How does the Penis Normally work?

The penis is the external male sex organ. The main roles of the penis are to carry urine out of the body and sperm into the woman’s vagina. There are 3 tubes inside the penis. One is called the urethra. It’s hollow and carries urine from the bladder through the penis to the outside. The other 2 tubes are called the corpora cavernosa. These are soft, spongy tubes that fill with blood to make the penis stiff during an erection. During sex, the stiffness of the penis makes it hard enough to push into the woman’s vagina. Then the urethra acts as a channel to carry semen into the vagina.

About penile cancer

Penile cancer is a rare form of cancer that occurs mostly in uncircumcised penises. Uncircumcised means that the piece of skin covering the head of the penis, called the foreskin, has not been removed. Treatment for most penile cancers caught very early include creams and laser therapy. If not caught early, treatment may mean surgery.

Types of penile cancer

Epidermoid/squamous cell carcinoma Squamous cell carcinoma can begin anywhere on the penis. But it usually develops on or under the foreskin. When found at an early stage, epidermoid carcinoma can usually be cured.

Basal cell carcinoma: Basal cells can sometimes become cancerous. These are round cells located under the squamous cells in a layer of skin called the lower epidermis.

Melanoma: The deepest layer of the epidermis contains scattered cells called melanocytes. These cells make the melanin that gives skin color. Melanoma starts in melanocytes. It is the most serious type of skin cancer. 

SarcomaAbout 1% of penile cancers are sarcomas. Sarcomas develop in the tissues that support and connect the body, such as blood vessels, muscle, and fat.

Main causes of penile cancer

Roughly half of all penile cancers are caused by certain types of  virus called human papillomavirus (HPV). It can get from:

  • any skin-to-skin contact of the genital area
  • vaginal, anal or oral sex
  • sharing sex toys

Who is more likely to get penile cancer?

  • People older than 50
  • Smoking tobacco
  • Have problems pulling back your foreskin (the skin covering your penis) to keep your penis clean (a condition called phimosis)
  • Have or had treatment for psoriasis with medicines called psoralens and an ultraviolet (UVA) light source (called PUVA treatment)
  • have a weakened immune system because of a condition like HIV

How to lower your chance of getting penile cancer

  • Protect yourself from getting HPV by getting the HPV vaccination 
  • Use condoms when having any kind of sex, to lower the chances of getting HPV
  • Stop smoking
  • Have a circumcision if you have phimosis and this is recommended to treat it
  • Make sure you regularly and thoroughly clean your penis and foreskin

Symptoms and Signs

  • A growth or sore on the penis, especially on the glans or foreskin
  • Changes in the color of the penis
  • Thickening of the skin on the penis
  • Persistent discharge with a foul odor beneath the foreskin
  • Blood coming from the tip of the penis or from under the foreskin
  • Unexplained pain in the shaft or tip of the penis
  • Irregular or growing bluish-brown flat lesions or marks beneath the foreskin or on the penis
  • Reddish, velvety rash beneath the foreskin
  • Small, crusty bumps beneath the foreskin
  • Swollen lymph nodes in the groin
  • Irregular swelling at the end of the penis

See a General physician if you have

  • Any changes to how your penis looks
  • Discharge or bleeding from your penis
  • Any of the other symptoms of penile cancer
  • Had treatment for your symptoms that has not helped in the time that it should

How penile cancer is diagnosed

Medical history and physical exam 

The doctor will take a detailed  medical history and also, he  will look at the genital area carefully for possible signs of penile cancer or other health problems.

Biopsy

  • Incisional biopsy: For an incisional biopsy only a part of the changed area is removed
  • Excisional biopsy: In an excisional biopsy, the entire lesion is removed.
  • Lymph node biopsy: If the cancer has spread deep within the penis, nearby lymph nodes usually will need to be checked for cancer spread.it can be done by :
  • Fine needle aspiration (FNA): To do this type of biopsy, the doctor puts a thin, hollow needle right into the lymph node and uses a syringe to pull out cells and a few drops of fluid.
  • Surgical biopsy: In some cases, the lymph nodes are not checked with FNA, but instead surgery is done to remove one or more lymph nodes

Imaging tests

Computed tomography (CT): A CT scan uses x-rays to make detailed cross-sectional images of the body. It can show how big the tumor is and can also help see if the cancer has spread to lymph nodes or other parts of the body.

Magnetic resonance imaging (MRI): Like CT scans, MRIs show detailed images of soft tissues in the body

Ultrasound:  It can be useful to find out how deeply the cancer has spread into the penis. It can also help find enlarged lymph nodes in the groin. This test is painless and does not expose to radiation

Chest x-ray: An x-ray might be done to see if the cancer has spread to the lungs.

Treating Penile Cancer

Surgery: Surgery is the most common treatment for all stages of penile cancer

Circumcision: If the cancer is only on the foreskin, circumcision can often cure the cancer. This operation removes the foreskin and some nearby skin.

Excision: An excision is a removal of the tumor and some surrounding healthy tissue using a scalpel or other surgical tool. Sometimes the surgeon may remove a larger area of healthy tissue around the tumor to make sure that all the cancer is removed.

Microscopically controlled surgery: The surgeon removes a layer of the skin that the tumor may have invaded and then checks the sample under a microscope right away. If it contains cancer, another layer is removed and examined.

Glansectomy: If the tumor is small and only on the glans (the tip of the penis), part or all of it may be removed. Skin grafts may be used rebuild the glans after surgery.

Partial or total penectomy

  • Partial penectomy  :Only the end of the penis is removed .
  • Total penectomy : The  entire penis is removed, including the roots that extend into the pelvis. The surgeon creates a new opening for urine to drain from the perineum, which is the area between the scrotum and the anus. This is called a perineal urethrostomy.

Lymph node dissection: Men with cancer that has grown deep within the penis (stage T2 or higher) usually need to have some nearby lymph nodes in the groin removed so they can be checked for cancer spread.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells. 

Local Treatments

Laser ablation: The doctor uses a beam of laser light to destroy (ablate) cancer cells. This can be useful for squamous cell carcinoma in situ (CIS) and for very thin or shallow basal cell carcinomas

Cryotherapy: Not used as often as laser ablation, cryosurgery works much the same way, but uses liquid nitrogen to freeze and kill the cancer cells

Topical chemotherapy: Topical chemotherapy means that a cancer-killing drug is put right on the skin instead of taken as a pill or injected into a vein

Follow-up care

Develop a survivorship care plan . This plan might include: 

  • A suggested schedule for follow-up exams and tests
  • A schedule for other tests you might need in the future, such as early detection (screening) tests for other types of cancer, or tests to look for long-term health effects from cancer or its treatment
  • A list of possible late- or long-term side effects from  treatment, including what to watch for and when should contact with doctor
  • Diet and physical activity suggestions
  • Reminders to keep  appointments with  primary care provider (PCP), who will monitor patient  general health care 

Adopting healthy behaviors such as not smokingeating wellgetting regular physical activity, and staying at a healthy weight might help to prevent the recurrence 

Disclaimer: All contents on this site are for general information and in no circumstances, information be substituted for professional advice from the relevant healthcare professional, Writer does not take responsibility for any damage done by the misuse or use of the information.

References

https://www.nhs.uk/ (NHS)

https://www.urologyhealth.org/ (UROLOGY CARE FOUNDATION)

https://www.cancer.org/ (AMERICAN CANCER SOCIETY)

https://www.cancer.net/ (CANCER NET (ASCO))