Carcinoma of the penis
Encyclopedia
Penile cancer is a malignant growth found on the skin or in the tissues of the penis
. A Squamous cell carcinoma
usually originating in the glans
or foreskin
is by far the most common type, occurring in 9 out of 10 cases. Penis cancer tends to develop in men over the age of sixty. Penile cancer is very rare in Europe
and North America
, occurring in about one in 100,000 men in the latter. It accounts for 0.2% of cancers and 0.1% of deaths from cancer amongst males in the United States
. However, in some parts of Africa
and South America
it accounts for up to 10% of cancers in men.
to estimate what stage the disease is in, to aid in treatment decisions and prognosis. The stages are assessed as follows(Jackson's staging):
Prognosis can range considerably for patients, depending where on the scale they have been staged. Generally speaking, the earlier the cancer is diagnosed, the better the prognosis. The overall 5-year survival rate for all stages of penile cancer is about 50%.
, radiation therapy
, chemotherapy
, and biological therapy. The most common treatment is one of five types of surgery:
Radiation therapy
is usually used adjuvantly with surgery to reduce the risk of recurrence. With earlier stages of penile cancer, a combination of topical chemotherapy
and less invasive surgery may be used. More advanced stages of penile cancer usually require a combination of surgery, radiation and chemotherapy.
In addition to all the above, treatment of the underlying disease like Brucellosis, is important to limit disease recurrence.
provides the following as risk factors for penile cancer: human papillomavirus
(HPV) infection, smoking
, smegma
and phimosis
(both found only in uncircumcised men), treatment of psoriasis
with UV light, age, and AIDS
. The other etiologic factor most commonly associated with penile carcinoma is poor hygiene. There is some evidence that lichen sclerosus (also known as balanitis xerotica obliterans
) may also be a risk factor.
One study reported a lifetime risk of a man in the United States developing invasive penile cancer (IPC) to be 1 in 600 if he is uncircumcised. though this study has been criticised. Several studies report that the risk is higher if a male was not circumcised neonatally, with relative risk
estimates including 3.2 and 22 associated with the presence of a foreskin, and 0.41 associated with its absence. Several authors also state that there is a lower incidence of penile cancer in circumcised men. A few studies suggested that circumcision decreased the risk of HPV infection in males. A study that concluded circumcision did not prevent penile cancer was done by Wallerstein, which reported that the risk of penile cancer in Japan
, Norway
, and Sweden
(countries with a low rate of circumcision) is about the same (1 in 100,000 per year) as in the US.
) to prevent infection by the four most common variants of HPV has been developed, successfully tested, and approved by the US Food and Drug Administration
for females between the ages of 9 and 26, and as of 2009, males between the ages of 16 and 26. Gardasil has been shown to also be effective in males, and has been approved by the FDA to be marketed as such.
Penis
The penis is a biological feature of male animals including both vertebrates and invertebrates...
. A Squamous cell carcinoma
Squamous cell carcinoma
Squamous cell carcinoma , occasionally rendered as "squamous-cell carcinoma", is a histologically distinct form of cancer. It arises from the uncontrolled multiplication of malignant cells deriving from epithelium, or showing particular cytological or tissue architectural characteristics of...
usually originating in the glans
Glans
The glans is a vascular structure located at the tip of the penis in men or a homologous genital structure of the clitoris in women.-Structure:...
or foreskin
Foreskin
In male human anatomy, the foreskin is a generally retractable double-layered fold of skin and mucous membrane that covers the glans penis and protects the urinary meatus when the penis is not erect...
is by far the most common type, occurring in 9 out of 10 cases. Penis cancer tends to develop in men over the age of sixty. Penile cancer is very rare in Europe
Europe
Europe is, by convention, one of the world's seven continents. Comprising the westernmost peninsula of Eurasia, Europe is generally 'divided' from Asia to its east by the watershed divides of the Ural and Caucasus Mountains, the Ural River, the Caspian and Black Seas, and the waterways connecting...
and North America
North America
North America is a continent wholly within the Northern Hemisphere and almost wholly within the Western Hemisphere. It is also considered a northern subcontinent of the Americas...
, occurring in about one in 100,000 men in the latter. It accounts for 0.2% of cancers and 0.1% of deaths from cancer amongst males in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
. However, in some parts of Africa
Africa
Africa is the world's second largest and second most populous continent, after Asia. At about 30.2 million km² including adjacent islands, it covers 6% of the Earth's total surface area and 20.4% of the total land area...
and South America
South America
South America is a continent situated in the Western Hemisphere, mostly in the Southern Hemisphere, with a relatively small portion in the Northern Hemisphere. The continent is also considered a subcontinent of the Americas. It is bordered on the west by the Pacific Ocean and on the north and east...
it accounts for up to 10% of cancers in men.
