Penile Cancer
- How Common Are Penile Cancers?
- What Are the Reasons for Seeking Medical Care for Penile Cancers?
- What Are the Risk Factors for Penile Cancer?
- How Is Penile Cancer Diagnosed?
- What Should You Do After a Penile Cancer Diagnosis Is Confirmed?
- What Are the Surgical Treatment Options After a Diagnosis of Penile Cancer Has Been Confirmed?
- What Is the Postoperative Treatment and Follow-Up for Penile Cancer?
- Are There Any Preventive Measures for Penile Cancer?
How Common Are Penile Cancers?
Penile cancers are among the rarest cancers in men and occur at varying rates in different regions.
While the incidence rate in Europe is 0.1–0.9 per 100,000, it is 0.7–0.9 per 100,000 in the United States. In Africa, Asia, and South America, however, the incidence rate is 19 per 100,000, and the disease accounts for 10–20% of all cancers in men in these regions. In our country, it is even less common.
What Are the Reasons for Seeking Medical Care for Penile Cancers?
Patients may seek medical attention for any suspicious lesion or sore observed anywhere on the penis (on the foreskin or the penile shaft).
If penile cancer is suspected, the size, location, number, appearance, color, and borders of the first lesion observed must be documented.
What Are the Risk Factors for Penile Cancer?
Phimosis (the inability to retract the foreskin) and chronic irritation or inflammation caused by poor hygiene are risk factors for penile cancer. For this reason, circumcision can be considered a preventive measure against penile cancer.
There is strong evidence that 50% of penile cancer cases are caused by HPV types 16 and 18. HPV types 16 and 18 are transmitted through unprotected sexual intercourse.
If penile cancer is suspected during an examination, the lymph nodes in the groin area should also be examined. A lymph node that is larger and harder than normal may indicate that the cancer has metastasized (spread) to these areas as well.
The most important factor in terms of survival is whether or not the cancer has spread to these lymph nodes.
How Is Penile Cancer Diagnosed?
A definitive diagnosis is made through pathological examination of a biopsy sample obtained from a lesion or wound on the penis using a biopsy needle or direct surgical excision.
What Should You Do After a Penile Cancer Diagnosis Is Confirmed?
The decision is based on the size of the lesion and lymph node involvement. During ultrasound examination to assess lesion depth, the extent of spread to the corpus cavernosum (the tissue responsible for penile erection) or the corpus spongiosum (the tissue surrounding the urethra) is evaluated. If lymph nodes are palpable, their exact location and size should be accurately recorded. Biopsy samples may also be taken from the lymph nodes (such as open biopsy or fine-needle aspiration, depending on the pathologist’s preference).
What Are the Surgical Treatment Options After a Diagnosis of Penile Cancer Has Been Confirmed?
Based on the pathology report, if the initial lesion is low-grade and in an early stage, treatment involving only the removal of the lesion—known as penile-preserving surgery—is recommended. However, if the initial biopsy pathology indicates that the cancer has spread to deeper tissues (T2—corpus spongiosum or corpus cavernosum) and/or is a high-grade tumor (one that could spread rapidly based on histological evaluation), it will be necessary to remove all or part of the penis.
If the cancer has spread to the lymph nodes, removal of the group of lymph nodes known as deep and superficial inguinal (groin) lymphadenectomy is recommended; this is a surgical procedure associated with significant morbidity (side effects and related complications—such as infection, drainage, and leg swelling). This procedure can be performed as a limited (modified) lymphadenectomy or as a more extensive radical lymphadenectomy. If the initial biopsy showed no lymph node involvement but a lymph node is palpated during follow-up, lymphadenectomy (removal of the lymph nodes) is again recommended.
Following a radical penectomy, in which the entire penis is removed, the patient’s urethra (the external urinary tract) is rerouted to the area between the anus and the scrotum (the sac of skin surrounding the testicles), known as the perineum.
What Is the Postoperative Treatment and Follow-Up for Penile Cancer?
If lymph node involvement is detected after a biopsy, imaging should first be performed to rule out metastasis (spread to other parts of the body). Surgery is performed on patients without metastasis. Patients with metastasis should receive chemotherapy. Patients with lymph node involvement whose postoperative pathology results indicate an advanced stage (T3–T4) may receive additional chemotherapy or radiation therapy.
Patients are monitored through periodic examinations and imaging at intervals determined by the pathology report.
Are There Any Preventive Measures for Penile Cancer?
Circumcision, the use of protection (such as condoms) during sexual intercourse for those who frequently change partners, and measures to improve genital hygiene are also recommended for the prevention of penile cancer.
Although penile cancer is quite rare in our country, it is a highly aggressive and deadly form of cancer if not detected in its early stages.
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