Penile cancer

Last updated
Carcinoma of the penis
Specialty Oncology
Frequency36,068 in 2020 [1]
Deaths13,211 (2020) [1]

Penile cancer, or penile carcinoma, is a cancer that develops in the skin or tissues of the penis. Symptoms may include abnormal growth, an ulcer or sore on the skin of the penis, and bleeding or foul smelling discharge. [2]

Contents

Risk factors include phimosis (inability to retract foreskin of the penis), chronic inflammation, smoking, HPV infection, condylomata acuminate, having multiple sexual partners, and early age of sexual intercourse. [3]

Around 95% of penile cancers are squamous-cell carcinomas. Other types of penile cancer such as Merkel-cell carcinoma, small-cell carcinoma, and melanoma are generally rare. [4] In 2020, it occurred in 36,000 men and caused 13,000 deaths. [1]

Signs and symptoms

Penile cancer can present as redness and irritation on the penis with a skin thickening on the glans or inner foreskin or an ulcerative, outward growing (exophytic) or “finger-like” (papillary) growth. [5] [6] Penile cancer may accompany penile discharge with or without difficulty or burning or tingling while urinating (dysuria) and bleeding from the penis. [5] [6]

Risk factors

Infections

Hygiene and injury

Other

Pathogenesis

Penile cancer arises from precursor lesions, which generally progress from low-grade to high-grade lesions. For HPV related penile cancers this sequence is as follows: [4]

  1. Squamous hyperplasia;
  2. Low-grade penile intraepithelial neoplasia (PIN);
  3. High-grade PIN (carcinoma in situ—Bowen's disease, Erythroplasia of Queyrat and bowenoid papulosis (BP));
  4. Invasive carcinoma of the penis.

However, in some cases, non-dysplastic or mildly dysplastic lesions may progress directly into cancer. Examples include flat penile lesions (FPL) and condylomata acuminata . [4]

In HPV negative cancers, the most common precursor lesion is lichen sclerosus (LS). [4]

Diagnosis

The International Society of Urological Pathology (ISUP) recommends the use of p16 INK4A immunostaining for the diagnosis and classification of HPV-related penile cancer. [21]

Classification

Around 95% of penile cancers are squamous-cell carcinomas. They are classified into the following types: [22]

Other types of carcinomas are rare and may include small-cell, Merkel-cell, clear-cell, sebaceous-cell or basal-cell tumors. Non-epithelial malignancies such as melanomas and sarcomas are even more rare. [4]

Staging

Like many malignancies, penile cancer can spread to other parts of the body. It is usually a primary malignancy, the initial place from which cancer spreads in the body. Much less often it is a secondary malignancy, one in which the cancer has spread to the penis from elsewhere. The staging of penile cancer is determined by the extent of tumor invasion, nodal metastasis, and distant metastasis. [23]

The T portion of the AJCC TNM staging guidelines are for the primary tumor as follows: [23]

  • TX: Primary tumor cannot be assessed.
  • T0: No evidence of primary tumor.
  • Tis: Carcinoma in situ.
  • Ta: Noninvasive verrucous carcinoma.
  • T1a: Tumor invades subepithelial connective tissue without lymph vascular invasion and is not poorly differentiated (i.e., grade 3–4).
  • T1b: Tumor invades subepithelial connective tissue with lymph vascular invasion or is poorly differentiated.
  • T2: Tumor invades the corpus spongiosum or cavernosum.
  • T3: Tumor invades the urethra or prostate.
  • T4: Tumor invades other adjacent structures.

Anatomic Stage or Prognostic Groups of penile cancer are as follows: [23]

  • Stage 0—Carcinoma in situ.
  • Stage I—The cancer is moderately or well-differentiated and only affects the subepithelial connective tissue.
  • Stage II—The cancer is poorly differentiated, affects lymphatics, or invades the corpora or urethra.
  • Stage IIIa—There is deep invasion into the penis and metastasis in one lymph node.
  • Stage IIIb—There is deep invasion into the penis and metastasis into multiple inguinal lymph nodes.
  • Stage IV—The cancer has invaded into structures adjacent to the penis, metastasized to pelvic nodes, or distant metastasis is present.