Symptoms
Symptoms include redness, irritation, a sore on the penis or a lump on the penis. Anyone with these symptoms should consult a doctor immediately.Pathology
- A. Precancerous Dermatologic Lesions
- B. Carcinoma in Situ (Bowen Disease, Erythroplasia of QueyratErythroplasia of QueyratErythroplasia of Queyrat is a squamous cell carcinoma in situ of the glans penis.Like Bowen's Disease, it is associated with Human Papilloma Virus 16 and is a precursor for invasive squamous cell carcinoma.It is named for Louis Queyrat....
) - C. Invasive Carcinoma of the Penis
Staging
Like many malignancies, penile cancer can spread to other parts of the body. It is usually a primary malignancy, the initial place from which a cancer spreads in the body. Much less often it is a secondary malignancy, one in which the cancer has spread to the penis from elsewhere. Doctors use the extent of metastasisMetastasis
Metastasis, or metastatic disease , is the spread of a disease from one organ or part to another non-adjacent organ or part. It was previously thought that only malignant tumor cells and infections have the capacity to metastasize; however, this is being reconsidered due to new research...
to estimate what stage the disease is in, to aid in treatment decisions and prognosis. The stages are assessed as follows(Jackson's staging):
- Stage I - Cancer has only affected the glansGlans penisThe glans penis is the sensitive bulbous structure at the distal end of the penis. The glans penis is anatomically homologous to the clitoral glans of the female...
and/or foreskin. - Stage II - Cancer has spread to the shaftPenisThe penis is a biological feature of male animals including both vertebrates and invertebrates...
of the penis. - Stage III - Mobile (operable) inguinal lymph nodes
- Stage IV - Fixed (inoperable) inguinal lymph nodes or distant metastasis.
- Recurrent - Cancer that has returned after treatment.
Prognosis can range considerably for patients, depending where on the scale they have been staged. Generally speaking, the earlier the cancer is diagnosed, the better the prognosis. The overall 5-year survival rate for all stages of penile cancer is about 50%.
Treatment
There are several treatment options for penile cancer, depending on staging. They include surgerySurgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
, radiation therapy
Radiation therapy
Radiation therapy , radiation oncology, or radiotherapy , sometimes abbreviated to XRT or DXT, is the medical use of ionizing radiation, generally as part of cancer treatment to control malignant cells.Radiation therapy is commonly applied to the cancerous tumor because of its ability to control...
, chemotherapy
Chemotherapy
Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....
, and biological therapy. The most common treatment is one of five types of surgery:
- Wide local excisionWide local excisionA wide local excision is a surgical procedure to remove a small area of diseased or problematic tissue with a margin of normal tissue. This procedure is commonly performed on the breast and to skin lesions, but can be used on any area of the body....
- The tumor and some surrounding healthy tissue are removed - MicrosurgeryMicrosurgeryMicrosurgery is a general term for surgery requiring an operating microscope. The most obvious developments have been procedures developed to allow anastomosis of successively smaller blood vessels and nerves which have allowed transfer of tissue from one part of the body to another and...
- Surgery performed with a microscope is used to remove the tumor and as little healthy tissue as possible - Laser surgeryLaser surgeryLaser surgery is surgery using a laser to cut tissue instead of a scalpel. Examples include the use of a laser scalpel in otherwise conventional surgery, and soft tissue laser surgery, in which the laser beam vaporizes soft tissue with high water content...
- laser light is used to burn or cut away cancerous cells - CircumcisionCircumcisionMale circumcision is the surgical removal of some or all of the foreskin from the penis. The word "circumcision" comes from Latin and ....
- cancerous foreskin is removed - Amputation (penectomyPenectomyPenectomy is the surgical removal of the penis for medical or personal reasons.- Medical Reasons for Penectomy :Cancer, for example, sometimes necessitates removal of part or of the penis. The amount of the penis removed depends on the severity of the cancer. Some men have only the tip of their...
) - a partial or total removal of the penis, and possibly the associated lymph nodes.
Radiation therapy
Radiation therapy
Radiation therapy , radiation oncology, or radiotherapy , sometimes abbreviated to XRT or DXT, is the medical use of ionizing radiation, generally as part of cancer treatment to control malignant cells.Radiation therapy is commonly applied to the cancerous tumor because of its ability to control...
is usually used adjuvantly with surgery to reduce the risk of recurrence. With earlier stages of penile cancer, a combination of topical chemotherapy
Chemotherapy
Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....
and less invasive surgery may be used. More advanced stages of penile cancer usually require a combination of surgery, radiation and chemotherapy.
