Penile cancer, or penile carcinoma, is a rare form of cancer in men. There are different types of penile cancer, depending on the type of cell that they arise from. Depending on the extent of the disease, penile carcinoma is classified into different stages. Obtaining a detailed understanding of this cancer, its prevalence, its types, and its stages can help in the possible prevention and early detection of this cancer.
Penile cancer refers to cancer occurring in the penis. Certain genetic mutations in the penile cells can cause them to divide abnormally and form a mass or tumor. In most cases, penile carcinoma emerges in the skin or covering tissues.
With early detection and timely intervention, it is possible to treat penile carcinoma successfully. For an early diagnosis, one needs to be mindful of the different symptoms associated with this cancer and see a doctor if any of those symptoms are persistently experienced.
In India, penile cancer is relatively rare. The risk factors associated with this cancer type include age, lifestyle choices, HPV infection, race and ethnicity, poor hygiene, etc. In 2022, about 4300 cases of penile carcinoma were recorded in India, and the incidence rate of this cancer stood at 1 in 917. Cancer of the penis is more prevalent among adults who are 60 and older. Reports suggest that in Asian, African, and South American countries, penile cancer accounts for 10% of all cancers in men.
Reports suggest that penile carcinoma incidence may increase significantly if appropriate preventive measures are not adopted. Along with preventive measures, it is also important to learn about the types, symptoms, possible causes, and treatment options for the effective management of this disease.
There are different types of penile cancer, depending on the type of cell they arise from. Some penile cancer types are more prevalent than others. Also, the growth rate and aggressiveness may vary from one to another. The type of penile carcinoma is an important parameter that specialists consider while creating treatment plans for this cancer.
The following are the different penile cancer types:
Squamous cell carcinoma, or squamous cell cancer, is the most common type of penile carcinoma. This cancer type arises from the thin, flat cells that are present on the surface of the penis. In the early stages, there will be changes in the texture and appearance of the skin, and in the advanced stages, there may be palpable lumps present.
When the cancerous cells are confined to the surface layer of the penile skin, it is referred to as Carcinoma in Situ (CIS). This is a precancerous condition that can progress to become an invasive cancer if left untreated. Carcinoma in Situ of the penis may often cause itching, burning sensations, ulceration of the glans, etc. It is important not to ignore these symptoms and receive timely treatment.
Penile intraepithelial neoplasia (PeIN) refers to the abnormal growth of cells within the penile epithelium. This condition may also serve as a precursor to invasive penile carcinoma. Those with this condition may experience changes in the texture and appearance of the penile skin, irritation, painful urination, and unusual discharge. Undergoing a proper evaluation of these symptoms supports early detection, prevention, and effective management of invasive penile carcinoma.
Basal cell carcinoma is one of the rare penile cancer types, and it arises from the basal cells of the skin. It has a slower growth rate, and it is relatively less aggressive than squamous cell carcinoma of the penis.
Adenocarcinoma of the penis arises from the glandular cells that are responsible for the production of sweat. This is also one of the rare penile cancer types.
This is an aggressive form of penile carcinoma that forms in the pigment-producing cells of the penis. It is characterized by the presence of pigmented nodules or lesions. Melanoma of the penis demands a careful evaluation and comprehensive treatment due to its aggressive nature.
Penile sarcoma is one of the rare penile cancer types, and it forms in the connective tissues of the penis. Appropriate medical intervention supports its effective management.
Despite being a rare form of cancer, penile cancer is a serious condition and requires prompt medical attention. The severity of penile carcinoma depends on its type, its stage during the diagnosis, and specific tumor parameters. Early detection and timely treatment become extremely important in the efficient management of penile carcinoma.
Penile cancer is categorized into different stages, depending on the extent of the disease. Staging is a crucial phase of penile carcinoma management, as it guides treatment decisions and provides insights into the prognosis.
TNM staging of penile cancer, which is a widely accepted form of staging, involves determining the extent of tumor (T) growth, lymph node involvement (N), and distant metastasis (M). Based on the information obtained from TNM staging, doctors categorize penile carcinoma under stages 0, 1, 2, 3, and 4.
