Cancer - penis

Alternative names
Penile cancer; Squamous cell cancer - penis

Definition
A malignant (aggressively growing with a tendency to spread) cancer that affects the penis.

Causes, incidence, and risk factors
The exact cause of penile cancer is not known, but the presence of smegma (cheese-like, odorous secretions found under the foreskin of the penis) may increase the risk. Uncircumcised men who do not keep the area under the foreskin clean, and men with a history of genital herpes are at higher risk for this rare disorder.

Symptoms

     
  • Genital lesions on the penis  
  • Painless sore on penis (occasionally, the lesion may cause pain)  
  • Penis pain and bleeding from the penis (may occur with advanced disease)

Signs and tests
Examination shows a non-tender lesion (typically near the end of the penis) which may resemble a pimple or wart.

Excision (surgical removal) of the tumor and a biopsy are necessary for diagnosis.

Treatment

Treatment for penile cancer varies depending on the location and degree of involvement of the tumor.

CHEMOTHERAPY
Chemotherapy may be used in addition to surgical excision (cutting out and removing) of the penile tumor. Bleomycin is usually the chemotherapy drug of choice for treating penile cancer.

The patient is usually hospitalized for the first few doses of chemotherapy to monitor for possible side effects. After the initial dose, most people receive chemotherapy on an outpatient basis at a clinic or physician’s office. Possible side effects are numerous and depend on the specific chemotherapy medicine used.

SURGERY
If the tumor is limited to a small lesion (affected area of tissue damage) near the tip of the penis, a partial penectomy (removal of a portion of the penis) may be performed using general anesthesia. The cancerous portion of the penis is removed. The patient is usually able to urinate normally after this procedure.

A total penectomy with creation of a urethrostomy (new urethral opening created in the groin area) is often necessary when the tumor is more advanced. This procedure is performed using general anesthesia.

LIFESTYLE CHANGES
It is recommended that you discuss your fears and concerns regarding sexual function and body image prior to surgery. Urination and sexual function can often be maintained, even when a significant portion of the penis is removed. Additionally, the stress associated with diagnosis and treatment of penile cancer can often be helped by joining a support group where members share common experiences and problems. See support group - cancer.

RADIATION THERAPY
A course of radiation therapy is often recommended in conjunction with surgical removal of localized and non-metastatic tumors. A common method of radiation therapy, external beam therapy, is performed usually on an outpatient basis by specially trained radiation therapists. Prior to treatment, a therapist will mark the location that is to be radiated with a semipermanent marking pen. The external beam radiation therapy is delivered to the penis using a device that resembles a normal x-ray machine.

The treatment itself is generally painless, however, there are several side effects associated with radiation therapy. Possible side effects include loss of appetite, fatigue, skin reactions such as redness and irritation, rectal burning or injury, cystitis (inflamed bladder), and hematuria (blood in urine).

External beam radiation therapy is usually performed 5 days a week for 6 - 8 weeks.

Support Groups
The stress of illness may be eased by joining a support group whose members share common experiences and problems. See cancer - support group.

Expectations (prognosis)
The outcome can be good with early diagnosis and treatment. The 5-year survival rate for penile cancers is 65%. Urination and sexual function can often be maintained even when a significant portion of the penis is removed.

Complications
Cancer of the penis frequently spreads to other parts of the body (metastasizes) early in the course of the disease.

Calling your health care provider
Call the health care provider if symptoms occur that are suggestive of cancer of the penis.

Prevention
Circumcision may decrease the risk. Men who are not circumcised should be taught at an early age the importance of cleaning beneath the foreskin as part of their personal hygiene. Good personal hygiene and safer sexual practices, such as abstinence, limiting the number of sexual partners, and use of condoms to prevent genital herpes infection, may decrease the risk of developing penile cancer.

Johns Hopkins patient information

Last revised: December 7, 2012
by Mamikon Bozoyan, M.D.

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