What is Penile Cancer

Cancer of the penis (penile cancer)

This information is about cancer of the penis. Cancer of the penis is rare. Approximately 400 men are diagnosed with it in the UK each year. It is most often diagnosed in men over the age of 50.

Causes and risk factor 

The exact cause of cancer of the penis is unknown. It is much less common in men who have had all or part of their foreskin removed (been circumcised) soon after birth. This is because men who have not been circumcised may find it more difficult to pull back the foreskin enough to clean thoroughly underneath.

Some skin conditions that affect the penis can go on to develop into cancer if they are left untreated. If you notice white patches, red scaly patches, or red moist patches of skin on your penis, it’s important to see your doctor so that you can get any treatment that you need.

Cancer of the penis isn’t infectious and cannot be passed on to other people. It is not caused by an inherited faulty gene and so other members of your family don’t have an increased risk of developing it

Signs and symptoms

The first signs of a penile cancer are often a change in colour of the skin and skin thickening. Later symptoms include a growth or sore on the penis, especially on the glans (head of the penis) or foreskin, but also sometimes on the shaft of the penis. There may be a discharge or bleeding. Most penile cancers are painless.

Sometimes the cancers appear as flat growths that are bluish-brown in colour, or as a red rash, or small crusty bumps. Often the cancers are only visible when the foreskin is pulled back.

These symptoms may occur with conditions other than cancer. Like most cancers, cancer of the penis is easiest to treat if it is diagnosed early, so if you have any worries it is best to go to your doctor straight away.

How it is diagnosed

Your GP will examine you and refer you to a hospital specialist for expert advice and treatment.

The specialist will examine the whole of the penis and your groin to feel for any swellings. To make a firm diagnosis, the doctor will take a sample of tissue (a biopsy) from any sore or abnormal areas on the penis. This will be done under an anaesthetic (local or general) so that the procedure is painless. The biopsies will be examined under a microscope.

Further tests

If the biopsy shows that you have cancer, your doctor will refer you to a specialist centre, which may be some distance from your home.

The doctors at the centre will usually do some further tests to check whether or not the cancer has spread.

Cancer can spread in the body, either in the bloodstream or through the lymphatic system. The lymphatic system is part of the body’s defence against infection and disease. The system is made up of a network of lymph nodes (also known as lymph glands) that are linked by fine ducts containing lymph fluid.

If the cancer has spread to the lymph nodes in your groin they may be enlarged.

The results of these tests will help the specialist.

A CT scan takes a series of x-rays which builds up a three-dimensional picture of the inside of the body. The scan is painless but takes from 10-30 minutes. CT scans use a small amount of radiation, which will be very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.

You may be given a drink or injection of a dye which allows particular areas to be seen more clearly. For a few minutes, this may make you feel hot all over. If you are allergic to iodine or have asthma you could have a more serious reaction to the injection, so it is important to let your doctor know beforehand.

If you have any enlarged lymph nodes in the groin, your doctor may put a needle into the node to get a sample of cells (biopsy). This is to see whether or not the enlargement is due to cancer. Enlarged lymph nodes can also be due to infection, and not cancer.

The stage of a cancer is a term used to describe its size and whether or not it has spread beyond its original site in the body. Knowing the particular type and stage of the cancer helps the doctors to decide on the most appropriate treatment for you.

The most commonly used staging system is called the TNM system, where:
T refers to the tumour size.
N refers to whether or not lymph nodes are affected
M refers to whether or not the cancer has spread to other parts of the body (metastases).

The T, N and M will often have numbers attached to describe the detail. For example, a T1 tumour may be very small and just in one layer of tissue, whereas a T4 tumour may be a larger size and spread through several layers of tissue.

The exact details of the T, N and M will depend on the type of cancer.

Number staging system

In addition to TNM staging, you’ll probably hear the doctors use a number staging system. There are usually three or four number stages for each cancer type.

