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Penile cancer is a rare cancer that occurs in men, most often in old age (it does not occur in childhood circumcised men). This tumor is relatively easy to diagnose as it attacks an external organ that can be easily examined by a physician. The symptoms of penile cancer include the presence of warts, lumps, and sometimes discharge from the penis.
What is penile hands?
Penile cancer is a rarely diagnosed cancer that affects men (although in recent years it has been diagnosed more and more often). This is related to the change in sexual activity in men who are increasingly infected with HPV. Penile cancer is easy to diagnose, as it attacks an external organ, so it can be easily recognized during a physical examination by a doctor. Symptoms of the disease may be discharge from the penis, nipple or induration on the penis and nodules. Unfortunately, despite the ease of diagnosis, patients very often report to a specialist with an advanced form of this disease. Cancer usually occurs in men around the age of 60, although nowadays it is diagnosed in younger and younger men.
In North America and Europe, penile cancer accounts for 0,3 to 0,6% of all malignancies in men. In Poland, the number of penile cancer patients has increased by 20% over the last thirty years.
Penile cancer causes
In countries where circumcision is performed, penile cancer is less common. Phimosis is a condition that affects the development of penile cancer. The carcinogenic element is believed to be in the mast, which contains exfoliated epithelial cells and the secretion of the prepuce glands, containing indole and skatole. Phimosis, which makes it impossible to clear the foreskin sac from the mast, causes its prolonged contact with the glans and the inner plate of the foreskin, which in turn may lead to the formation of a neoplasm. Men should take care of their personal hygiene and do not allow the mastic to remain under the foreskin and in the area of the gastric groove. Apart from inadequate hygiene, we mention among the factors that increase the risk of cancer
- heavy smoking,
- irradiation with UVA light,
- the presence of pre-cancerous changes,
- HPV infection,
- inflammation in the area of the penis glans.
The causes of penile cancer include precancerous changes contributing to its development:
- Bowen’s disease (characterized by scabs on the skin of the shaft of the penis)
- pre-invasive intraepithelial carcinoma,
- genital warts in the form of, for example, lumps that resemble cauliflower changes during development,
- red keratosis in the form of red planes usually located in the area of the penis glans,
- white keratosis characterized by white spots located on the mucosa,
- atrophic or scleroderma (often accompanied by burning sensation and itching),
- bowenoid lumpiness, characterized by brown or pink lumps
- cutaneous horn (epidermis with keratosis),
- lesions with low tumor growth.
Penile cancer – symptoms
Penile cancer can take the form of a cauliflower nodule, ulcer, infiltration, wart, nodule or induration and endophytic lesions (tissue loss). The disease process begins on the glans or the inner lamina of the foreskin. Most often, the penile cancer is painless, it does not cause urination disorders, but it can infiltrate the cavernous bodies of the penis and the spongy body of the urethra (at an advanced stage). In addition, this cancer can spread through the lymph vessels to the lymph nodes in the groin, then you can feel hard small lumps in the groin.
Sometimes, in the course of penile cancer, there is serous or bloody discharge, and the presence of phimosis in a man significantly delays the proper diagnosis of the disease. The lump may go unnoticed especially when it is located under the foreskin. Untreated cancer leads to the development of many infections and the formation of necrosis in the lymph nodes and the penis. In addition, a complication in the form of sepsis may occur, which may eventually result in the patient’s death.
Diagnosis of penile cancer
A suspicious lesion in the penile area is usually noticed without a patient without any problems. In a urology clinic, a physical examination of the scrotum and penis is a routine activity that can often save lives. Therefore, the physical examination is the basis in the diagnosis of penile cancer. During the examination, the size of the changes on the penis, their infiltration of the whitish membrane, the location of these changes and the cavernous and spongy bodies are assessed. In addition, the specialist carefully looks at the inguinal lymph nodes and checks for metastasis.
One hundred percent diagnosis is made on the basis of the tumor biopsy results from the previously collected sample. The material for the study is collected on an outpatient basis, under local anesthesia (there is no need to stay in the hospital). The cutout is taken from large lesions, while in the case of smaller ones – it is removed completely. Neoplastic changes on the foreskin are often an indication for its removal (circumcision) – this procedure is performed under local or general anesthesia, and the patient should stay in the hospital in the urology department.
Imaging tests are also performed in the diagnosis of penile cancer, but they are of much less importance. Ultrasound examination allows to assess the infiltration of the cavernous bodies and the spongy body (similar to magnetic resonance imaging after administration of prostaglandin E inducing artificial erection).
Penile cancer treatment
Diagnosing penile cancer at an early stage enables treatment without loss of organ by excision of the lesion itself. Therefore, noticing a lump or ulceration within the penis should be an indication for an immediate visit to a urologist and appropriate treatment. In patients with advanced cancer, partial or complete removal of the penis and removal of the inguinal lymph nodes are necessary. The best way to prevent penile cancer is to keep the toilet clean every day, and to seek the advice of a urologist if you find phimosis.
Penile cancer and metastases
A physical examination is also helpful in revealing possible metastases. It should be noted that the penile neoplasm metastasizes first to the inguinal lymph nodes, and only then to the lymph nodes located in the pelvis. What does it mean? If the inguinal nodes are “clean”, then at the same time the pelvic nodes have not been attacked, and further diagnostics is unnecessary. If the lymph nodes are not enlarged during the physical examination, an ultrasound scan is performed to find the affected lymph nodes. Enlarged lymph nodes are automatically an indication for a biopsy. However, it should be remembered that they may also increase as a result of inflammatory changes, and not because of metastases.
On the other hand, the presence of metastases in the inguinal nodes makes people look for them in the pelvic nodes. As an auxiliary, computed tomography is performed.
Important! Metastasis in distant parts of the body is relatively rare, but routine chest X-rays can be performed.