Penile Cancer: Essential Information for Men
Penile cancer is a rare but serious form of cancer that originates in the tissues of the penis, most commonly on the foreskin or the glans (head) of the penis. The majority of penile cancers are squamous cell carcinomas, which means they begin in the flat skin cells lining the penis. This type of cancer grows slowly and often starts as a small lesion, sore, or lump that may be mistaken for a benign skin condition.
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What are the early signs and symptoms of penile cancer?
Early signs and symptoms of penile cancer often appear on the skin of the penis and may vary in appearance. Recognising these changes early is key to prompt diagnosis and treatment.
- A lump, growth, or sore on the penis that does not heal
- Redness, irritation, or a rash on the penis
- A foul-smelling discharge under the foreskin
- Bleeding from the penis or under the foreskin
- Thickening or colour changes of the penile skin
- Persistent itching or burning sensation
- A swelling at the tip of the penis or foreskin
- Enlarged lymph nodes in the groin area (in later stages)
A doctor must examine any persistent or unusual changes in the penis. Do not ignore these symptoms, which may resemble infections or other skin conditions.
What are the prime causes and risk factors?
The exact cause of penile cancer is not always clear, but several known risk factors increase the chances of developing it.
- Human papillomavirus (HPV) infection: Certain HPV strains increase the risk of penile cancer.
- Uncircumcised men: Higher risk due to difficulty maintaining hygiene under the foreskin.
- Poor genital hygiene increases the risk of chronic infections and inflammation.
- Phimosis: Phimosis, a condition characterised by an unretractable foreskin, traps secretions and heightens the risk of infection.
- Smoking: Tobacco chemicals can damage penile cells and weaken the immune response.
- Age: Most cases occur in men over 50.
- Multiple sexual partners: Increases the chance of HPV and other infections.
- Weakened immune system: Especially in people with HIV or those on immunosuppressive drugs.
- Chronic inflammatory conditions like lichen sclerosis can affect the penile skin.
Avoiding these risk factors, where possible and maintaining good hygiene can help lower the risk of penile cancer.
How is penile cancer diagnosed?
Penile cancer is diagnosed through a combination of physical examination, medical history, and specific tests to confirm the presence and extent of the disease.
- Physical examination: A doctor checks the penis for lumps, sores, discolouration, or abnormal tissue.
- Medical history: Includes questions about symptoms, hygiene, sexual history, and risk factors like HPV or smoking.
- Biopsy: A small tissue sample is taken from the affected area and examined under a microscope to confirm cancer.
- Imaging tests: Used to check the spread of cancer:
- Ultrasound: Helps assess deeper tissues.
- MRI or CT scan: Detects tumour spread to lymph nodes or nearby organs.
- Lymph node assessment: Doctors check swollen nodes in the groin using:
- Fine-needle aspiration (FNA) or
- Sentinel lymph node biopsy
Early diagnosis improves treatment success and reduces the chance of cancer spreading.
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What are the different types or stages of penile cancer?
Types of Penile Cancer:
Penile cancer mainly depends on the type of cell where it begins. Common types include:
Squamous cell carcinoma:
- The most common type (over 90% of cases); starts in the flat skin cells of the penis.
Basal cell carcinoma:
- It grows slowly and rarely spreads.
Melanoma:
- A rare but aggressive form begins in the pigment-producing cells.
Adenocarcinoma:
- It starts in glandular tissues, which is rare.
Sarcoma:
- It arises from connective tissues like blood vessels or muscles, which are very rare.
Stages of Penile Cancer: Staging describes how far the cancer has spread
Stage 0 (Carcinoma in situ):
- Abnormal cells are only on the surface layer of the skin.
Stage I:
- Cancer has grown below the surface but hasn't reached blood vessels or lymph nodes.
Stage II:
- Cancer has invaded deeper tissues of the penis, possibly including blood vessels.
Stage III:
- Cancer has spread to nearby lymph nodes in the groin.
Stage IV:
- Cancer has spread to deeper tissues, pelvic lymph nodes, or distant organs.
Staging guides treatment and helps predict the outcome. Early-stage cancers have a better prognosis.
What are the treatment options available?
Treatment for penile cancer depends on the stage, type, location, and overall health of the patient. The main aim is to remove the cancer while preserving function and appearance as much as possible.
- Surgery
- Most common treatment. Options include:
- Circumcision: If cancer is limited to the foreskin.
- Wide local excision: Removal of the tumour with a margin of healthy tissue.
- Partial penectomy: Removal of part of the penis.