Stage 1 describes a cancer at an early stage when it’s usually small in size and hasn’t spread, whereas stage 4 describes cancer at a more advanced stage when it has usually spread to other parts of the body. Stages 2 and 3 are in-between these stages.

The number stages are made up of different combinations of the TNM stages. So a stage 1 cancer may be described as either T1, N0, M0 or T2, N0, M0.

Number stages may also be further subdivided to give more detailed information about tumour size and spread. For example, a stage 3 cancer may be subdivided into stage 3a, stage 3b and stage 3c. A stage 3b cancer may differ from a stage 3a cancer in either the tumour size or if the cancer has spread to lymph nodes.

Talking about staging

In the last few years, staging systems have become increasingly complex and they now describe the size and spread of different types of cancer in much greater detail. This can be very helpful in planning the details of treatment or predicting outcomes.

However, doctors will often use a much simpler approach when talking about staging. They might use words like ‘early’ or ‘local’ if the cancer hasn’t spread, ‘locally advanced’ if it has begun to spread into surrounding tissues or nearby lymph nodes, or ‘advanced’ or ‘widespread’ if it has spread to other parts of the body. Your doctors can give you more information about the stage of your particular cancer.

Grading

Grading refers to the appearance of the cancer cells under the microscope and gives an idea of how quickly the cancer may develop.

Low-grade means that the cancer cells look very like normal cells; they are usually slow-growing and are less likely to spread. In high-grade tumours, the cells look very abnormal, are likely to grow more quickly, and are more likely to spread.

Treatment

Your treatment will be carried out in the specialist centre that you have been referred to. This will either be a hospital with a surgeon who specialises in treating cancer of the penis or a cancer treatment centre.

The type of treatment that you are given will depend on a number of things, including the position and size of the cancer, its grade, whether or not it has spread and your general health.

The treatments used for penile cancer include surgery, which is the main treatment,chemotherapy and Radiotherapy. With advances in surgical techniques it’s usually possible to preserve the penis or to reconstruct it surgically.

Before you agree to any treatment, your specialist will talk to you about the possible side effects and how to deal with them.

Surgery

Small, surface cancers that have not spread are treated by removing only the affected area and a small area around it. The cancer can be removed with conventional

surgery,using a laser or by freezing (cryotherapy). Cryotherapy is carried out with a cold probe, which freezes and kills the cancer cells.

If the cancer is affecting only the foreskin, it may be possible to treat it with circumcision alone.

All the above treatments can usually be given to you as a day-case. They may be done under local or general anaesthetic, depending on individual circumstances.

Wide local excision If the cancer has spread over a wider area, you will need to have an operation known as a wide local excision. This means removing the cancer with a border of healthy tissue around it. This border of healthy tissue is important as it reduces the risk of the cancer coming back in the future. The operation is usually carried out under a general anaesthetic and will involve a short stay in hospital.

Removal of lymph nodes  The surgeon may also remove a small number of lymph nodes from your groin to find out if the cancer has spread. If the nodes in your groin are obviously enlarged you will usually have all the nodes in your groin removed (radical groin dissection).

Surgery to preserve the penis and reconstruction For larger cancers of the head of the penis, the bulbous part (the glans) will be removed. In this situation it is possible to give back a normal appearance by using skin from somewhere else in the body (skin graft).

You will need to stay in hospital for about five days and have the wound dressed regularly for up to a fortnight.

Removing the penis (penectomy) This may be advised if the cancer is large and is covering a large area of the penis. Amputation may be partial (where part of the penis is removed) or total (removal of the whole penis). The operation most suitable for you depends on the position of the tumour. If the tumour is near the base of the penis, total amputation may be the only option. This operation is now much less common, as doctors can usually preserve the penis.

Reconstructive surgery It may be possible to have a penis reconstructed after amputation (if there are no signs that the cancer has spread anywhere else in the body). This requires another operation. The techniques that may be used include taking skin and muscle from your arm and using this to make a new penis.

