PENILE CANCER

WHAT IS PENILE CANCER

The penis is not often thought of as being an organ affected by cancer. The truth is, like any other part of the body, it can develop cancer. In Western societies, this is still considered rare (affecting less than 0.5% of male cancer diagnosis) although rates can increase in some countries such as India, Uganda, Brazil and Peru (1). Penile cancer is mainly diagnosed in men over 60 years of age, although there are always cases where the person affected is younger (2). The penis itself is made up of different tissues; skin, nerves, smooth muscle and blood vessels and has both a sexual function and one of ridding the body of waste (urine). As the penis has these tissue types it is subject to the same possible changes as everywhere else in the body. These changes may be benign (not cancerous) or malignant (cancerous). This section will look at penile cancer only, although benign conditions will be added as the site develops.

risk factors for PENILE CANCER?

There are no outright causes of penile cancer. It is best to think of the following as possibly contributing to it.

Phimosis: possibly due to chronic intermittent inflammation/hygiene issues. If there is a build-up of smegma, this may lead to chronic inflammation.

Human papillomavirus (HPV) infection: papillomaviruses are icosahedral particles that belong to the family Papovaviridae. They are non-enveloped viruses, where their capsid contains 72 capsomeres. Two structural proteins form the capsid and consist of two structural proteins; the late L1 protein and early L2 protein. Due to the lack of an envelope, they can retain viability extracellular for up to at least 1 week and can resist organic solvents and heat treatment to 56°C. Infection may cause local cell proliferation (warts/condylomas and cervical intraepithelial neoplasia). These growths will normally grow on skin or mucosal tissue. HPV6 and HPV11 cause most cases of wart infection (low-risk). High-risk HPV types include 16, 18, 31 and 45 which are linked to cancers. HPV infection is ‘frequently’ detected in anal, oral and penile cancers in men. In generally immunocompetent men, there may be natural regression of changes. The mechanism of carcinogenesis is thought to be due to E6 and E7 oncogene products which bind to tumour suppressor genes and alter cell cycle activities HPV types 16 and 18 are classed as carcinogenic agents for humans (3).

Age: risk of penile cancers increases with age.

Smoking: there is a relationship but not causal association with smoking and increase cases of penile cancer.

Lichen sclerosis: this is a chronic inflammatory disease that affects genitalia and sometimes the extragenital skin. Lesions are often detected on the penis and mucosa; occurring on the glans and foreskin as erythematous papules and plaques. These become white and hard, eventually leading to scarring, phimosis, blistering, itching and burning. Treatment is via corticosteroids and calcineurin-inhibitors.

SIGNS/SYMPTONS OF PENILE CANCER

What are the treatment options for me if the Consultant thinks it is penile cancer?

Treatment will depend on many factors including how much cancer is there is and how extensive it feels.

The general approach for penile cancer will be surgical. There are numerous approaches to this depending on the extent of the tumour and how much this has spread. If the tumour is localised in the glans, the patient will be offered a glansectomy (removal of the head of the penis). They can be offered partial glansectomy, but this will risk residual cancer and give a less aesthetic appearance to the penis. If the glans are removed, sometimes the surgeon will ask if you want a skin graft to improve the finished look of the operation. This may lead to an extended hospital stay and can be quite painful in recovery.

Biopsy (removal of a small part of the possible cancer to test) may be offered but this may delay the treatment as it will need to be sent to the laboratory for processing and reporting by a specialist in tissues (histo-pathologist).

The groin nodes will then be scanned as this is often the first metastatic site. If the nodes are involved, sentinel node removal/biopsy may be undertaken. This can lead to other complications.

Complete penectomy may be undertaken. This can often be very difficult for a man to deal with and every effort will be made to provide you with support.

What are the Implications?

There are many negative side-effects to penile cancer and subsequent treatment. This includes:

Difficulty adjusting to the removal of penile tissue. This may include masculinity issues and psychological implications. These are completely understandable issues but often there will be support groups that can help you.