Cancer of the Penis
What is it?
Cancer is when cells in a particular organ, such as the penis, begin to abnormally divide and grow, forming a lump, which is called a tumour. Tumours can be either benign or malignant. Benign tumours do not spread to other parts of the body, although they can press on surrounding organs, affecting their function. Malignant tumours are able to spread beyond their original site, and if they are not treated, can invade and destroy surrounding tissues. Sometimes cells break off and travel in the bloodstream or lymphatic system to other organs in the body, growing new tumours there.
With penile cancer, tumours usually appear on the end of the penis or on the foreskin. Penile cancer is relatively uncommon, occurring in 1 in 100,000 individuals. In North America, where circumcision is routinely performed, penile cancer is rare. It is thought that bacterial production of smegma (cheese-like substance that can form under the foreskin of the penis) is a risk factor. Unprotected sexual relations with multiple partners and cigarette smoking are also risk factors. It is most common in men aged over 60 years.
What are the symptoms?
In order to recognise any changes at an early stage, it is important to examine yourself regularly. If you have noticed any of the following, you should make an appointment to see your GP as soon as possible.
The last two symptoms (bleeding during urination and/or painful urination) can be symptoms of many other conditions and may not necessarily mean you have penile cancer. This is why it is important that you see your GP as soon as you notice anything unusual.
How is it diagnosed?
Your doctor will examine your sore or lump. If cancer is suspected you will be referred to a hospital specialist for advice and treatment. In order to make a diagnosis, the cells of the sore or lump must be examined closely under a microscope to see if they are cancerous. Your doctor will either surgically remove the lump completely or remove a small section of it (biopsy) to send to the laboratory for investigation.
If cancer is detected you will be sent to a specialist in a hospital. There you will undergo further investigations to assess how developed the cancer is and to check whether the cancer has spread to other parts of the body. These investigations could include a computerised tomography (CT) scan or magnetic resonance imaging (MRI) of your abdomen and pelvis. A CT scan takes x-rays of your body from different angles to make a detailed cross-sectional image. Sometimes a dye is injected to make the images more detailed. MRI uses magnetic fields instead of x-rays to produce similar images. Sometimes a bone scan may also be performed, to check whether the cancer has spread to your bones.
What is the treatment?
Surgery
The first line of treatment is usually surgery. If the cancer is caught in the very early stages, and limited to the foreskin, removal of the cancer cells and a simple circumcision (removal of the foreskin) may be all that is required. If the cancer is at a very early stage and is only on the glans (the head of the penis), the use of a fluorouracil cream (a cell-killing (cytotoxic) medication that can be applied in cream form) and/or microsurgery may be sufficient.
If the tumour is at a later stage, but is still only small, near the tip of the penis, a partial penectomy (removal of a portion of the penis) may be carried out under general anaesthetic. Laser surgery is also an alternative at this stage, although this is still in its experimental stage. Laser surgery uses a precise, intensely-focused beam of light to dissolve or burn away the cancer cells.
If the tumour is very advanced, and has spread, a total penectomy (amputation of the whole penis) is required. A new urethral opening for urine to pass through is made in the groin area.
It is possible to have a penis reconstructed after amputation. Skin and muscle may be used to construct a penis during a separate operation.
Radiotherapy
Radiotherapy is the use of x-rays (and other rays) to destroy cancer cells, while avoiding harming normal cells. The rays are delivered to the penis by a machine that looks a bit like an x-ray machine. Radiotherapy is usually used alongside surgery on early stage tumours, and those that have not yet spread. The treatment is usually painless, although there may be some short-term side effects such as skin irritation, cystitis, and blood in the urine.
Chemotherapy
Chemotherapy is the use of special anti-cancer (cytotoxic) medicines to destroy cancer cells. These medicines are given either by injection or by mouth and stop the growth and division of cancer cells that have spread to any part of the body. Chemotherapy is usually given to people that have an advanced form of cancer that has spread to other parts of the body. There are many side effects of chemotherapy and these vary depending on the exact medicine that is taken.
Further information
Your local GP surgery is the best place for you to find information on penile cancer, especially if you have specific concerns about your symptoms or treatment. Charities can also be useful sources of information and support.
Cancer BACUP www.cancerbacup.org.uk
Cancer Research UK www.cancerresearchuk.org
Men's Health Forum www.malehealth.co.uk
