Penile cancer: symptoms, causes and treatment

Definition

What is penile cancer?

Penile cancer is a type of cancer that occurs in the skin and tissue of the penis. This condition occurs when the cells in the penis develop uncontrollably.

The penis is a male sex organ which is also part of the reproductive system and urinary tract in the body. Inside the penis, there is the urethra that drains urine from the bladder to the outside of the body, as well as sperm from the testes.

Each tissue in the penis is made up of several types of cells. Therefore, penile cancer is divided into several types, including:

Squamous cell carcinoma

About 95% of abnormal cells originate from flat skin cells called squamous cells that are found anywhere in the penis.

However, it most often appears on the foreskin or glandular area and develops quite slowly. Men who have not been circumcised are more likely to get this cancer than men who are circumcised.

Squamous cell carcinoma is divided into several types, namely:

• Verucous carcinoma.This disease is known as Buschke-Lowenstein tumor which is similar to large genital warts. Tumors can grow to nearby tissue but very rarely spread to other parts of the body.
• Carcinoma in situ. The abnormal cells are found early, usually in the upper layer of the skin of the penis and have not spread to deeper tissues. This disease is sometimes called erythroplasia.

Melanoma

This type of melanoma cancer begins with melanocyte cells, which are cells that make your skin brown and protect your skin from sun exposure. Melanocyte cells are also present in the penis and when they become abnormal they can spread rapidly.

Basal cell carcinoma

Basal cell carcinoma attacks the basal cells in the male sex organs. This type of cancer is quite rare, spreads quite slowly and rarely attacks other parts of the body.

Adenocarcinoma and sarcoma

This type is often known as Paget's disease of the penis. Adenocarcinoma attacks the sweat glands on the skin of the penis and is very rare in men. There are also types of sarcomas that develop in the blood vessels, smooth muscle, or connective tissue in the penis.

How common is penile cancer?

Penile cancer is a less common type of cancer. In Indonesia, around 899 new cases were recorded with a death rate of 334 people, quoted from the 2018 Globocan data. Although quite rare, this type of cancer attacks more than anal cancer.

Signs & symptoms

What are the signs and symptoms of penile cancer?

The most common symptoms of penile cancer are:

1. Changes in the condition of the penis skin

One of the most easily detectable features is a change in the condition of the penis skin. These changes can be seen at the tip of the penis or on the foreskin (in uncircumcised men).

Changes that indicate penile cancer symptoms include:

• Thickening of the affected skin.
• Skin discoloration.
• The presence of a lump.
• Open wounds that may bleed.
• There are small lumps that peel off.
• Tissue or swelling appears brownish blue.
• Odor-smelling discharge or bleeding from the foreskin of the penis.

2. Swelling

The swollen tip of the penis makes the foreskin difficult to pull. This condition is usually one of the symptoms of penile cancer.

3. Lumps in the lymph nodes

If the cancer has spread, generally the lymph nodes around the penis will be affected. Lymph nodes can become swollen and you can feel them under the skin, especially in the groin area.

When to see a doctor?

If you feel the above symptoms of cancer, see a doctor immediately. Especially if the condition you have been experiencing for more than 2 weeks or it does not heal after you treat it.

Cause

What causes penile cancer?

The causes of penile cancer are largely unknown. However, scientists have found factors that are closely related to this disease.

Normal cells can control it by making substances called tumor suppressor gene products so they do not divide and grow too fast. Because, if it continues to divide and grow rapidly, it can lead to cancer.

Two proteins, namely E6 and D7 are proteins made by the HPV virus (human papillomavirus). This protein is known to be susceptible to blocking the performance of tumor suppressor gene products in cells. This allows cells to grow out of control and turn into cancer.

This means that when the body is infected with the HPV virus, there is a possibility that the body's cells become abnormal and end up becoming cancer.

Not only that, scientists also found that the cause of penile cancer could be damage to cell DNA that is triggered by smoking. DNA itself contains a series of commands for cells to divide, grow, and die.

If the DNA is damaged, the orders in it will also be messed up so that it can make cells abnormal.

Risk factors

What increases the risk of developing penile cancer?

Although the exact cause of penile cancer is not known, scientists have found various factors that can increase the risk of the disease, such as:

• Smoking habit. Cigarette smoke that enters the body can damage DNA so that it can trigger cells in the penis to become abnormal.
• Infected with the HPV virus. This virus can inhibit the performance of normal cells so that it stimulates cells to act without control. Transmission of this virus can be through unprotected sex, either by mouth, anus, or through vaginal penetration.
• Infected with HIV. This virus can cause AIDS which weakens the immune system and allows infection of other viruses that increase the risk of cancer in the male genital organs.
• Age. The risk of cancer in the male sex organs increases with age. Most cases of this cancer are found in men aged over 55 years.
• Be in the UV treatment of psoriasis. PUVA therapy treatment in the penis area can cause the surrounding cells to become abnormal.
• Not circumcised. Most cases of this cancer affect men who are not circumcised. Most likely this is phimosis (the foreskin becomes tight and difficult to pull back) and smegma (buildup of a thick substance under the smegma).

Diagnosis & treatment

The information provided is not a substitute for medical advice. ALWAYS consult your doctor.

How is penile cancer diagnosed?

Before a diagnosis of penile cancer is confirmed, the doctor will ask you to undergo a series of medical tests, such as:

• Physical test. The doctor will check the condition of the penis, ask what symptoms of penile cancer you have, and check your medical history.
• Imaging test. Through this test, the doctor will get a detailed picture of the abnormal tissue in the penis. These include CT scans, MRIs, chest x-rays, and ultrasounds.
• Biopsy. If the doctor finds suspicious tissue, the tissue will be taken and used as a sample to be examined for cancer or not.

How is penile cancer treated?

If the cancer found is a type of carcinoma in situ, then the treatment is the use of chemotherapy creams or laser surgery to remove areas of skin that have abnormal cells. Then, a skin graft will be done after the surgery.

While cancer of the sex organs has entered an advanced stage, penile cancer treatment that is being undertaken is:

• Surgical removal of cancer cells and reconstructive surgery. Skin and muscles can be extracted from elsewhere in the body to re-create a functioning penis.
• Radiotherapy, which is radiation therapy to kill cancer cells in the penis.
• Chemotherapy, namely treatment relying on drugs to kill cancer, such as cisplatin, fluorouracil, paclitaxel (Taxol^®), ifosfamide (Ifex^®), mitomycin, and capecitabine (Xeloda^®).

Home care

What are some lifestyle changes or home remedies that can be done to treat penile cancer?

The adoption of a healthy lifestyle for penile cancer patients is a must-do home treatment. You must not smoke, must follow a cancer diet, and get regular exercise.

You also have to take regular health checks. The use of drugs outside the doctor's recommendation must be consulted before use.

Prevention

How do you prevent penile cancer?

Most scientists argue that cancer of the sex organs can be prevented. Ways to prevent penile cancer that you can do include:

• Underwent circumcision (cutting the foreskin on the penis).
• Maintain the cleanliness of the intimate organs to prevent the buildup of substances under the foreskin (smegma).
• Using a condom during sex.
• Quit smoking.