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Preventing Penile Cancer: Education, Vaccination, and Safe Practices

 What is penile cancer? 

Penile cancer develops when normal cells of penis start replicating uninhibited. Cancer can form anywhere in penis, but it most commonly starts on the head or foreskin. Cancer cells multiply out of control, forming a mass called a tumor. These cells can crowd out healthy cells. Over time, cancer cells can spread to other parts of body, damaging healthy tissue and organs. 

What are the types of penile cancer? 

Penile cancer can be of various types. They are of different aggressiveness and have different lines of management. Some common types of penile cancer are: 

● Squamous cell carcinoma: Ninety-five percent of penile cancers are squamous cell carcinoma. This type of cancer forms in the top part of skin layer called the epithelium. ● Basal cell carcinoma: Cancer begins in the bottom layer of epithelium. BCC is a slow-growing form of penile cancer. 

● Melanoma: This cancer begins in cells that control how dark or light skin is, called melanocytes. Melanoma is a more aggressive form of cancer. 

● Sarcoma: Cancer develops in muscle or connective tissue. It’s an extremely rare form of penile cancer. 

At what age does penile cancer usually occur? 

Cancer is most commonly diagnosed in people over 55, but people under 40 can also get it. The average age of diagnosis is 60. 

What are the symptoms of penile cancer? 

Penile cancer usually causes penis to look different. The skin may become discoloured or there may. Be an obvious lump seen. Signs and symptoms of penile cancer include: 

● A painless lump or sore (that may bleed). 

● Swelling and irritation, especially in the head of penis, also called balanitis. ● Skin thickening or changing skin colour. 

● Flat growths that look blueish-brown. 

● Foul-smelling fluid underneath foreskin. 

● Small, crusty bumps. 

● Rash. 

Less serious conditions like infections and allergic reactions also cause these symptoms. Still, don’t leave things to chance. It’s better to have doctor take a look so early-stage cancer doesn’t go untreated. 

What causes penile cancer? 

Researchers don’t know what causes the change that transforms a healthy cell into a cancer cell, but they’ve discovered several risk factors. A risk factor doesn’t cause penile cancer, but it increases the possibility of having one.

What are the risk factors for penile cancer? 

The most significant risk factor for penile cancer is age. About 80% of penile cancer diagnoses occur in people 55 or older. Not being circumcised when you were an infant may also increase risk. Circumcision removes the foreskin of penis, exposing the head. Many risk factors related to penile cancer are likely related to having a foreskin. 

Phimosis 

Phimosis is common in uncircumcised infants but rare in uncircumcised adults. It’s a condition that causes foreskin to become so tight that you can’t retract it to access the head of penis. It’s possible that phimosis lasting into adulthood increases the risk of infection and inflammation beneath foreskin. Both may increase cancer risk. 

HPV 

Many of the same high-risk strains of the HPV that cause cervical cancer have been found in people with penile cancer. The HPV associated with cervical and penile cancer is a sexually transmitted virus. Although HPV is present in nearly all instances of cervical cancer, it’s present about half the time in people with penile cancer. Still, HPV infection is a significant risk factor for penile cancer. 

HIV 

Penile cancer is more common in people with human immunodeficiency virus. It’s possible that the same sexual behaviours that increase a person’s risk of HPV (for example, unprotected sex, multiple partners, etc.) also increase the risk of HIV infection. It’s possible, too, that HIV infection alone increases cancer risk. Research is ongoing. 

Tobacco use 

Smoking cigarettes and chewing tobacco increases penile cancer risk. Tobacco may slow body’s ability to fight infection, raising risk. Tobacco use may damage cells, causing changes that lead to cancer. 

Lichen sclerosus 

Lichen sclerosis (LS) is an inflammatory disorder that may cause the head of penis or foreskin to feel painful, irritated or itchy. LS increases risk of penile cancer. Lichen sclerosus may also increase risk of HPV infection. 

Poor hygiene 

Not washing penis frequently or thoroughly may increase risk of smegma. Smegma is a build-up of fluids body secretes naturally. If you’re uncircumcised, smegma can collect beneath foreskin and become thick and smelly. Smegma leads to irritation and inflammation that may increase cancer risk. 

