Penile cancer or penile carcinoma is mostly diagnosed in men aged sixty years and older and refers to the rare form of cancer of the external male reproductive organs. Penile cancer is one of the cancers that can be detected during screening examinations and can be cured surgically.
What is penile cancer?
In penile cancer or penile carcinoma, tumors form on the penis and in particular on the glans and the foreskin. Penile cancer rarely spreads to the rest of the body through the bloodstream. Penile cancer is a slow-growing tumor that causes little or no discomfort in the early stages. However, if left untreated, it can affect the corpora cavernosa, prostate, urethra, and lymph nodes of the abdomen. A characteristic feature of the cancer is squamous cell carcinoma. This is a malignant tumor that develops in the uppermost layer of the skin and often has a wart-like or ulcer-like appearance. Other skin cancers can also develop on the penis. Degeneration of pigment cells, as occurs in malignant melanoma, is also possible as a penile cancer.
Causes
In addition to age-related cell degeneration, penile cancer is thought to be caused by viruses. The focus is on infections caused by HPV, which are causative for some uterine cancers in women. In part, scientists assume that these human papillomaviruses can also cause penile cancer in men through infection. Since infectious diseases are basically considered to cause penile cancer, lack of hygiene is a risk factor for developing penile cancer. The sebum that forms under the foreskin (smegma) is a breeding ground for disease if not carefully removed in daily personal hygiene. In addition, there are pathological changes to the foreskin such as foreskin stenosis. In so-called phimosis, as a cause of penile cancer due to a narrowing, the foreskin can also not be pushed back enough for sufficient cleaning of the glans.
Symptoms, complaints and signs
Penile cancer does not cause any clear symptoms at the beginning. The patient initially feels tired and listless, and occasionally there is mild pressure pain in the shaft region. As the disease progresses, swelling and induration form in the area of the glans and foreskin. These skin changes are initially rough and swollen before hardening and developing into nodules. This may be accompanied by a foul-smelling discharge. Rarely, blood is discharged. If the carcinoma enlarges and spreads to surrounding areas, it can often be felt in the groin area. The cancer may spread to other areas and cause other symptoms and discomfort depending on the region affected. Possible symptoms include organ dysfunction, nerve disorders and neurological deficits, as well as swelling, ulcers and other skin changes. If no treatment is given by then at the latest, penile cancer can be fatal. A growing carcinoma on the penis also leads to serious complications during urination and sexual intercourse. This significantly limits the quality of life and well-being of those affected. A progressing cancer can also be recognized externally. Thus, a sickly appearance appears and the affected person noticeably loses weight. If penile carcinoma is treated early, the symptoms usually subside quickly. After a few weeks to months, urination should return to normal.
Diagnosis and course
By palpation and visualization, the examining physician first basically diagnoses suspected penile cancer. A biopsy is used to clarify what type of penile cancer it is, while other procedures are eventually used to determine the extent of the tumor. Diagnosis is made through ultrasound examinations and tomography procedures. In the early stages, penile cancer initially affects only the glans and foreskin. Only in the further course does it penetrate into the body via the erectile tissue and the urethra. These are caused by the pathologically swollen lymph nodes in the groin blocking the removal of tissue water from the legs. Rarely and in advanced stages, penile cancer can metastasize to more distant parts of the body, which can only be detected with imaging techniques.
Complications
It is true that penile cancer (penile carcinoma) is a malignant tumor.However, since the carcinoma usually develops very slowly, there is usually a very good chance of cure if it is treated early. In over 90 percent of all cases, patients treated early survive for more than five years. However, because the disease usually only causes non-specific symptoms and often no pain, it can happen that the first treatment is given too late and sometimes even after metastases have appeared. In these cases, the prognosis deteriorates noticeably. Often, the penis must then be completely amputated. Sometimes metastases are observed in the lymph nodes and other organs. If distant metastases occur, additional treatment with radiation and chemotherapy must be given. However, in these cases a cure is no longer possible. Only the course of the cancer can still be delayed. If distant metastases are present, there is only a five-year survival rate of five percent. At this stage of the disease, palliative measures are often the only way to reduce the patient’s suffering. In most cases, penile carcinoma is a squamous cell carcinoma, which progresses very slowly and is therefore easily treatable even in later stages. However, in the presence of the rare melanoma, an extremely malignant skin cancer, the prognosis of the disease is often very poor even in the early stages of the disease.
When should you see a doctor?