In addition to all the above, treatment of the underlying disease like Brucellosis, is important to limit disease recurrence.
Risk factors
The exact cause of penile cancer is unknown. The American Cancer SocietyAmerican Cancer Society
The American Cancer Society is the "nationwide community-based voluntary health organization" dedicated, in their own words, "to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy, and...
provides the following as risk factors for penile cancer: human papillomavirus
Human papillomavirus
Human papillomavirus is a member of the papillomavirus family of viruses that is capable of infecting humans. Like all papillomaviruses, HPVs establish productive infections only in keratinocytes of the skin or mucous membranes...
(HPV) infection, smoking
Tobacco smoking
Tobacco smoking is the practice where tobacco is burned and the resulting smoke is inhaled. The practice may have begun as early as 5000–3000 BCE. Tobacco was introduced to Eurasia in the late 16th century where it followed common trade routes...
, smegma
Smegma
Smegma is a combination of exfoliated epithelial cells, transudated skin oils, and moisture. It occurs in both female and male mammalian genitalia.-Human smegma:Both females and males produce smegma...
and phimosis
Phimosis
Phimosis , from the Greek phimos ), is a condition where, in men, the foreskin cannot be fully retracted over the glans penis...
(both found only in uncircumcised men), treatment of psoriasis
Psoriasis
Psoriasis is an autoimmune disease that appears on the skin. It occurs when the immune system mistakes the skin cells as a pathogen, and sends out faulty signals that speed up the growth cycle of skin cells. Psoriasis is not contagious. However, psoriasis has been linked to an increased risk of...
with UV light, age, and AIDS
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
. The other etiologic factor most commonly associated with penile carcinoma is poor hygiene. There is some evidence that lichen sclerosus (also known as balanitis xerotica obliterans
Balanitis xerotica obliterans
Balanitis xerotica obliterans is a dermatological condition affecting the male genitalia. It was first described by Stuhmer in 1928, though earlier reports describe what may have been the same condition....
) may also be a risk factor.
Circumcision
Most cases of penile cancer occur in countries where men are uncircumcised. There has been some debate over whether circumcision is a form of prevention.One study reported a lifetime risk of a man in the United States developing invasive penile cancer (IPC) to be 1 in 600 if he is uncircumcised. though this study has been criticised. Several studies report that the risk is higher if a male was not circumcised neonatally, with relative risk
Relative risk
In statistics and mathematical epidemiology, relative risk is the risk of an event relative to exposure. Relative risk is a ratio of the probability of the event occurring in the exposed group versus a non-exposed group....
estimates including 3.2 and 22 associated with the presence of a foreskin, and 0.41 associated with its absence. Several authors also state that there is a lower incidence of penile cancer in circumcised men. A few studies suggested that circumcision decreased the risk of HPV infection in males. A study that concluded circumcision did not prevent penile cancer was done by Wallerstein, which reported that the risk of penile cancer in Japan
Japan
Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...
, Norway
Norway
Norway , officially the Kingdom of Norway, is a Nordic unitary constitutional monarchy whose territory comprises the western portion of the Scandinavian Peninsula, Jan Mayen, and the Arctic archipelago of Svalbard and Bouvet Island. Norway has a total area of and a population of about 4.9 million...
, and Sweden
Sweden
Sweden , officially the Kingdom of Sweden , is a Nordic country on the Scandinavian Peninsula in Northern Europe. Sweden borders with Norway and Finland and is connected to Denmark by a bridge-tunnel across the Öresund....
(countries with a low rate of circumcision) is about the same (1 in 100,000 per year) as in the US.
HPV Vaccine
Infection with HPV is associated with some penile cancers. A quadri-valent vaccine (GardasilGardasil
Gardasil , also known as Gardisil or Silgard, is a vaccine for use in the prevention of certain types of human papillomavirus , specifically HPV types 6, 11, 16 and 18. HPV types 16 and 18 cause an estimated 70% of cervical cancers, and are responsible for most HPV-induced anal, vulvar, vaginal,...
) to prevent infection by the four most common variants of HPV has been developed, successfully tested, and approved by the US Food and Drug Administration
Food and Drug Administration
The Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...
for females between the ages of 9 and 26, and as of 2009, males between the ages of 16 and 26. Gardasil has been shown to also be effective in males, and has been approved by the FDA to be marketed as such.