Penile tumor by A.Griguolo

Generality

Penile cancer is the malignant tumor resulting from the uncontrolled proliferation of one of the skin cells or particular penile tissues.

Currently, the exact cause of penile cancer is unknown; however, doctors have found a strong correlation between the cancer in question and factors such as: cigarette smoking, human papilloma virus infections, AIDS and poor personal hygiene.

To signal the onset of penile cancer is the formation, usually on the glans or foreskin, of a lump or ulcer, associated with symptoms such as: pain, redness, itching, burning, changes in skin color, etc.

The success of therapies against penile cancer depends on the timeliness of the diagnosis: the earlier the diagnosis, the better the chance of recovery.

Failure to treat or delayed treatment is generally fatal due to the spread of the tumor to other organs.

Short anatomical review of the penis

The penis is the male reproductive organ.

Cylindrical in shape and covered with leather, it can be anatomically divided into 3 main parts, which are: the root, the rod (or body ) and the glans .

• Root: located between the pubis and the perineum, it represents the point of origin of the penis.

• Auction: it is the central part of the penis as well as the most considerable; to its formation the two cavernous bodies and the spongy body participate, three structures constituted by erectile tissue and wrapped by connective tissue.

  Inside the cavernous bodies the cavernous arteries flow; inside the spongy body, however, the urethra passes.

• Glans: it is the most distal portion of the penis; including urinary meatus for the expulsion of urine and sperm, it is provided with a flap of sliding skin called foreskin.

What is Penile Cancer?

Penile cancer, or penile cancer, is the malignant tumor that originates from the uncontrolled proliferation of one of the cells constituting the skin or the particular tissues of the penis.

To understand: medical significance of a malignant tumor

Also known as cancer or malignant neoplasm, a malignant tumor is a mass of cells with uncontrolled growth and with a tendency to spread both in the surrounding and distant tissues.

Epidemiology

In the industrialized world (ex: United States and Europe), penile cancer is a rare condition; according to reports from the American Cancer Society, in fact, every year it affects one man every 100, 000.

In 2018, in the United States, diagnoses of penile cancer were 2, 320 and deaths from cancer tumors 380.

Causes

Similarly to other malignant neoplasms, penile cancer is also the consequence of a slow accumulation of genetic mutations, on the part of the DNA of one of the cells that make up the affected organ (the penis, in the case in question). In fact, these mutations are responsible for the phenomenon of uncontrolled proliferation that characterizes the formation and growth of malignant tumors.

Despite numerous research on this subject, doctors have not yet identified the precise causes of the aforementioned genetic mutations; however, they are quite sure that factors such as:

• Cigarette smoke ;
• Infections supported by the human papilloma virus (or HPV );

• AIDS, or the infection produced by the human immunodeficiency virus (or HIV );
• Poor personal hygiene .

Who is more at risk of penile cancer?

Based on the findings of various statistical studies, the experts concluded that they are more at risk of penile cancer:

• Uncircumcised men (ie with the foreskin), who suffer from recurrent phimosis and / or smegma .

  Phimosis is the anomaly of the penis, due to which the foreskin presents a narrowing that prevents it from sliding backwards and uncovering the glans; phimosis is an impediment to erection and, in the most severe cases, even to expulsion of sperm.

  Smegma, on the other hand, is a product of secretion of the penis, which typically forms under the foreskin and in which dead epithelial cells, sebum and humid substances of urinary origin take part; being rich in proteins, smegma is an ideal medium of replication and growth for many microorganisms, both bacterial and fungal.

• Men with psoriasis who received ultraviolet light treatment ;
• Men living in areas of the world where sanitary conditions are poor ;
• Men who do not take sufficient care of their personal hygiene;
• Men over the age of 60 ;
• Smoking men;
• Men with AIDS or who have contracted human papilloma virus. Regarding human papilloma virus infections, statistical studies have shown that these unpleasant circumstances are more common in uncircumcised men; this means that circumcision preserves from the infecting action of the human papilloma virus;
• Men with a past history of recurrent Balanites . Balanitis is the inflammation of the glans.

Types of Penile Cancer

Penile cancer can originate from various cells that make up the skin of the penis or the particular tissues of this organ; the cell of origin is important, because it is on it that doctors base the typological classification of penile cancer .

Going more specifically to the aforementioned typological classification, a penile tumor can originate from:

• A scaly cell and an example of squamous cell carcinoma ;
• A Merkel cell and an example of Merkel cell carcinoma ;
• A melanocyte and have the typical characteristics of a melanoma ;
• A basal cell and an example of basal cell carcinoma ;
• A so-called " small cell " and an example of small cell carcinoma ;

In 95% of cases, penile cancer is a squamous cell carcinoma; in the remaining 5%, it is one of the other three tumor types described above (ie either a Merkel cell carcinoma or a melanoma or a small cell carcinoma).

Symptoms and Complications

The first and most significant symptom of penile cancer is an abnormal protuberance similar to a nodule or, alternatively, a wound similar to an ulcer, obviously located on the penis.

The size of this nodule or ulcer varies from patient to patient: in some cases, it is contained; in other circumstances, however, it is relevant.