HPV positive tumors

Human papillomavirus prevalence in penile cancers is high at about 40%. HPV16 is the predominant genotype accounting for approximately 63% of HPV-positive tumors. Among warty/basaloid cancers the HPV prevalence is 70–100% while in other types it is around 30%. [4]

Prevention

Treatment

Treatment of penile cancer will vary depending on the clinical stage of the tumor at the time of diagnosis. [26] There are several treatment options for penile cancer, depending on staging. They include surgery, radiation therapy, chemotherapy, and biological therapy. The most common treatment is one of five types of surgery:

The role of radiation therapy includes an organ-sparing approach for early-stage penile cancer at specialized centres. Furthermore, adjuvant therapy is used for patients with locally advanced disease or for symptom management. [27]

Prognosis

Prognosis can range considerably for patients, depending where on the scale they have been staged. Generally speaking, the earlier the cancer is diagnosed, the better the prognosis. The overall 5-year survival rate for all stages of penile cancer is about 50%. [23]

Epidemiology

Penile cancer is a rare cancer in developed nations, with annual incidence varying from 0.3 to 1 per 100,000 per year, accounting for around 0.4–0.6% of all malignancies. [4] The annual incidence is approximately 1 in 100,000 men in the United States, [28] 1 in 250,000 in Australia, [29] and 0.82 per 100,000 in Denmark. [30] In the United Kingdom, fewer than 500 men are diagnosed with penile cancer every year. [13] [31]

In the developing world, penile cancer is much more common. For instance, in Paraguay, Uruguay, Uganda and Brazil the incidence is 4.2, 4.4, 2.8 and 1.5–3.7 per 100,000, respectively. [4] [9] In some South American countries, Africa, and Asia, this cancer type constitutes up to 10% of malignant diseases in men. [4]

As of 1997 the lifetime risk was estimated as 1 in 1,437 in the United States and 1 in 1,694 in Denmark. [32]

See also

Related Research Articles

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Smegma is a combination of shed skin cells, skin oils, and moisture. It occurs in both male and female mammalian genitalia. In females, it collects around the clitoris and in the folds of the labia minora; in males, smegma collects under the foreskin.

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<span class="mw-page-title-main">Paraphimosis</span> Medical condition

Paraphimosis is an uncommon medical condition in which the foreskin of a penis becomes trapped behind the glans penis, and cannot be reduced. If this condition persists for several hours or there is any sign of a lack of blood flow, paraphimosis should be treated as a medical emergency, as it can result in gangrene.

<span class="mw-page-title-main">Phimosis</span> Medical condition

Phimosis is a condition in which the foreskin of the penis cannot stretch to allow it to be pulled back past the glans. A balloon-like swelling under the foreskin may occur with urination. In teenagers and adults, it may result in pain during an erection, but is otherwise not painful. Those affected are at greater risk of inflammation of the glans, known as balanitis, and other complications.

<span class="mw-page-title-main">Balanitis</span> Inflammation of the glans penis

Balanitis is inflammation of the glans penis. When the foreskin is also affected, the proper term is balanoposthitis. Balanitis on boys still in diapers must be distinguished from redness caused by ammoniacal dermatitis. The word balanitis is from the Greek βάλανοςbalanos, literally meaning 'acorn', used because of the similarity in shape to the glans penis.

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<span class="mw-page-title-main">Lichen sclerosus</span> Itchy skin rash usually affecting the genitals

Lichen sclerosus (LS) is a chronic, inflammatory skin disease of unknown cause which can affect any body part of any person but has a strong preference for the genitals and is also known as balanitis xerotica obliterans (BXO) when it affects the penis. Lichen sclerosus is not contagious. There is a well-documented increase of skin cancer risk in LS, potentially improvable with treatment. LS in adult age women is normally incurable, but improvable with treatment, and often gets progressively worse if not treated properly. Most males with mild or intermediate disease restricted to foreskin or glans can be cured by either medical or surgical treatment.

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<span class="mw-page-title-main">Circumcision</span> Removal of the human foreskin

Circumcision is a procedure that removes the foreskin from the human penis. In the most common form of the operation, the foreskin is extended with forceps, then a circumcision device may be placed, after which the foreskin is excised. Topical or locally injected anesthesia is generally used to reduce pain and physiologic stress. Circumcision is generally electively performed, most commonly done as a form of preventive healthcare, as a religious obligation, or as a cultural practice. It is also an option for cases of phimosis, other pathologies that do not resolve with other treatments, and chronic urinary tract infections (UTIs). The procedure is contraindicated in cases of certain genital structure abnormalities or poor general health.