Is penile cancer contagious? 

Penile cancer isn’t contagious. However, HPV — one of the risk factors for penile cancer — is transmitted through skin-to-skin contact (most often) during unprotected sex.

How is penile cancer diagnosed? 

Doctor may perform the following to diagnose penile cancer: 

Physical exam and history: Doctor will examine you to check for unusual skin changes, like a lump or discolouration on penis. They’ll also ask about symptoms, habits and past illnesses. This information can help Doctor determine whether the changes likely result from cancer or a more common cause like an infection or allergic reaction. 

● Biopsy: A biopsy is the only way to confirm a cancer diagnosis. During the procedure, Doctor removes suspicious-looking cells or tissues. A specialist who works in a lab (pathologist) views the cells under a microscope to check for signs of cancer. 

Imaging: You may need imaging to see how much the cancer’s spread. Depending on cancer, Doctor may order a CT scan. MRI, PET CT or an ultrasoung. 

What are the stages of penile cancer? 

Imaging helps Doctor stage cancer. Staging the cancer allows them to classify how serious cancer is, based on the size of a tumor and how much it’s spread throughout body. This information guides treatment decisions. 

Penile cancer is staged using the TNM staging system. Each letter provides unique information about cancer. 

T (Tumor): “T” provides information about tumor, including whether the cancer cells have formed a tumor and (if so) how much it’s grown into penis. 

N (Lymph nodes): “N” provides information about whether the cancer has spread to lymph nodes. If it has, Doctor can note which lymph nodes are affected. ● M (Metastasise): “M” provides information about whether the cancer has spread to other organs in body. If it has, Doctor can note which organs are affected. 

Numbers following the letters (TNM) provide additional information about the tumor, lymph nodes affected and whether the cancer has metastasised. The numbers range from 1 to 4, with 1 meaning less cancer spread and 4 meaning the most spread (metastasis). 

Cancer staging can be complex, but it communicates important information about how serious condition is. 

How is penile cancer treated? 

Treatment will depend on the size of the tumor, whether it’s spread and its aggressiveness (how likely it is that the cancer will return after treatment). 

For cancer that’s in earlier stages, Doctor may recommend one or a combination of the following treatments: 

Medicated creams: Doctor may recommend a cream that you regularly apply to penis. Common medicines include fluorouracil and imiquimod. 

Circumcision: If the cancer is only on foreskin, Doctor may remove the tissue. ● Laser ablation: This procedure uses lasers that create extreme heat to destroy the tumor.

Excision: Doctor may cut the cancer cells or tumor from penis. 

For cancer that’s more advanced, Doctor may recommend: 

Penectomy: A partial penectomy removes part of penis. A total penectomy removes entire penis. For a total penectomy, Doctor will create an opening in abdomen or the skin between anus and scrotum (perineum) so you can pee. 

Lymphadenectomy: Doctor may remove lymph nodes (most commonly in the groin) if the cancer’s spread there. 

Doctor may use radiation, chemotherapy or both to shrink cancer cells before performing surgery. 

How can I reduce my risk of penile cancer? Following are few things which reduce the chances of getting penile cancer: 

Weigh the benefits of circumcision. Circumcising an infant reduces their risk of penile cancer as an adult. 

Get treated for phimosis. Phimosis in uncircumcised adults has many potential causes, ranging from infections to poor hygiene. Identifying the cause and receiving prompt treatment can reduce risk of penile cancer. 

Practice safer sex. Safe sexual practices and limiting number of sexual partners can reduce risk of HPV infection. 

Avoid tobacco products. Abstinence from smoking reduces the risk of penile cancer and many other types of cancer. 

Practice good hygiene. Good hygiene is an important part. Cleaning penis regularly with mild soap and warm water can wash away germs that can cause inflammation or infection. 

Is penile cancer fatal? 

Penile cancer can be fatal, especially if it’s spread beyond penis. You can reduce risk by putting good habits into place, like practicing safer sex and avoiding tobacco products. See doctor at the first sign of a change in penis, like a lump or discolouration.

Dr. Puneet Ahluwalia
Renal Care
Meet The Doctor
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