Penile cancerA disease where abnormal cells split without control and spread to other nearby body tissue and/or organs. Cancer cells can also spread to other parts of the body through the bloodstream and lymph systems. is a rare type of malignancy that develops in the penis. The penis is the male sex organ comprised of four main parts: the head of the penis (glans), body/shaft, foreskin (moveable layer of skin covering the glans), and the frenulum (small tag of skin under the penis between the foreskin and the shaft).
The penis has functions in both the urinary and reproductive systems. In the urinary system, the penis contains the urethra, which is a thin tube that carries urine from the bladderA small, elastic/muscle type sac/bag in the body, where urine (wee) is stored for urinating/weeing. Is found in the lower abdomen/belly area. to the outside of the body. In the reproductive system, bloodhello flows to the penis during sexual arousal to make it erect, allowing for sexual intercourse and the passage of sperm from the testicles to the outside of the body.
Penile cancers are generally diagnosed in men over 50, however, it can affect anyone with a penis – including men, teenagers, transgender women, non-binary individuals, and intersex people – at any age.
Types of Penile Cancer
There are several types of penile cancer, that are categorised by which types of cells
• the smallest, living parts of the body. Cells work together to form or build the body
• a human is made up of millions of Cells
• Cells reproduce themselves to make sure a body stays working
• sometimes Cells can be abnormal or damaged and these can be cancer cells
the cancer develops from.
Squamous Cell Carcinoma (SCC)
Squamous cell carcinoma’s (SCCs) are the most common type of penile cancer. This type of cancer develops from the squamous cells that cover the surface of the penis. SCC penile cancer often develops in the foreskin of uncircumcised men or in the glans, but can develop in the skin of the shaft as well. While this type of cancer can be aggressive, it can have a good prognosisTo predict how a disease/condition may progress and what the outcome might be. when caught early.
Carcinoma in situ (CIS)/penile intraepithelial neoplasia (PeIN)
Carcinoma in situCancer that only involves the cells in which it began and does not spread to other areas, tissues, or body parts. (CIS), also known as penile intraepithelial neoplasia (PeIN), is the earliest stage of penile SCC. It is the most common precancerous condition of the penis, and only appears in the very top layer of skin cells.
Basal Cell Carcinoma (BCC)
Basal cell carcinomaA cancer that begins in the skin or in tissue that covers our inside body organs. (BCC) of the penis is a rare subtype of penile cancer, that is often classified as a type of skin cancer. They develop from the basal cells in the skin, which are located under the squamous cells. BCCs are not usually aggressive, are slow growing, and usually have a good prognosis.
Adenocarcinoma
A penile adenocarcinomaa cancer that grows in gland tissue is a very rare subtype of penile cancer that develops from the sweat glands in the penis. Due to the rarity of the disease, there has been limited research done into the prognosis of this disease.
Melanoma
Penile melanomas are a rare subtype of penile cancer that develop from melanocytes, which are the cells that give skin its pigmentation or colour. While melanomas generally develop in areas exposed to the sun, they can rarely develop in areas not exposed to the skin. Penile melanomas can be aggressive, but the prognosis can be good when caught early.
Penile Sarcoma
Penile sarcomas are the rarest subtype of penile cancer. They often develop in deeper tissues of the penis, such as blood vessels, muscle, fat, or connective tissue, and can be very aggressive. Due to the rarity of this subtype, there has been limited research done into the prognosis of this disease.
Treatment
If penile cancer is detected, it will be staged and graded based on size, metastasisKnown as secondary cancer, it grows/spreads from the original/ primary cancer. (whether the cancer has spread to other parts of the body) and how the cancer cells look under the microscope. Staging and grading helps your doctors determine the best treatment for you.
Cancers can be staged using the TNM staging system:
- T (tumour) indicates the size and depth of the tumour.
- N (nodes) indicates whether the cancer has spread to nearby lymphA clear fluid that moves through the body through the lymphatic system, carrying cells that fight infection. nodes.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0-IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissue.
- Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and had not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localisedOnly to one area/place of body. cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also known as localised cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advancedAt a late stage, far along or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Grade
• A score that tells how quickly a tumour might spread and grow by looking at how the abnormal cells and tissue look under a microscope.
• Grade is not the same as stage.
• Grading is different depending on the type of cancer.
I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour. - Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testinga procedure that analyses DNA to identify changes in genes, chromosomes and proteins, which can be used to analyse tumour DNA to help determine which treatment has the greatest chance of success, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment is dependent on several factors, including location, stage of disease and overall health.