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Pseudoepitheliomatous keratotic and micaceous balanitis, (PKMB) is a cutaneous condition characterized by skin lesions on the glans penis that are wart-like with scaling. It can present as a cutaneous horn. PKMB is usually asymptomatic, with occasional irritation, burning sensation, fissuring, or maceration.

<span class="mw-page-title-main">Dorsal slit</span> Incision on penis foreskin expoing the glans

A dorsal slit is a single incision along the upper length of the foreskin from the tip to the corona, exposing the glans without removing any tissue. An ancient practice, it has been a traditional custom among a number of peoples, particularly Filipinos and Pacific Islanders, probably for thousands of years.

<span class="mw-page-title-main">Foreskin</span> Retractable fold of skin which covers and protects the glans of the penis

In male human anatomy, the foreskin, also known as the prepuce, is the double-layered fold of skin, mucosal and muscular tissue at the distal end of the human penis that covers the glans and the urinary meatus. The foreskin is attached to the glans by an elastic band of tissue, known as the frenulum. The outer skin of the foreskin meets with the inner preputial mucosa at the area of the mucocutaneous junction. The foreskin is mobile, fairly stretchable and sustains the glans in a moist environment. Except for humans, a similar structure known as a penile sheath appears in the male sexual organs of all primates and the vast majority of mammals.