The following are the different penile cancer stages:
Stage 0 penile carcinoma refers to the precancerous state. The disease is localized to the skin's surface and has not invaded deeper tissues. Stage 0 cases are often treated with surgery alone.
Stage 1 penile cancer is confined to the penis, and it is the first stage of penile cancer. With early detection and appropriate treatment, penile cancer stage 1 can be treated successfully.
In stage 2, cancer has spread to nearby structures or tissues, but not to lymph nodes. Treatment may involve a combination of surgery, radiation, or chemotherapy.
In stage 3, cancer has reached nearby lymph nodes or other structures. Treatment becomes more extensive, and the prognosis depends on the extent of the spread.
Stage 4 penile cancer refers to the advanced stage where the disease has spread to distant body parts. Treatment primarily involves delaying the disease's progression and reducing symptoms.
Penile cancer commonly presents with symptoms like sores, growths, changes in color and texture of the penile skin, bleeding, unusual discharge, and pain. Most of these symptoms are easily observable, making early detection possible.
Smoking, HPV infection, HIV/AIDS, etc., are identified as risk factors or possible causes of penile cancer in men. It is necessary to be aware of different risk factors to reduce the overall risk of penile cancer.
Some patients may not experience any signs of penile cancer, while others will exhibit early symptoms. Unlike the symptoms of other cancers, penile cancer symptoms often don’t go unnoticed as they are easily visible to the naked eye.
Learning about the different signs and symptoms of penile cancer can lead to early detection and timely intervention.
Having a persistent lesion or a sore on the penis that doesn't show any signs of healing within a normal timeframe could be one of the penile cancer symptoms. As it is one of the first symptoms of penile cancer, it is important not to ignore this sign and to see a specialist immediately.
One of the most important penile cancer symptoms is a rash that may present as persistent skin irritation or redness. It is also one of the early signs of penile cancer.
Smelly discharge could also be one of the penile cancer symptoms. Those experiencing persistent, smelly discharge should see a doctor for a proper evaluation.
Bleeding from the penis, especially if it is persistent, should not be ignored. Penile bleeding may occur simultaneously or during activities like urination.
Penile skin thickening is also one of the important penile cancer symptoms. Any changes in the texture of the penile skin should be examined by a doctor.
A change in the penile skin color, in terms of unusual discoloration or darkening, is one of the signs of penile cancer. Regular self-examination can help one reach out to the doctor at the right time and receive appropriate treatment.
As a non-specific symptom, fatigue is often seen in patients with advanced-stage penile cancer. Those experiencing persistent fatigue should consult a doctor for a prompt evaluation.
In advanced stages, penile cancer may spread to other body organs, such as the stomach, and cause secondary symptoms. In these cases, patients may experience stomach pain, and one must see a doctor if it is experienced persistently.
Unintended weight loss is often one of the stage 4 penile cancer symptoms. Those experiencing sudden weight loss should consult a doctor to find out the underlying cause.
The exact cause of penile cancer is yet to be identified. However, several lifestyle-based and non-lifestyle-related factors have been identified as risk factors or possible causes of penile cancer. The following are some of the possible penile cancer causes or risk factors:
Smoking is identified as one of the potential penile cancer causes. The carcinogens present in tobacco reach the penis through the bloodstream. These harmful substances damage the DNA structure of cells present in the penis, which will eventually lead to the uncontrolled division of the penile cells and tumor formation.
Penile cancer can occur at any age; however, its risk increases with age. Individuals aged 60 and above are at a higher risk of developing penile carcinoma. The cumulative effects of environmental exposure or lifestyle choices over time make increasing age one of the possible penile cancer causes.
Having HIV/AIDS can increase one’s risk of developing penile cancer. HIV/AIDS weakens the immune system, which plays a pivotal role in fighting off early-stage cancers. Also, having a weakened immune system makes one more susceptible to other infections, such as HPV infection, which is also one of the possible penile cancer causes.
Human papillomavirus, or HPV, infection is a sexually transmitted infection that is found to increase the risk of penile cancer. HPV types 16 and 18 are linked to penile cancer development in men.
