Definition
Penile cancer is a rather rare disease that originates from the transformation in a neoplastic sense of the cells of the male sexual organ. The most common form (95% of cases) originates from the epidermal lining of the glans and from the inner part of the foreskin ( spinocellular carcinoma ). Other tumors, such as penile melanoma, basalioma and sarcoma, are very rare.
Penile cancer is widespread especially in countries where hygienic-sanitary conditions are precarious, while it is decidedly less frequent in communities where, for religious reasons, circumcision is practiced at birth or before puberty (Jews and Muslim populations).
Risk factors that can predispose to the development of penile cancer include phimosis (stenotic foreskin), chronic inflammation (eg balanoposthites, lichen sclerosus and atrophic etc.), poor local hygiene, ultraviolet rays treatments, smoking and sexual promiscuity. Furthermore, it is proven that human papilloma virus (HPV) infections, especially type 16 and 18, can promote the onset of the disease.
Penile cancer can result from the evolution of low-risk pre-malignant lesions (cutaneous wart and xerotic obliterans) and high-risk (Queyrat's erythroplasia and Bowen's disease).
The incidence of penile cancer grows with increasing age; the most affected range is between 60 and 70 years.
Most common symptoms and signs *
- Pain in the penis
- Groin pain
- Erythema
- Swollen lymph nodes
- Mass or swelling in the groin
- Nodule
- papules
- plaques
- Urinary retention
- Blood in the ejaculate
- Blood in the urine
- Skin Ulcers
Further indications
The clinical presentation of penile cancer is variable, but generally there is an alteration in the appearance of the skin that covers the glans, foreskin, rod and / or coronal sulcus, which can change color, become thinner or thicker.
Most patients have a superficial erythematous lesion or a small whitish plaque. In other cases, penile cancer begins as a purulent or verrucoid formation, a hard lump or an ulcer with rounded edges, which does not heal for a long time. These penile lesions of papillary, nodular, ulcerative or flat morphology may be asymptomatic or may bleed and cause more or less intense pain. Even a bulge at the glans level, an inguinal mass or urinary retention can indicate the presence of a tumor.
The first sites of any metastases are lymph nodes; in the advanced stages of the disease, on the other hand, the spread of cancer cells occurs at a distance, preferentially affecting the liver, bones, lungs and brain.
The diagnosis of penile cancer is formulated through a careful objective examination of the external genitalia, biopsy of the suspected lesion, magnetic resonance of the penis and palpation of the inguinal lymph nodes. In symptomatic patients, inguinal ultrasound with possible needle-biopsy of lymph nodes, computed tomography (CT), positron emission tomography (PET) and bone scintigraphy may also be indicated.
If diagnosed in its earliest stages, penile cancer is generally treatable. The choice of the most suitable treatment depends on several factors, such as the size of the neoplastic mass, location and relationship with the surrounding tissues. If the tumor is superficial, we proceed with minimal resections, which can also be performed with laser therapy and cryotherapy. In the case of advanced neoplasms, the excision of the portion affected by the tumor or a more radical intervention (such as glandulectomy, partial and total penile amputation, etc.) is evaluated, in combination with radiotherapy and chemotherapy. Inguinal and / or pelvic lymphadenectomy is performed in case of positive lymph nodes.