Sometimes it is also possible for surgeons to reconnect some of the nerves in order to provide sensation and the necessary blood flow to allow the reconstructed penis to become erect. If you have damaged nerves you can try to repair them before needing surgery, read the full article.

Radiotherapy

treats cancer using high-energy rays to destroy cancer cells, while doing as little harm as possible to healthy cells.

Radiotherapy is occasionally used instead of surgery. This may be when someone is not well enough to have an operation or doesn’t want to have surgery.

It used to be a common treatment for small cancers of the head of the penis (glans), but nowadays it is used less often because of improvements in surgery.

However, radiotherapy may be used to treat affected lymph nodes in the groin to help reduce the risk of the cancer spreading.

It may also be given to treat symptoms, such as pain, if the cancer has spread to other parts of the body, like the bones.

Radiotherapy is normally given as a series of short daily treatments in the hospital’s radiotherapy department. High energy x-rays are directed at the area of the cancer by using a machine. The treatments are usually given from Monday to Friday, with a rest at the weekend. Each treatment takes 10-15 minutes. The number of treatments will depend on the type and size of the cancer, but the whole course of treatment for early cancer will usually last up to six weeks. Your doctor will discuss the treatment and possible side effects with you.

Before each session of radiotherapy, the radiographer will position you carefully on the couch and make sure that you are comfortable. During your treatment you will be left alone in the room, but you will be able to talk to the radiographer who will be watching you carefully from the next room.

Radiotherapy is not painful, but you do have to lie still for a few minutes while your treatment is being given. The treatment won’t make you radioactive and it is perfectly safe for you to be around other people, including children, after your treatment.

Side effects of radiotherapy

There are sometimes side effects from radiotherapy treatment to the penis. The skin on your penis may become sore during your treatment and for a period of time afterwards. Staff at the radiotherapy department will be able to give advice on how to look after your skin in the area being treated.

Long-term, the side effects of radiotherapy can cause thickening and stiffening of healthy tissues (fibrosis). In some men, this can result in a narrowing of the tube that carries urine through the penis (the urethra) and so can cause difficulty in passing urine. If narrowing of the urethra does develop, it can usually be helped by an operation to stretch (dilate) the area. This is done by passing a tube into the urethra and is performed under a general anaesthetic.

Chemotherapy

is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It can be one drug or several drugs used together. It is not commonly used to treat cancer of the penis. Chemotherapy cream may sometimes be used to treat very small, early cancers that are confined to the foreskin and end of the penis (glans).

Chemotherapy may also be given as tablets, or by injection, into a vein for more advanced cancer. It may be given along with surgery or radiotherapy (or both).

Clinical trial

Research into new ways of treating cancer of the penis is going on all the time. Cancer doctors use trials to assess new treatments. Before any trial is allowed to take place, an ethics committee must have approved it, and agreed that it is in the interest of the patients.

You may be asked to take part in a clinical trial. Your doctor must discuss the treatment with you so that you have full understanding of the trial and what it involves. You may then decide not to take part, or withdraw from the trial, at any stage. You will then receive the best standard treatment available.

Follow-up

After your treatment is completed, you will have regular check-ups and possibly scans or x-rays. These will probably continue for several years. If you have any problems, or notice any new symptoms between these times, let your doctor know as soon as possible.

Your feelings

You may have many different feelings  including anger, resentment, guilt, anxiety and fear. These are all normal reactions, and are part of the process many people go through in trying to come to terms with their illness.

Everyone has their own way of coping with difficult situations; some people find it helpful to talk to friends or family, while others prefer to seek help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope, but help is there if you need it. You may wish to contact our a Cancer support worker  for information about counselling in your area.

It can help to talk to your partner about how you are feeling, and about the changes in your relationship. This can be very difficult and you may need to get help from a specialist nurse or counsellor. They can help you, and your partner, to deal with these changes. Your GP, hospital doctor, or one of our cancer information nurse specialists can usually put you in touch with a counsellor or specialist nurse.

Read more about neuropathy on https://neuropathyreliefguide.com.