Uncircumcised men have a slightly higher risk of developing penile cancer as compared to circumcised men. In uncircumcised men, a mixture of dead skin cells, bacteria, and oils, called smegma, accumulates under the foreskin. If left unmanaged, smegma accumulation may increase the risk of penile cancer on the foreskin. This can increase the risk of inflammation and HPV infection, which are risk factors for penile cancer.
Certain premalignant conditions of the penis may also serve as possible penile cancer causes. Cutaneous horn, leukoplakia, penile intraepithelial neoplasia (PeIN), balanitis xerotica obliterans, Buschke-Lownstein tumor, and lichen sclerosus et atrophicus are some of the important premalignant conditions that can lead to penile cancer, if left untreated.
Excessive exposure to UV radiation, particularly from tanning beds, is found to increase the risk of skin cancer, which can progress into penile cancer over time. UV light exposure is recommended as a treatment (PUVA therapy) for psoriasis in some cases.
It is important to discuss the benefits and risks and ensure that the benefits outweigh the risks before considering these treatments.
If symptoms like the presence of growths and lumps on the penile surface, sores, and changes in the appearance, color, and texture of the penile skin are observed persistently, it is important to consult a specialist. Early diagnosis and timely treatment are important for better clinical outcomes.
Despite being rare, penile cancer necessitates careful attention to both diagnosis and treatment to ensure better quality health outcomes. Being aware of the different diagnostic tests and treatment options available for penile cancer can help one make informed decisions.
For an accurate penile cancer diagnosis, doctors recommend different types of tests. These include both invasive and non-invasive tests. The following are the different procedures recommended for penile cancer diagnosis:
Blood tests are recommended to look for specific markers that indicate the presence of penile cancer. Blood tests may also help assess the functioning of various organs in the body. For a penile cancer diagnosis, blood tests are often recommended along with other diagnostic procedures.
A biopsy involves the collection of a penile tissue sample and its microscopic examination for the presence of cancerous cells. This procedure helps in arriving at a definitive diagnosis and provides additional information, such as the type, stage, and grade of penile cancer.
Ultrasound is an imaging test that uses sound waves to create detailed images of the internal structures of the penis. It provides information related to the size and parameters related to the tumor. Based on the results of the ultrasound scan, additional penile cancer tests may be recommended.
A CT scan, which is a valuable tool for penile cancer diagnosis, uses X-rays to create cross-sectional images of the body. A penile CT scan is recommended for its diagnosis, staging, and treatment planning as it provides valuable information, such as the extent of the tumor growth, lymph node involvement, and metastasis.
MRI is an important tool for penile cancer diagnosis. An MRI scan creates detailed images of the internal structures of the penis using magnetic fields and radio waves. Like CT scans, MRI scans also provide comprehensive information about the tumor, which helps in disease staging and treatment planning.
A PET scan is recommended during a penile cancer diagnosis to look for increased metabolic activity in the body. This procedure involves injecting a radioactive tracer, which is picked up by cancer cells in the body. A PET scan helps in determining the extent of cancer spread and identifying potential metastatic sites.
Penile cancer treatment is recommended based on the stage of penile cancer, its type, its grade, the patient’s age, and the patient’s overall health condition. The following are the different approaches recommended for penile cancer treatment:
Surgery is often the primary line of penile cancer treatment. A penile cancer operation may involve the removal of the cancerous tissues along with a small portion of healthy tissues nearby. Doctors may recommend the following penile cancer surgery approaches, depending on the stage of the disease:
Partial Penectomy: Removes a portion of the penis affected by cancer while preserving its function.
Total Penectomy: Removes the penis completely; this procedure is often followed by penile reconstruction.
Mohs Surgery: Removes the cancerous tissue layer-by-layer to preserve healthy tissue.
Cryosurgery: Freezes cancer cells using liquid nitrogen; often recommended for superficial lesions.
Lymph Node Dissection: Removes cancer-affected lymph nodes to prevent further cancer spread.
Penile Reconstruction (Phalloplasty): Creates a new penis using tissue grafts from other body parts.
Glans Resurfacing: Removes and reconstructs the glans; suitable for cancers limited to the tip of the penis.
Penile Implants: Replaces the penile tissues with specialized implants to restore erectile function after penile cancer surgery.
