What is penile cancer
Penile cancer is a rare tumor that, although it can affect young men, has a higher incidence after 50 years of age. In Brazil, this type of tumor represents 2% of all types of cancer that affect men.
According to research carried out by the SBU (Brazilian Society of Urology), although there are a large number of treatments for penile cancer concentrated in the state of São Paulo, most patients come from the North and Northeast regions of the country.
According to INCA (National Cancer Institute), more than half of patients with penile cancer take more than a year to seek medical care after the appearance of the initial lesions.
Penile cancer subtypes
In early stages, malignant cells are located in the superficial layers of the organ. This type of tumor, known as squamous cell carcinoma, represents 95% of cases and has a high chance of cure. Most of these tumors are slow growing and found on the foreskin or on the glans. If diagnosed at an early stage, the chance of cure is very high. Over time, it can spread to the groin and abdomen.
The other types of penile cancer are:
- Verrucous carcinoma – rare form of squamous cell tumor. Verrucous carcinoma, also known as Buschke-Lowenstein tumor, looks like a benign genital wart. It can spread to adjacent tissues, but rarely spreads to other organs;
- Carcinoma in situ – considered the early stage of squamous cell penile cancer. At this stage, cancer cells are found only on the surface of the skin. Carcinoma in situ of the glans is sometimes called erythroplakia of Queyrat. When diagnosed in the body of the penis or other parts of Organs genitals it is called Bowen’s disease;
- Melanoma – a type of skin cancer that starts in melanocytes, the cells responsible for skin pigmentation. These tumors tend to grow and spread quickly and are more aggressive than other types of skin cancer. Only a small percentage of penile cancers are melanomas;
- Basal cell carcinoma – another type of skin cancer that can develop on the penis, accounting for a small percentage of cases. This type of tumor is slow growing and rarely spreads to other parts of the body;
- Adenocarcinoma (Paget’s disease of the penis) – a very rare type of cancer of the penis that develops from the sweat glands in the skin of the penis and can be difficult to distinguish from carcinoma in situ; and
- Sarcoma – a small percentage of penile tumors develop from blood vessels, muscles or other connective tissue cells in the penis and are called sarcomas.
Symptoms and signs of penile cancer
The most common clinical manifestation of penile cancer is a persistent sore or ulcer, located on the glans, foreskin, or body of the penis. The presence of one of these signs, associated with a white secretion (smegma), can be indicative of the disease. Another is the presence of inguinal ganglia (swells in the groin).
In more detail, the symptoms of penile cancer are:
- Skin change – one of the most common symptoms of penile cancer. In addition to possible changes in color and thickness, some reddish and velvety tissue or brown lesions may appear;
- Secretion – in some cases, the wounds may present constant secretions of white color and strong odor;
- Lumps – lumps or bumps in the groin area can also occur in patients with penile cancer; and
- Difficulty in healing – the presence of a reddish wound that does not heal is another indication. This is a type of precancerous lesion called erythroplakia of Queyrat.
Attention: The symptoms above do not always indicate a malignant tumor on the penis. There are warts or spots in the region that are benign changes, usually located on the skin covering the head or on the head of the penis.
Diagnosing penile cancer
The chances of curing the neoplasm are much higher when diagnosed at an early stage. Any changes to the penis, such as lesions or blemishes, should be evaluated by a doctor. Even after clinical examination, the diagnosis is only confirmed after other tests and biopsies.
The biopsy is performed with the removal of a fragment of the affected region that undergoes laboratory analysis. There are some types of biopsy are:
- Incisional biopsy – indicated for larger lesions that have deepened into the skin. The site is anesthetized and the doctor removes only a piece of tissue;
- Excisional biopsy – for lesions up to 1 cm, with general anesthesia and removal of the entire lesion; and
- Fine Needle Aspiration Puncture (FNAB) – a needle attached to a syringe is used to aspirate a sample of the tumor and forward material for analysis.
Imaging tests are also important in the tumor evaluation process, helping to determine the extent of the disease. They are:
- Magnetic resonance imaging – electromagnetic waves are used to form images and allow determining the size, location of the cancer and the eventual presence of metastases;
- CT scan – some CT scans are performed in two stages: without and with contrast. The administration of contrast in the vein should be performed when looking for details, making the diagnosis more accurate; and
- Ultrasound – determines the depth of the tumor in the penis and also identifies eventual involvement of the groin lymph nodes.
The choice of treatment is individualized and depends on factors such as extent, tumor site and involvement of the inguinal ganglia (linguals). Surgery, radiotherapy and chemotherapy are options to combat the disease with individual or combined use. The stage at which the disease is discovered also influences the decision.
Surgical indication is the most common and there are several types of surgery that can be used to fight penile cancer, depending on the location, stage and type of neoplasm:
- Circumcision – technique used when the tumor is located in the foreskin. The foreskin and surrounding skin are removed. It may be indicated before radiotherapy treatment;
- Simple excision – the procedure, similar to a biopsy, involves removing the tumor along with a margin of normal tissue around it. The objective is to prevent any cancer cell from remaining in place;
- Mohs surgery – in this type of procedure, the layer of skin that the tumor may have invaded is removed and analyzed. Confirming the disease, a new layer is removed and examined. The layering process is repeated until the skin samples are free of cancer cells;
- Laser resection – a beam of light vaporizes cancer cells, which is useful for more superficial cancers such as squamous cell carcinoma and basal cell cancer.
- Cryosurgery – is the freezing of cancer cells with liquid nitrogen. It is effective in the treatment of verrucous penile cancer and in situ carcinoma of the glans;
- Penectomine – partial or total removal of the penis. It is the most efficient way to treat a cancer that has developed inside the organ; and
- Lymphadenectomy – is the surgery of the lymph nodes and occurs when the tumor has gone too deep. The procedure prevents the spread of the disease.
There is the possibility of topical treatment. Imiquimod is a cream medicine that stimulates the body’s immune system and must be applied to the skin. It is occasionally used in the treatment of carcinoma in situ of the penis.
And chemotherapy can also be used. Because it is a systemic treatment, it not only affects cancer cells, but also healthy cells in the body. There are two types of chemotherapy for treating penile cancer:
- Topical chemotherapy – the drug, in the form of a cream, is applied directly to the skin. As it acts on cancer cells located on the surface of the dermis, it is most used in precancerous conditions or for early stage carcinoma; and
- Systemic chemotherapy – administered orally or intravenously, is indicated for tumors that have spread to lymph nodes or other organs. Associated with surgery, systemic chemotherapy is used before the procedure to reduce the size of tumors.
Proper hygiene of the penis is the best way to prevent cancer in the organ. Daily cleaning should be done with soap and water, especially after sexual intercourse and masturbation. Other practices also help to prevent this type of tumor:
- Phimosis surgery – simple, quick operation that does not require hospitalization. Also called circumcision, phimosis surgery is usually performed in childhood. As hygiene habits are the most important in prevention, circumcised men have some advantage in cleaning the organ;
- Condom – the use of condoms reduces the risk of contagion of sexually transmitted diseases, such as the HPV virus, and the incidence of penile cancer;
- Self-examination – it is important for men to identify early lesions or any change in skin color and seek immediate medical attention.