Penile cancer is a rare malignant tumor of the penis which manifests itself most often in the glans or the inner surface of the foreskin. Penile cancer grows very slowly and symptoms can look insignificant at first. However, even when symptoms occur at the onset of the disease, many affected men do not seek professional help until very late because they are embarrassed and afraid and often prefer to suppress the problem.

However, symptoms such as skin lesions or lumpy indurations in the glans or foreskin, and discharge or bleeding from the penis should always be taken seriously. The earlier penile cancer is detected and treated, the better the chance of removing the tumor and keeping the penis.

What is penile cancer?

Penile cancer refers to the tumors that usually occur on the glans and the foreskin of a man’s penis. At an advanced stage, there is a risk that the disease will spread to the corpus cavity and even the abdominal wall. If the cancer spreads through the lymphatic system, daughter tumors in the pelvic and groin area are possible. In rare cases, the cancer cells can also penetrate the bloodstream and then form metastases (daughter tumors) in other organs, such as the lungs.

By far the largest number of penile cancer cases are malignant tumors of the foreskin. 95 percent of affected patients suffer from the so-called squamous cell carcinoma. This form of skin cancer often develops also in body regions that are exposed to increased solar radiation. Squamous cell carcinoma is characterized by lumps and cornification of the skin. If you try to remove them, bleeding may occur. Penile cancer is often detected very late. The typical skin changes are rarely perceived as a serious disease at first, especially since no pain occurs. Many sufferers only go to the doctor when bleeding and discharge occur.

Risk factors

Research into the causes of penile cancer is still at an early stage. At present, doctors and researchers do not yet have comprehensively established findings on the subject. However, they have found more and more evidence that poor hygiene can lead to a penis carcinoma. In particular, the accumulation of smegma (also known as foreskin tallow) under the foreskin seem to promote the development of tumors on the penis, especially in men who suffer from a foreskin narrowing (phimosis). The impossibility of pushing the foreskin back far enough in these cases leads to a permanent accumulation of foreskin tallow.

Mucosal changes may also indicate a possible case of penile cancer. If the mucous membrane shows whitish changes, there is a risk that these are leukoplakia, which represent a precursor of squamous cell carcinomas.

The transmission of papilloma viruses in sexual contact may also favor the development of tumors on the penis. These infections promote the formation of warts on the genital skin.

In addition to these factors, researchers have found a link between chronic inflammation of the glans (balanitis) and the foreskin (posthitis) and penile cancer. Some studies have concluded that smokers also have an increased risk of developing a penis carcinoma. The disease usually only occurs at an advanced age. The vast majority of patients are over 60 years old.

Symptoms of penile cancer?

In the early stages of penile cancer, characteristic symptoms can only be identified to a limited extent. However, increased attention is required if you notice swelling and hardening on the foreskin or glans. At a later stage, the foreskin may develop a cauliflower-like surface where bleeding occurs. Also foul-smelling discharge is one of the symptoms that indicate an emerging tumor on the penis.

See your doctor if you have these signs or symptoms:

• Lump or lesion on the penis;
• Change in the color of the penis
• Lump or thickening of the skin on the penis;
• Redness or irritation on the penis;
• Reddish or velvety rash on the glans or under the foreskin;
• Small crusted bumps;
• Bluish-brown flat masses;
• Smelly discharge or bleeding from the penis or from below the foreskin;
• Swelling at the end of the penis;
• Groin mass;
• Unexplained pain in the body or the tip of the penis;
• Itchy or burning area or lesion;

Diagnosis

The diagnosis of penile cancer is usually carried out through an intensive conversation with the patient. The doctor will inquire not only about the current ailments, but also about past illnesses. Thereafter, an initial investigation of the affected region will be carried out. The doctor will examine the change in the penis and will then take a tissue sample. This will then be analyzed in detail in the laboratory under the microscope.

If penile cancer is confirmed after the initial test, further examinations will be carried out. These are used to find out whether the tumor has already spread to the lymph nodes or other organs. The doctor will use various examination procedures in order to obtain certainty on these issues and to be able to obtain a clear picture. In addition, both ultrasound examinations and computed tomography, or CT scan for short, will be carried out. Magnetic resonance imaging (MRI) is also used to detect cancer.

In a computed tomography, all layers of the body are gradually radiated. Magnetic resonance resonance imaging (MRI) is used to examine organs and lymph nodes in the abdominal cavity, groin and pelvis area for cancer. With the help of magnetic fields, images are generated from the inside of the body. In scintigraphy, on the other hand, the radioactive radiation in the body is measured. Different substances, which accumulate in the body during a lifetime and cause diseases, emit radiation of varying degrees, which can be measured. Thus, the doctor will recognize the distribution of these substances in the body and possible damage to the examined areas.

If there is a reasonable suspicion, the doctor will request an X-ray of the lungs or a skeletal scintigraphy. As with all cancers, the earlier it is detected and treated, the greater the chances of cure.

Treatment of penile cancer

Regardless of the stage of the disease, surgical removal of the tumor is the first priority of therapy for penile cancer. The extent of this procedure depends on the stage of the cancer. In extreme cases, this can mean the amputation of the penis. In the vast majority of cases, however, the removal of the limited area affected by the tumor is sufficient. Additional surgery is necessary if metastases have been detected in lymph nodes or other organs. Again, the surgeon will first remove the daughter tumors, and under certain circumstances chemotherapy or radiotherapy will follow.

If the cancer is detected at an early stage, there is now little risk that the penis will have to be amputated. Indeed, doctors are primarily concerned with the preservation of the organ. However, this requires intensive follow-up, which lasts at least five years. This is the only way to ensure that the patient can continue to be sexually active and maintain a satisfactory quality of life. If you notice any changes to your penis described here, contact your GP or urologist as quickly as possible.

Can you get a penis transplant?

This type of treatment is being studied as a way to restore the urinary and sexual capacity of patients in which it has been necessary to remove the penis during cancer treatment. This surgery is still experimental and during tests that have already been done, approximately 15 hours were needed to connect all the blood vessels and nerves.

The transplanted organ must be from a donor with similar structural characteristics to reduce the risk of infection, bleeding and rejection. However, it is not yet possible to predict the success of the transplant in the treatment of erectile dysfunction, which can negatively affect the patient’s psychological health.

How to prevent penile cancer

To prevent the risk of developing penile cancer, some care should be taken such as:

• Maintain daily penis hygiene, especially under the foreskin to prevent bacterial and viral infections;
• Use condom during intimate contact;
• No smoking.

Although there is no specific cause for developing penile cancer, these cares help avoid some risk factors such as poor hygiene or HPV infection, for example.