rare and may include small-cell, Merkel-cell, clear-cell, sebaceous-cell or basal-cell tumors. Non-epithelial malignancies such as melanomas and sarcomas are even more rare.[4]
Staging
Like many
The T portion of the
- TX: Primary tumor cannot be assessed.
- T0: No evidence of primary tumor.
- Tis: Carcinoma in situ.
- Ta: Noninvasive verrucous carcinoma.
- T1a: Tumor invades subepithelial connective tissue without lymph vascular invasion and is not poorly differentiated (i.e., grade 3–4).
- T1b: Tumor invades subepithelial connective tissue with lymph vascular invasion or is poorly differentiated.
- T2: Tumor invades the corpus spongiosum or cavernosum.
- T3: Tumor invades the urethra or prostate.
- T4: Tumor invades other adjacent structures.
Anatomic Stage or Prognostic Groups of penile cancer are as follows:[23]
- Stage 0—Carcinoma in situ.
- Stage I—The cancer is moderately or well-differentiated and only affects the subepithelial connective tissue.
- Stage II—The cancer is poorly differentiated, affects lymphatics, or invades the corpora or urethra.
- Stage IIIa—There is deep invasion into the penis and metastasis in one lymph node.
- Stage IIIb—There is deep invasion into the penis and metastasis into multiple inguinal lymph nodes.
- Stage IV—The cancer has invaded into structures adjacent to the penis, metastasized to pelvic nodes, or distant metastasis is present.
HPV positive tumors
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 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.[24]
- 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][25] 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.[24]
- Paraphimosis can be prevented by not leaving the foreskin retracted for prolonged periods of time.[24]
Treatment
Treatment of penile cancer will vary depending on the clinical stage of the tumor at the time of diagnosis.
- 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 (lymph nodes.
The role of radiation therapy includes an organ-sparing approach for early-stage penile cancer at specialized centres. Furthermore, adjuvant therapy is used for patients with locally advanced disease or for symptom management.[27]
Prognosis
Prognosis can range considerably for patients, depending where on the scale they have been staged. Generally speaking, the earlier the cancer is diagnosed, the better the prognosis. The overall 5-year survival rate for all stages of penile cancer is about 50%.[23]
Epidemiology
Penile cancer is a rare cancer in
In the
As of 1997[update] the
See also
References
- ^ a b c "Penile Cancer Factsheet" (PDF). Global Cancer Observatory. Retrieved 7 January 2022.
- ^ "Signs and Symptoms of Penile Cancer | Signs Of Penile Cancer". www.cancer.org. Retrieved 2019-12-18.
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- ^ a b "Signs and Symptoms of Penile Cancer | Signs Of Penile Cancer". www.cancer.org. Retrieved 2020-12-08.
- ^ a b c d e f g h i "What Are the Risk Factors for Penile Cancer?". www.cancer.org. Retrieved 2 April 2018.
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- ^ "Penile Cancer". National Cancer Institute. 1980-01-01. Retrieved 2 April 2018.
- ^ https://www.cdc.gov/cancer/hpv/statistics/penile.htm HPV-Associated Penile Cancer Rates by Race and Ethnicity] Centers for Disease Control and Prevention
- ^ de Bravo BF, DeSoto M, Seu K (April 2009). "HPV: Q&A". Cancer Prevention and Treatment Fund. Retrieved August 13, 2013.
- ^ a b "Risks and causes - Penile cancer - Cancer Research UK". cancerhelp.cancerresearchuk.org. 2017-08-30. Retrieved 2 April 2018.
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- ^ "Penile Cancer". The Lecturio Medical Concept Library. Retrieved 3 October 2021.
- ^ a b c d "Stage Information for Penile Cancer". National Cancer Institute. 1980-01-01. Retrieved 3 November 2013.
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- ^ The American Cancer Society: Penile Cancer: What is penile cancer? American Cancer Society, Last revised: January 8, 2012
- ^ The Official Website of the Royal Australasian College of Physicians, Published September 2010
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- ^ The American Cancer Society: Penile Cancer: What are the key statistics about penile cancer American Cancer Society, Last revised: January 18, 2012
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