Treatment options for penile cancer may include:
- Surgerytreatment involving removal of cancerous tissue and/or tumours and a margin of healthy tissue around it to reduce recurrence, potentially including:
- Circumcision (removal of the foreskin).
- Simple excisionTo cut out or remove by cutting. (removal of the tumour and a small amount of nearby tissue).
- Wide local excision (removal of the tumour and a larger portion of nearby tissue).
- Glans resurfacing (removal of the top layer of tissue on the glans. Skin graft may also be required to replace tissue taken).
- Partial glansectomy (removal of part of the glans).
- Total glansectomy (complete removal of glans).
- Partial penectomy (removal of part of the penis and reconstruction of the urethra).
- Total penectomy (complete removal of penis and reconstruction of urethra).
- Lymphonodectomy (removal of affected lymph nodes).
- Chemotherapy
• a chemical drug treatment to kill or slow-growing cancer Cells
• these drugs are called cytotoxic drugs
, potentially including topical chemotherapy. - Radiation therapya treatment that uses controlled doses of radiation to damage or kill cancer cells, potentially including:
- External beam radiation therapy.
- BrachytherapyRadiation therapy that is done close to the surface (outside) of the body area or is done inside the body itself by using needles and/or seeds to deliver radiation radiation treatment that targets specific tissue(s) or area with no danger or harm to other tissue(s) around the cancer..
- Laser therapya procedure that uses an infrared laser to raise the temperature of the tumour to shrink and damage cancer cells.
- Photodynamic therapya procedure that involves inserting a light-sensitive drug (photosensitiser) to shrink and damage cancer cells when exposed to a light source.
- Cryotherapythe process of freezing off cancerous tumours and/or lesions using liquid nitrogen.
- Clinical trials.
- Palliative carea variety of practices and exercises used to provide pain relief and improve quality of life without curing the disease.
For more information on the treatment options, please refer to the Rare Cancers Australia Treatment Options page.
Risk factors
While the causes of penile cancer remain unknown, the following factors may increase your risk of developing the disease:
- Being infected with the Human papillomavirus (HPV).
- Not being circumcised.
- Having a history of smoking.
- Having a weakened immune system.
- Being over 50 years old.
- Certain skin conditions, such as:
- Psoriasis.
- Lichen Sclerosis.
- Phimosis.
- Being infected with the human immunodeficiency virus (HIV).
- Being infected with the acquired immunodeficiency syndrome (AIDS).
- Having precancerous lesions, such as CIS and/or PeIN.
- Previous exposure to ultraviolet (UV) radiation.
Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Symptoms
Early symptoms of penile cancer may include:
- A growth or sore on any area of the penis that doesn’t go away after a few weeks.
- Unusual bleeding from the penis and/or under the foreskin.
- Foul-smelling discharge
• Going home or leaving the hospital.
• Fluid coming out of a wound or body part.
from under the foreskin. - A lump on any area of the penis.
- Changes in colour of penile skin/foreskin.
- Thickening of penile skin/foreskin.
- Unexplained pain in any area of the penis.
- Swelling of the tip of the penis.
- Persistent rash on any area of the penis.
- Unexplained lumps in the groinArea between the abdomen (belly) and thighs (top of upper legs). region.
Not everyone with the symptoms above will have cancer, but see your general practitioner (GP) if you are concerned.
Diagnosis/diagnosing
If your doctor suspects you have penile cancer, they will order a range of diagnostic tests.
Imaging & blood tests
The doctor will take images of your body using magnetic resonance imagingTaking images/photos of inside body parts using magnet rather than x-ray. (MRITaking images/photos of inside body parts using magnet rather than x-ray.), a computed tomography scan (CT scanA 3-D (three dimensional) x-ray pictures that gives more information than a normal x-ray.), and/or positron emission tomography (PET scanA test that uses a radioactive drug to show a picture of how your tissues and organs are working. Also known as a positron emission tomography scan.), depending on where it is suspected the cancer is. The doctor may also look at other parts of the body and look for signs of metastasis. Additionally, a blood and urine test may also be taken to assessTo measure, look at and learn from. your overall health and help guide treatment decisions.
Biopsy
Once the location(s) of the cancer has been identified, the doctor will perform a biopsyremoval of a section of tissue to analyse for cancer cells to remove a section of tissue using a needle. This can be done by either a punch biopsy, a fine needle aspiration, and/or a lymph nodeA small lump or mass of tissue in your body.A small lump or mass of tissue in your body.A small lump or mass of tissue in your body. biopsy. The samples are then analysed for cancer cells.