Pelvic Exenteration: Removes organs in the pelvic region; recommended in advanced cases.
Laser treatment uses focused light energy to destroy penile cancer tissue. Laser treatment for penile cancer is often recommended in cases of smaller tumors or lesions. This is a minimally invasive approach, and it is effective in precisely targeting specific areas and limiting damage to healthy tissues.
Photodynamic therapy involves the administration of light-sensitive drugs and exposure to a specific type of light to destroy cancer cells. This penile cancer treatment is often recommended to treat superficial penile lesions.
Radiation therapy for penile cancer involves the use of high-energy rays to target and destroy cancer cells. It may be administered alone or in combination with penile cancer surgery, chemotherapy, or other treatments. Radiotherapy for penile cancer may help shrink the tumor, destroy residual cancer cells, or alleviate pain and discomfort in advanced stages.
Chemotherapy for penile cancer involves the use of powerful drugs to kill cancer cells. Also referred to as penile cancer medication, chemotherapy is often recommended in advanced stages when cancer has spread outside the penis. As an effective penile carcinoma treatment, chemotherapy may be administered systemically (through the bloodstream) to target cancer cells throughout the body.
Palliative care is a disease management approach recommended to improve the quality of life. A personalized palliative care program focuses on improving symptoms, managing pain, and supporting emotional and psychological well-being among patients. Palliative or supportive care is often an integral part of a comprehensive treatment plan, aiming to enhance comfort and the overall patient experience.
As one of the best cancer hospitals in India, HCG stands out for penile cancer treatment due to its specialized expertise in uro-oncology. The state-of-the-art diagnostic facilities and comprehensive treatment options, including advanced therapies, ensure patients receive cutting-edge care. Holistic support services further contribute to a comprehensive and compassionate approach to penile cancer care.
Various factors can contribute to the increased risk of penile cancer. Learning about the different penile cancer risk factors and adopting appropriate preventive measures can help reduce the overall risk of penile cancer.
When the incidence of penile cancer by age was studied, it was observed that this cancer type was more prevalent among older individuals.
With aging, the cells in the penis undergo various changes, and cells may become more susceptible to cancerous mutations. Also, cumulative exposure to other penile cancer risk factors, such as tobacco smoking, smegma accumulation, poor hygiene practices, etc., can make age an important risk factor for penile cancer.
Smoking stands as one of the significant penile cancer risk factors due to the harmful carcinogens present in tobacco. The DNA damage caused by these carcinogens increases the likelihood of penile cells becoming cancerous.
Phimosis, which refers to the tightness of the foreskin, may also increase the risk of penile cancer. Those with phimosis may face challenges maintaining proper hygiene, and this leads to the accumulation of dead cells, bacteria, and fluid, which in turn increases the risk of penile cancer.
Smegma accumulation is an important risk factor for penile cancer. Smegma refers to the mixture of fatty oils, dead skin cells, bacteria, and sweat that gets accumulated under the foreskin. If left unmanaged, it can lead to inflammation, which in turn increases the risk of penile cancer.
HIV/AIDS leads to a compromised immune system, which makes the body more susceptible to conditions like cancer. In such cases, the body will fail to identify and attack cancer cells, and this leads to increased penile cancer risk.
Certain psoriasis treatments, such as psoralen plus ultraviolet A (PUVA) therapy, have also been identified as one of the penile cancer risk factors. Those undergoing such treatments should talk to their doctors about their potential risks and opt for regular penile cancer screening.
Circumcision surgically removes the foreskin of the penis and reduces smegma accumulation, which is an important risk factor for penile cancer.
Having good hygiene practices, especially with respect to genital health, is one of the most important measures for penile cancer prevention. It helps prevent smegma accumulation and reduces the chances of developing conditions like phimosis, which can increase the risk of penile cancer.
Healthy lifestyle habits play a pivotal role in penile cancer prevention. Refraining from tobacco usage, practicing safe sex habits, paying attention to penile hygiene, and adopting healthy food and exercise habits are penile cancer prevention measures that can help reduce the risk of cancer development.
Penile cancer is a rare form of cancer that demands prompt medical attention for its efficient management. Learning about different penile cancer types, its stages, and its severity can help one make informed health decisions.
