Penile Cancer

What is Penile Cancer?

Like any other cancer in the body, cancer can develop in male organ also. Fortunately this is one of the few cancers, which could be prevented by maintaining hygiene of penis. A simple measure of regularly cleaning the glans penis (Bell end of the penis) by retracting the foreskin while taking bath can prevent this cancer. Incidence of cancer penis is more in developing countries and it is rare to find this cancer in Israeli Jews or Muslims as they are circumcised. Among Indians, It is 2 to 3 times more common in rural area than the urban population. Cancer of penis is curable if detected at the early stage but if patients present late and cancer reaches lymph glands (glands present at the upper part of the thigh) then it becomes difficult to get rid of it and more often than not it becomes fatal.

What are the risk factors for cancer penis?

Known risk factors are 1. Poor local hygiene 2. Frequent sexual encounter with different partners and having unprotected sex 3. Infection with HPV infection. 3. Smoking

What are the early signs of cancer penis?

Invariably cancer starts from the foreskin or the glans penis (bulbous forepart of the penis).

1. Beware of any red discoloration of the Glans or prepuce 

2. Any pain less/ pain full ulcer over the glans or foreskin.

3. See a urologist if you notice any kind of abnormal growth!

What are the stages of cancer?

In India, most of the patients present very late. Poor personal hygiene, ignorance and embarrassment of reporting the problem in penis are main reasons why patients present late. Cancer starts from the foreskin or the glans penis ( bulbous forepart of the penis) as red discoloration, ulcer or as a small tumor, which if ignored, then it grows deeper to various parts of the penis. After the involvement of deeper tissues it goes to the lymph glands present at the upper part of the thigh. It has propensity to spread to both sides of thigh. Then it goes to the deeper lymph glands present in the pelvis and finally involves various organs in the body like lungs and liver in particular.

What laboratory test and imaging should I get?

1. Generally they are not helpful unless patient has lymph glands at the upper part of thigh or he is too obese to feel for the glands, then he may need Contrast enhanced CT scan to know the status of lymph glands. 2. X-ray chest. 3. General physical examination of the whole body to be done by the Urologist.

Is there any role of biopsy?

Yes biopsy of the lesion on the penis is mandatory to establish the diagnosis. This biopsy can be done under local anesthesia also if patient co-operates.

What if I am sexually active and want to preserve my penis?

In patients, who are sexually active and have smaller lesions, then radiotherapy as a treatment can be opted for. Radiation therapy may affect the cosmetic and functional outcome in future. 

It should be opted for

1. in highly motivated patients 2. if the lesion is less than 2 cm 3. stage is less than T1 and T2

What are the treatment options available?

Primary therapy of penile cancer is removal of a part of penis containing cancer. This is called partial penectomy and we leave a cosmetically and functionally acceptable penis for patient to perform sex and pee in standing position. In Majority of the patients it is possible to preserve the part of penis.

What should I look for after surgery?

Patients need to follow up with the urologist on a regular basis and they should also look for some warning signs for re-appearance of the cancer at the cut stump of the penis and at the upper part of thigh. ( better to identify the area of examination with the urologist) 

What are the important signs I should look for cancer recurrence?

To see for any bleeding ulcer at the remaining part of the penis. 2. To see for any swelling in the inguinal region (upper part of the thigh)

What is the gold standard treatment of inguinal Lymph nodes in carcinoma penis?

A. If you have high grade cancer or cancer is invading the deeper part like corpora spongiosa and cavernosa then inguinal lymph nodes should be treated by surgery even if they are not palpable. Open surgery with limited superficial dissection (MODIFIED CATALONA TECHNIQUE) Video Link and frozen section analysis is the gold standard of treatment. If Frozen is negative then deep pelvic lymph nodes can be spared. 

Is there any role of robotic surgery?

Yes for the removal of inguinal lymph glands, when they are not very large and immobile, robot assisted video endoscopic inguinal lymphadenectomy (VEIL) is an option to choose from. 

How long am I going to survive once I am diagnosed with the cancer?

You can be cured of this cancer if treated early by a qualified surgeon or a Urologist. Insist your doctor to manage inguinal lymph nodes also and take a second opinion if you are not happy with the decision. If you are not treated properly and get lymph glands in the inguinal area untreated, then it becomes difficult to cure the cancer and it may then become fatal too.

What about options of chemotherapy and radiation? 

Advanced disease in terms of presence of large fixed inguinal glands or when the disease goes beyond it and present in different parts of the body, then chemotherapy should be considered. Chemotherapy is better be given by a medical oncologist. Radiation therapy may also be used for pain relief and treatment of metastasis.

What is the most important message I should carry home?

Clean your penis every day and look for early signs and seek medical help as this is a preventable and curable cancer if picked up early.