Cancer of the Penis
(Penile Cancer)
What is cancer of the penis?
Cancer of the penis is a disease in which malignant cells originate in the tissues of the penis. Cancer of the penis is, fortunately, rare in the United States.
Which men are at increased risk?
Men who are not circumcised at birth have a higher risk for developing cancer of the penis. (A circumcision is an operation in which the doctor takes away part or all of the foreskin, the skin which covers the tip of the penis.)
What causes cancer of the penis?
A virus that can be sexually transmitted called human papillomavirus (HPV), particularly HPV 16, has been connected to the development of cervical cancer. Since antibodies against HPV 16 are present in over 60% of patients with cancer of the penis, HPV 16 appears to play a role also in causing cancer of the penis.
What are the symptoms of cancer of the penis?
A doctor should be seen if there are any of the following problems: growths or sores on the penis, any unusual liquid coming from the penis (abnormal discharge), or bleeding.
What will the doctor do?
The doctor will examine the penis and feel for any lumps.
What is the biopsy?
If the penis does not look normal or if the doctor feels any lumps, a small sample of tissue (a biopsy) is removed from the penis and looked at under a microscope to detect any cancer cells. A doctor specialist for examining tissues samples under a microscope is called a pathologist.
What is the staging of the cancer?
If cancer of the penis is found, more tests are done to find out if the cancer has spread from the penis to other parts of the body (staging). A doctor needs to know the stage of the disease to plan treatment. The following stages are used for cancer of the penis: - Stage I: Cancer cells are found only on the surface of the head of the penis (glans) and on the foreskin (the loose skin that covers the head of the penis).
- Stage II: Cancer cells are found in the deeper tissues of the glans and have spread to the shaft of the penis (the long, slender cylinders of tissue inside the penis that contain spongy tissue and expand to produce erections).
- Stage III: Cancer cells are found in the penis and have spread to nearby lymph nodes in the groin. (Lymph nodes are small bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells).
- Stage IV: Cancer cells are found throughout the penis and the lymph nodes in the groin and/or have spread to other parts of the body.
- Recurrent disease: Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the same area or in another place.
What kinds of treatment are there for cancer of the penis?
There are treatments for all patients with cancer of the penis. Three kinds of treatment used are surgery, radiation therapy , and chemotherapy .
Is surgery common for cancer of the penis?
Surgery is the most common treatment of all stages of cancer of the penis. The surgeon may take out the cancer using one of the following operations: - Wide local excision takes out only the cancer and some normal tissue on either side.
- Microsurgery is an operation that removes the cancer and as little normal tissue as possible. During this surgery, the doctor uses a microscope to look at the cancerous area to make sure all the cancer cells are removed.
- Laser surgery uses a narrow beam of light to remove cancer cells.
- Circumcision is an operation that removes the foreskin.
- Amputation of the penis is an operation that takes out the penis. It is the most common and most effective treatment of cancer of the penis. In a partial penectomy, part of the penis is taken out. In a total penectomy, the whole penis is removed. Lymph nodes in the groin may be taken out during surgery.
What is the radiation treatment for penile cancer?
Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation) or from putting materials that contain radiation through thin plastic tubes into the area where the cancer cells are (internal radiation). Radiation may be used alone or after surgery.
What is the chemotherapy for this type of cancer?
Chemotherapy uses drugs to kill cancer cells. Fluorouracil cream (a chemotherapy drug put on the skin of the penis) is sometimes used for very small surface cancers of the penis. Chemotherapy may also be given by pill or by a needle in a vein. When chemotherapy is given in this way, it is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells outside the penis. For example, a combination of 3 chemotherapeutic agents (vincristine, bleomycin, and methotrexate ) has proved effective in treating stage III penile cancer.
What is the treatment by stage?
Treatment of cancer of the penis depends on the stage of the disease, the type of disease, and the patient's age and overall condition.
Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing on in many parts of the country for most stages of cancer of the penis. To learn more about clinical trials, call the Cancer Information Service at 1-800-4- CANCER (1-800-422-6237); TTY at 1-800-332-8615.
How is stage I penile cancer treated?
If the cancer is limited to the foreskin, treatment will probably be wide local excision and circumcision. If the cancer begins in the glans and does not involve other tissues, treatment may involve fluorouracil cream and/or microsurgery.
If the tumor begins in the glans and involves other tissues, treatment may involve: microsurgery or amputation of the penis (partial penectomy); the lymph nodes in the groin may also be removed; external radiation therapy.
How is stage II penile cancer treated?
Treatment may be amputation of the penis (partial, total, or radical penectomy) or radiation therapy followed by amputation of the penis.
How is stage III penile cancer treated?
Treatment may be amputation of the penis, followed by removal of lymph nodes on both sides of the groin or amputation of the penis followed by radiation therapy. A combination of vincristine, bleomycin, and methotrexate provides effective chemotherapy.
How is stage IV penile cancer treated?
Treatment will be designed to reduce symptoms and may include wide local excision, microsurgery, amputation of the penis, or radiation therapy. Clinical trials combining chemotherapy with palliative methods of local control are considered appropriate; tested chemotherapeutic drugs with some efficacy include vincristine, cisplatin, methotrexate, and bleomycin. The combination of vincristine, bleomycin, and methotrexate has been found effective.
How is recurrent penile cancer treated?
If the cancer has come back (recurred), treatment may include amputation of the penis or radiation therapy. Locally recurrent disease can be approached by surgery or radiation therapy. Patients who fail irradiation as the initial treatment are often salvaged by penile amputation. Patients with lymph node recurrences that are not controllable by local measures are candidates for clinical trials testing new biological and chemotherapeutic agents.
Are these the "definitive" ways to treat this cancer?
If by "definitive" is meant the "authoritative", the answer is "No." These are currently the standard modes of treatment. However, clinical trials are always going on for most stages of cancer of the penis so that the situation is constantly evolving. (Again to learn more about these clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615).
What is the prognosis (outlook) with cancer of the penis?
The prognosis (chance of recovery) and choice of treatment depend on the stage of the cancer (whether it is just in the penis or has spread to other places), and the patient's general state of health. Stage I obviously carries a far better prognosis than stage IV cancer of the penis.
(This review based, in part, on information from the National Cancer Institute). Cancer of the Penis At A Glance - Cancer of the penis is more common in uncircumcised men.
- Cancer can cause growths or sores on the penis.
- Cancer can cause abnormal discharge or bleeding from the penis.
- Treatment depends on the stage of the cancer.
- Treatments include surgery, radiotherapy and chemotherapy.
- The prognosis (chance of recovery) depends on the stage of the cancer.
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