Penile Cancer

Penile Cancer

Overview

  • Penile cancer is a rare cancer and it originates in the epithelium of the inner prepuce and glans of penis. Due to hesitancy from patients, most patients present late with advanced disease.
  • The psychological impact of the disease is highly significant.
  • The cause of penile squamous cell carcinoma is unclear but human papillomavirus (HPV) appears to be a causative factor.

What are the risk factors?

  • HPV infection plays a role in the development of penile cancer. About half of cancers are associated with HPV, with the main subtypes being HPV-16 and HPV-18.
  • Genital warts and other conditions like lichen planus predispose to penile cancer
  • Multiple sexual partners/ HIV infection is a risk factor
  • Smoking.
  • Other risk factors include exposure to chemicals such as insecticides, fertilisers, styrene and acrylonitrile.

 A few penile lesions are thought to be premalignant and may progress to Penile cancer. These include:

  • Erythroplasia of Queret
  • Bowen`s disease
  • Buschke Lowenstein Tumour

What are the signs and symptoms?

  • Patient presents with an ulcer, lump or erythematous lesion over penis.
  • Itching or burning sensation below prepuce
  • Difficulty in urination in advanced disease
  • Inguinal Lymph node swelling in advanced cases.

Evaluation

Patient needs biopsy from the lesion to confirm the diagnosis

Staging is done by CT, MRI or by Whole body PET CT

Inguinal node may need biopsy from the lesion.

What are the treatment options?

  1. Surgery
  2. Surgical techniques include:

    • For small penile lesions: circumcision or wide local excisions are mainstay treatments. Local recurrences over time may occur and re-treatment may be required.
    • For glanular and distal penile tumours: it is now possible to preserve much more length, and cosmetic and functional results are far superior to conventional partial penectomy.
    • In advance tumours may need total penectomy and perineal urethrostomy
    • Regional lymph nodes: lymphadenectomy is the standard treatment of patients with inguinal lymph node metastases.
  3. Radiotherapy
    • Radiotherapy is most appropriate for small lesions in patients unfit or unwilling to undergo surgery.
    • Radiotherapy as treatment of the primary tumour may be delivered either by external beam treatment or brachytherapy
    • Radiotherapy for the management of regional lymph node metastases
    • Adjuvant radiation to the inguinal lymphatic area has been advocated by some but there is no strong evidence of benefit
  4. Chemotherapy
  5. Penile cancer has only a limited response to chemotherapy and used in adjuvant setting

  6. Topical agents
  7. Topical agents like 5 FU cream or Laser therapy is used for premalignant lesions and Carcinoma in Situ

What is offered in our centre?

All the above treatment options for carcinoma penis including

  • Surgeries like Partial penectomy for early lesions
  • Total penectomy + perineal Urethrostomy
  • Inguinal and Iliac Block dissection
  • Chemotherapy and Radiotherapy for locally advanced disease

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