Swelling in the male intimate area is considered a cause for concern. If ulcers develop, the usual skin appearance changes or pain occurs, a doctor is needed. Decreased libido, erectile dysfunction, and increased urination should be investigated and treated. Since penile cancer, if left untreated, leads to the spread of cancer cells and can result in premature death of the affected person, a doctor should be consulted at the first signs of irregularities. If there are irregularities in going to the toilet, a sensory disturbance in the intimate area or pain in the groin area, a doctor should be consulted. Swelling of the lymph or palpable lumps in the male abdomen should be presented to a doctor. Other signs of health irregularity include a decrease in weight, behavioral abnormalities, and faintness. Reduced resilience, listlessness and general dissatisfaction are indications that should be followed up. If there is inner restlessness, general weakness and a continuous decrease in well-being, a visit to the doctor is advisable. A feeling of tightness in the abdomen, discomfort with locomotion, and digestive complications should be discussed with a physician. A lowered quality of life, anxiety, insomnia and diarrhea are indications of an existing disease. If the symptoms persist over a long period of time or increase in intensity as well as extent, a visit to a physician is advised.
Treatment and therapy
In the treatment of penile cancer, it is crucial to detect the tumor as early as possible. Penile cancer is mainly removed surgically. Early detection is necessary so that the surgery damages as little tissue as possible and the penis can be preserved. If the penile cancer has already reached the erectile tissue, the only option is often the psychologically very stressful amputation of the entire penis. At this stage, however, penile cancer is still curable despite amputation. Only when the disease has progressed further is life-saving surgery for penile cancer ruled out. Chemotherapy and radiation are no longer used to fight penile cancer at this late stage, but are used to relieve symptoms. Because penile cancer affects the lymph nodes in the groin, a symptom of a more advanced stage is water retention in the legs, which is reduced again by radiation and lymphatic drainage. Towards the end of the disease, penile cancer and its metastases cause painful conditions, which are treated in the way by the individualized administration of painkillers.
Outlook and prognosis
The prognosis for penile carcinoma can vary widely. Decisive factors are the stage of the cancer, the presence of metastases, the chosen form of therapy, and also the age of the patient. With early detection and treatment of penile cancer, the chances of cure are very good at around 70 to 90 percent. As a rule, the penis can also be preserved.However, most patients do not see a doctor until the cancer has already progressed and lymph node metastases have already formed. This significantly worsens the prognosis, which is only about 46 percent. Often, amputation of the entire penis or parts of the penis is then necessary. Once distant metastases have already formed, the prognosis is very poor. The 5-year survival rate for affected patients is only 5 percent. In general, older affected patients have a much poorer outlook than younger ones. The choice of therapy is also decisive. Surgical removal of the metastases as well as the affected tissue on the penis is usually more successful than chemotherapy. In the advanced stage, additional radiotherapy is usually necessary, as cure will not occur without it.
Prevention
Since penile cancer causes little discomfort in its early stages, regular screening for men over the age of 45 is the best way to detect the tumor early enough. With regard to the strong involvement of infectious diseases, careful personal hygiene is one of the best measures to prevent its development. Circumcision of the foreskin to prevent penile cancer should also be considered.
Aftercare
Follow-up care occurs as a standard part of any cancer treatment. Doctors hope this will help detect the recurrence of carcinoma early. This is because even with penile cancer, a diagnosis at an early stage leads to the best chance of cure. Scheduled examinations cover at least the first five years after completion of initial therapy. Initially, they take place quarterly. Then the interval increases from appointment to appointment. Follow-up care is usually the responsibility of the clinic where the initial treatment took place. Depending on the outcome of the therapy, rehabilitation may be indicated. In this rehabilitation, the patient returns to everyday life under expert guidance. If necessary, medication is also adjusted. A satisfactory quality of life and the exercise of one’s own sexuality are important objectives of medical treatment after penile carcinoma. Every examination includes a discussion between doctor and patient. Specific questions should clarify the question of a new disease. Examination of the prostate and the male member also take place. If necessary, imaging procedures such as a CT, MRI and ultrasound examination are used. If there is a reasonable suspicion of new disease, a tissue sample is also taken and examined under a microscope. This complex procedure is intended to prevent life-threatening complications in advance.
What you can do yourself
The affected person is well advised to follow the doctor’s instructions if diagnosed with penile cancer. Since the disease can lead to death, early and comprehensive medical care should take place. Already at the first irregularities and abnormalities in the intimate area, a visit to the doctor is advisable. Since self-healing is not to be expected with this disease, changes in the area of the genital organ should be discussed with a medical professional as soon as possible. In order to exclude other diseases quickly, adequate contraception should always be used during sexual intercourse. The use of condoms is advisable when changing sexual partners. The disease often occurs in men over the age of 60. Participation in regular screening examinations is recommended so that the disease can be diagnosed in its early stages. In particular, men whose sexual partner has suffered an infection caused by HPV should attend check-ups. Since the virus is often the cause of later penile carcinoma, timely treatment with antibiotics against the viral disease is recommended. The foreskin of the penis should be cleaned daily. After sexual intercourse, removal of the foreskin is especially important to prevent the development of diseases. If there is a constriction of the foreskin, it is advisable to clean the external genital organs several times a day.