- Total penectomy: Removal of the entire penis, used in advanced cases.
- Lymph node removal: If cancer has spread to lymph nodes in the groin.
- Most common treatment. Options include:
- Radiotherapy
- It uses high-energy rays to destroy cancer cells.
- Drs use it instead of or after surgery.
- Suitable for small tumours or patients unfit for surgery.
- Chemotherapy
- Uses drugs to kill cancer cells.
- It can be topical (applied on the skin), systemic (oral or IV), or used with radiotherapy.
- Often given when cancer has spread beyond the penis.
- Laser therapy or cryotherapy
- Used for early-stage or surface-level cancers.
- Doctors use minimally invasive techniques to preserve more tissue.
- Immunotherapy or targeted therapy
- It is still under study, and doctors use it in advanced or resistant cases.
Treatment choice depends on balancing cancer control with preserving urinary and sexual function. Early diagnosis usually allows for less aggressive treatment.
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How does penile cancer affect sexual health and urinary function?
Penile cancer and its treatment can significantly affect both sexual health and urinary function, depending on the stage and the type of treatment used.
Effects on Sexual Health:
- Reduced sexual function: Surgery, especially partial or total penectomy, can impair the ability to have sexual intercourse.
- Loss of sensation: Removal of sensitive tissues may reduce sexual pleasure.
- Erectile dysfunction: This can occur after surgery or due to psychological impact.
- Emotional distress: Body image issues, anxiety, or depression may affect libido and relationships.
- Fertility concerns: Although rare, some treatments may reduce fertility.
Effects on Urinary Function:
- Altered urine flow: After penile surgery, such as penectomy, patients experience changes in their urine stream, including redirection or weakening.
- New urinary opening: In total penectomy, a perineal urethrostomy is created (opening between the scrotum and anus) for urination.
- Urinary incontinence: Rare but possible after extensive surgery.
Support from specialists, such as urologists, counsellors, or sexual health experts, can help patients adapt and maintain their quality of life.
What are the chances of recovery or survival (prognosis)?
The prognosis for penile cancer depends on the stage at diagnosis, tumour type, spread to lymph nodes, and overall health of the patient. Early detection improves survival rates.
- Early-stage (Stage 0 or I)
- High survival rate
- Over 85–90% of patients recover with proper treatment
- Stage II
- Cancer confined to the penis often has a good prognosis.
- Survival rate around 70–80%
- Stage III
- Cancer has spread to the groin lymph nodes
- The survival rate drops to 50–65%, depending on treatment success
- Stage IV
- Cancer has spread to pelvic nodes or distant organs
- Lower survival rate, around 20–30%
Other Prognostic Factors:
- Lymph node involvement: Strongest predictor of outcome
- Tumour size and grade: Larger, more aggressive tumours carry a poorer prognosis
- Response to treatment: Effective treatment improves outlook significantly
Regular follow-up and early intervention help improve survival and quality of life.
How can penile cancer be prevented?
Adopting certain lifestyle habits and reducing known risk factors can help prevent penile cancer. Prevention mainly focuses on hygiene, reducing infections, and avoiding behaviours that increase cancer risk. Maintaining proper genital hygiene is crucial. Regular washing of the penis, especially under the foreskin in uncircumcised men, helps prevent the build-up of smegma and reduces chronic inflammation, which can increase cancer risk.
Circumcision may lower the risk of penile cancer by making hygiene easier and reducing the chances of infections and phimosis (a condition where the patient cannot pull back his foreskin). While routine circumcision is not mandatory, it can be a preventive measure, particularly in high-risk populations. Protecting against human papillomavirus (HPV) infection is another key preventive step. HPV is a common sexually transmitted infection strongly linked to penile cancer. Using condoms during sexual activity lowers the risk of HPV and other diseases. Vaccinating boys and young men against HPV can significantly reduce their risk of developing HPV-related cancers.
- Avoiding smoking plays a vital role in prevention. Tobacco weakens the immune system and damages cells, making them more vulnerable to cancer.
- Reducing the number of sexual partners and practising safe sex also decreases the risk of HPV infection and other sexually transmitted diseases.
Finally, regular medical check-ups and early treatment of any penile lesions, persistent sores, or infections help prevent progression to cancer. Men should seek prompt medical advice if they notice any unusual changes in the penis.
In summary, penile cancer prevention focuses on good hygiene, safe sexual practices, HPV vaccination, avoiding tobacco, and early medical attention to abnormalities. These measures collectively reduce the risk and help protect penile health.