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References

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  2. ↑ "Signs and Symptoms of Penile Cancer | Signs Of Penile Cancer". www.cancer.org. Retrieved 2019-12-18.
  3. ↑ Sumedia-Online. "EAU Guidelines: Penile Cancer". Uroweb. Retrieved 2019-12-18.
  4. 1 2 3 4 5 6 7 8 9 10 11 12 13 Bleeker MC, Heideman DA, Snijders PJ, Horenblas S, Dillner J, Meijer CJ (April 2009). "Penile cancer: epidemiology, pathogenesis and prevention". World Journal of Urology. 27 (2): 141–50. doi:10.1007/s00345-008-0302-z. PMID   18607597. S2CID   25742226.
  5. 1 2 Turner, Bruce; Drudge-Coates, Lawrence; Henderson, Sarah (2013-03-20). "Penile cancer: diagnosis, clinical features and management". Nursing Standard. 27 (29): 50–57. doi:10.7748/ns2013.03.27.29.50.e6135. ISSN   0029-6570. PMID   23634501.
  6. 1 2 "Signs and Symptoms of Penile Cancer | Signs Of Penile Cancer". www.cancer.org. Retrieved 2020-12-08.
  7. 1 2 3 4 5 6 7 8 9 "What Are the Risk Factors for Penile Cancer?". www.cancer.org. Retrieved 2 April 2018.
  8. ↑ Bleeker MC, Heideman DL, Snijders PJ, Horenblas S, Meijer CJ (2011). "Epidemiology and Etiology of Penile Cancer". Textbook of Penile Cancer. pp. 1–11. doi:10.1007/978-1-84882-879-7_1. ISBN   978-1-84882-878-0.
  9. 1 2 3 4 5 6 7 Pow-Sang MR, Ferreira U, Pow-Sang JM, Nardi AC, Destefano V (August 2010). "Epidemiology and natural history of penile cancer". Urology. 76 (2 Suppl 1): S2-6. doi:10.1016/j.urology.2010.03.003. PMID   20691882.
  10. ↑ "Penile Cancer". National Cancer Institute. 1980-01-01. Retrieved 2 April 2018.
  11. ↑ https://www.cdc.gov/cancer/hpv/statistics/penile.htm HPV-Associated Penile Cancer Rates by Race and Ethnicity] Centers for Disease Control and Prevention
  12. ↑ de Bravo BF, DeSoto M, Seu K (April 2009). "HPV: Q&A". Cancer Prevention and Treatment Fund. Retrieved August 13, 2013.
  13. 1 2 "Risks and causes - Penile cancer - Cancer Research UK". cancerhelp.cancerresearchuk.org. 2017-08-30. Retrieved 2 April 2018.
  14. 1 2 3 4 5 6 7 Minhas S, Manseck A, Watya S, Hegarty PK (August 2010). "Penile cancer--prevention and premalignant conditions". Urology. 76 (2 Suppl 1): S24-35. doi:10.1016/j.urology.2010.04.007. PMID   20691883.
  15. ↑ Reis AA, Paula LB, Paula AA, Saddi VA, Cruz AD (June 2010). "[Clinico-epidemiological aspects associated with penile cancer]". Ciencia & Saude Coletiva (in Portuguese). 15 (Suppl 1): 1105–11. doi: 10.1590/s1413-81232010000700018 . PMID   20640268.
  16. ↑ Morris BJ, Gray RH, Castellsague X, Bosch FX, Halperin DT, Waskett JH, Hankins CA (2011). "The Strong Protective Effect of Circumcision against Cancer of the Penis". Advances in Urology. 2011: 812368. doi: 10.1155/2011/812368 . PMC   3113366 . PMID   21687572.
  17. ↑ PubMed Health PubMed, Last Reviewed: September 16, 2011
  18. ↑ "Symptoms of penile cancer - Penile cancer - Cancer Research UK". cancerhelp.cancerresearchuk.org. 2017-08-30. Retrieved 2 April 2018.
  19. 1 2 Larke NL, Thomas SL, dos Santos Silva I, Weiss HA (August 2011). "Male circumcision and penile cancer: a systematic review and meta-analysis". Cancer Causes & Control. 22 (8): 1097–110. doi:10.1007/s10552-011-9785-9. PMC   3139859 . PMID   21695385.
  20. ↑ Micali G, Nasca MR, Innocenzi D, Schwartz RA (March 2006). "Penile cancer". Journal of the American Academy of Dermatology. 54 (3): 369–91, quiz 391–4. doi:10.1016/j.jaad.2005.05.007. PMID   16488287.
  21. ↑ Canete-Portillo S, Velazquez EF, Kristiansen G, Egevad L, Grignon D, Chaux A, Cubilla AL (July 2020). "Report From the International Society of Urological Pathology (ISUP) Consultation Conference on Molecular Pathology of Urogenital Cancers V: Recommendations on the Use of Immunohistochemical and Molecular Biomarkers in Penile Cancer". The American Journal of Surgical Pathology. 44 (7): e80–e86. doi:10.1097/PAS.0000000000001477. PMID   32235153. S2CID   214766446.
  22. ↑ "Penile Cancer". The Lecturio Medical Concept Library. Retrieved 3 October 2021.
  23. 1 2 3 4 "Stage Information for Penile Cancer". National Cancer Institute. 1980-01-01. Retrieved 3 November 2013.
  24. 1 2 3 Shabbir M, Barod R, Hegarty PK, Minhas S (2013). "Primary prevention and vaccination for penile cancer". Ther Adv Urol. 5 (3): 161–169. doi:10.1177/1756287212465456. PMC   3655354 . PMID   23730331.
  25. ↑ de Souza KW, dos Reis PE, Gomes IP, de Carvalho EC (March 2011). "[Prevention strategies for testicular and penile cancer: an integrative review]". Revista da Escola de Enfermagem da USP (in Portuguese). 45 (1): 277–82. doi: 10.1590/s0080-62342011000100039 . PMID   21445520.
  26. ↑ Engelsgjerd JS, LaGrange CA (2020). Penile Cancer. Treasure Island (FL): StatPearls Publishing. PMID   29763105 . Retrieved 2020-12-07.{{cite book}}: |work= ignored (help)
  27. ↑ Hakenberg OW, Dräger DL, Erbersdobler A, Naumann CM, Jünemann KP, Protzel C (September 2018). "The Diagnosis and Treatment of Penile Cancer". Deutsches Ärzteblatt International. 115 (39): 646–652. doi:10.3238/arztebl.2018.0646. PMC   6224543 . PMID   30375327.
  28. ↑ The American Cancer Society: Penile Cancer: What is penile cancer? American Cancer Society, Last revised: January 8, 2012
  29. ↑ The Official Website of the Royal Australasian College of Physicians, Published September 2010
  30. ↑ Frisch M, Friis S, Kjaer SK, Melbye M (December 1995). "Falling incidence of penis cancer in an uncircumcised population (Denmark 1943-90)". BMJ (Clinical Research Ed.). 311 (7018): 1471. doi:10.1136/bmj.311.7018.1471. PMC   2543732 . PMID   8520335.
  31. ↑ The American Cancer Society: Penile Cancer: What are the key statistics about penile cancer American Cancer Society, Last revised: January 18, 2012
  32. ↑ Cold CJ, Storms MR, Van Howe RS (April 1997). "Carcinoma in situ of the penis in a 76-year-old circumcised man". The Journal of Family Practice. 44 (4): 407–10. PMID   9108839.
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