Symptoms of penile cancer

The penis is the male genital organ. The penis is made up of the urethra, a tube through which semen and urine pass through, the head also called the glans, and a piece of skin covering it called the foreskin. Cancer of the penis is extremely rare and the chances of recovery from penile cancer are very high. Penile cancer develops when malignant cells form on the skin or in the tissue of the penis, but it mostly occurs under the foreskin or on the glans.

Penile Cancer Causes

It is not yet known what exactly causes penile cancer, but there are certain risk groups established. For example, uncircumcised men have a higher chance of developing malignant penile cancer than circumcised men.

Penile Cancer Symptoms

The symptoms of penile cancer include a reddish, velvety rash on the glans, an unusual painless growth like an ulcer or sore on the foreskin or glans, a strong smelling substance under the foreskin, a change in color of the penis, and enlargement of the lymph nodes in the groin in the advanced stages of the illness.

This last symptom is not only connected to this illness, but it manifests itself in the conditions of genital herpes or syphilis. This is why it is important to consult your doctor about any questions and symptoms which may appear.

Penile cancer is a rare malignancy in Europe and America with an incidence of?1/100,000 men. This frequency is much higher in Africa, Asia, South America and account for up to 10% of cancer in some region. The prevalence of penile cancer is higher in nations with Human Papilloma Virus (HPV) Infection. The age adjusted incidence in Brazil is about 8.3/100,000 men and was even higher in Uganda (commonest tumor in men) in the 1960s. The incidence in Uganda has declined steadily probably due to urbanization, better health system and improved hygiene to a rate of 3 to 4/100,000 men.

The incidence of the penile cancer peaks in the sixth decade of life even though it may occur in younger patients. In middle- and low-income countries where circumcision is not routinely practiced, the rate of penile cancer could be ten times higher. Conversely, in Israel where circumcision is performed exclusively for all men at birth; the incidence rate is as low as 0.1 to 0.3/100,000 men.
Penile cancer may result in distressing outcome when diagnosed lately with a five-year survival rate of 50%. When pelvic lymph nodes are involved, the 5-year survival rate may be as low as 0%.
A total 10 publications comprising of 432 black patients with penile cancer were reviewed over a period of 1970 to 2016. A pool analysis of the mean age of men with penile cancer was 52.8?years with a range of 20?years to 83?years. Most of the men in the review were petty farmers, rural inhabitants, low socioeconomic status or unemployed.
The Human Papilloma virus (HPV) have been identified as etiological agents associated with penile cancer. HPV Isotypes 16 and 18 have been proven to induce carcinogenesis for penile cancer. Studies from Thailand, Denmark, and Spain showed an HPV prevalence ranging from 55 to 65%. Another review of 31 publication involving 1466 patients with penile cancer revealed an overall prevalence of HPV at 46.9% with dominant subtypes HPV 16 (60.2%) and HPV 18 (13.4%).
Squamous cell carcinoma (SCC) is the predominant histological type in 90% of penile cancer. SCC of the penis can be further categorized as basaloid, verrucous and papillary types. Less common histological variants include adenocarcinoma, melanoma and sarcoma.
Evidence has shown that there is acceptable sexual activity and quality of life after penile sparing procedures like laser surgery or wide local excision. However, some decline in sexual activities have been observed after glansectomy and more after partial penectomy.

Penile cancer is rare with SCC being the commonest histological type. HPV, lack of circumcision, phimosis, poor hygiene and low socioeconomic status are established risk factors. Most men with penile cancer in SSA present with locally advanced to advanced disease with devastating consequences. The option of penile sparing procedure is reduced with most resulting to mutilating surgeries. The lack of appropriate chemotherapy and radiotherapy worsens the prognosis in the region. HPV vaccination may not be cost-effective for most regions in SSA therefore, neonatal circumcision might be the best advocated alternative for prevention.

✓ Fact confirmed: Management guidelines of penile cancer- a contemporary review of sub-Saharan Africa Ayun Cassell, Bashir Yunusa, Burgess Manobah & Desire Wambo; 01 May 2020

Penile Cancer Risk Factors and Prevention

There are definitive risk factors that could be said to increase the chance of developing penile cancer, and those fall into these groups:

(1) Men who do not wash under the foreskin regularly, in the case they have not been circumcised.

(2) The men who are infected by the Human Papilloma Virus or have genital warts.

(3) Men over the age of 40, as cases of penile cancer before that age are very rare.

(4) Smokers.

It naturally follows that the longer men take to turn to the doctor will increase the chances for the disease to progress.

Practicing safe sex is one of the ways of protection against penile cancer, as venereal diseases like genital warts are not transmitted. Practicing good personal hygiene and paying attention to thoroughly washing the whole penis is another way of protection. As smoking increases the risk, it should be stopped.

Penile Cancer Diagnosis and Treatment

Penile cancer diagnosis begins with a physical examination and an overview of the whole medical history of the patient. The doctor then prescribes further testing, such as a biopsy to analyze a small part of the tissue under a microscope. To confirm the diagnosis, the patient is referred to an ultrasound and a CT scan to determine the stage of development.

The treatment of penile cancer involves surgery, chemotherapy, and radiotherapy. In the case that the cancer is not big, normal sex life and urination will be continued without difficulties.