The parts of the penis usually involved in the most characteristic symptom of penile cancer are the foreskin or glans ; the involvement of the body, therefore, is less common than its relevance in terms of dimensions may suggest.

The other symptoms of penile cancer

At the nodule / ulcer and sometimes in the immediate vicinity, the patient with penile cancer complains of a series of typical symptoms, which includes:

• Itch;
• Burning;
• Emission of a foul-smelling liquid;
• Redness;
• Ache;

• Loss of blood;
• Skin color changes;
• Skin thickening;
• Irritation.

It is also important to point out that penile cancer can cause phimosis and enlargement of the inguinal lymph nodes following its onset.

Complications

Penile cancer is, like many malignant tumors, a neoplasm capable of infiltrating neighboring tissues and lymph nodes, and spreading some of its cells - the so-called metastases or tumor metastases - into the bloodstream, thus "contaminating" even organs far from the penis .

Readers are reminded that the spread of metastases from a malignant tumor is a process of significant clinical severity, which is often fatal for those who are its victims.

When should I go to the doctor?

Especially when it falls into a risk category (eg: smoker with a history of HPV infection or an elderly person suffering from AIDS), a man should always contact his doctor immediately or go to the nearest hospital, if he develops a lump or a penile ulcer, lump or ulcer associated with symptoms such as: pain, redness, itching, burning, etc.

Early diagnosis of penile cancer is very important, because it allows the condition to be treated early, before it gives rise to serious complications (metastasis).

Diagnosis

To formulate the diagnosis of penile cancer, information from the patient's symptoms, physical examination, medical history and biopsy on a sample of cells belonging to the presumed tumor ( tumor biopsy ) is essential.

After the diagnosis of penile cancer, the doctor may wish to investigate the situation with radiological examinations, such as CT or MRI of the pelvic area.

Tumor Biopsy

A tumor biopsy consists in the collection and subsequent analysis in the laboratory of a sample of cells belonging to a tumor.

In the case of penile cancer, tumor biopsy is the investigation necessary for the diagnostic confirmation of what has only been hypothesized up to that point as well as the examination that allows to establish an important characteristic of malignant tumors: the so-called staging (or stage ).

What is staging of a malignant tumor?

The staging of a malignant tumor includes all that information, collected during biopsy, which concerns the size of the tumor mass, its infiltrating power and its metastasizing capacities.

WHAT IS THE COLLECTION SITE?

To confirm the presence of a penile tumor by biopsy, the diagnostic doctor must have the laboratory tests conducted on a sample of cells taken from the nodule or ulcer on the penis.

Radiological examinations

After the diagnosis of penile cancer, radiological examinations of the pelvic area help the doctor to verify whether the neoplasm has invaded the neighboring organs and tissues .

These investigations are particularly important in the presence of a penis tumor in the middle-advanced phase.

Therapy

There are various therapeutic approaches for treating penile cancer and implementing one rather than another or combining some of them to the detriment of others depends on precise factors, which are:

• The site of the tumor . The tumor site corresponds to where the nodule or ulcer originates from which was widely discussed in the chapter on symptoms;
• The stage of tumor progression . Generally speaking, a penile tumor in the early stages allows the therapist to resort to less bloody treatments, while a penile tumor at an advanced stage obliges him to use highly invasive treatments;
• The patient's general health status . A patient in good health is able to endure a very invasive treatment very well; on the contrary, a patient in precarious health condition is not strong enough to withstand the more "gory" therapies.

  From this it follows that, the general state of health becomes a limit, when it does not allow the implementation of a vital treatment due to the excessive invasiveness of the latter.

Currently, among the possible therapeutic approaches available to those suffering from penile cancer, include:

• Laser therapy;
• Surgery;
• Chemotherapy;
• Radiotherapy.

Laser Therapy

Also known as laser ablation, laser therapy is indicated when penile cancer is a stage 0 squamous cell carcinoma (ie a carcinoma in situ ).

Surgery

The surgical approach includes various treatments, such as circumcision, cryosurgery, excision and penectomy .

CIRCUMCISION

Circumcision is the surgical removal of the foreskin.

In a context of penile cancer, its implementation is indicated when the neoplasm is limited to the foreskin and is not at an advanced stage.

cryosurgery

Cryosurgery is a special surgical treatment, which involves applying liquid nitrogen directly to the tumor mass in order to freeze it and cause the death of its constituent cells.

In a context of penile cancer, its implementation is indicated when the neoplasm is in its earliest stages and is based on the glans.

SURGICAL EXIT

The surgical excision of a penile tumor consists in the removal of the tumor mass and of the neighboring normal tissues, performed by means of the classic surgical scalpel and after the application of a local anesthetic.

Surgical excision is adoptable when the tumor is in its early stages or has recently passed the first stages.

Among the implications of surgical excision include the application of some sutures and, in the case where the removal has concerned a large area of ​​normal tissue, the grafting of a skin transplant.

penectomy

Penectomy is the partial or total removal of the penis.

In a context of penile cancer, its implementation is reserved for the most advanced cases, in which cancer cells have contaminated the organ more or less widely and are about to spread elsewhere.

Chemotherapy

Chemotherapy consists of the administration of drugs capable of killing rapidly growing cells, including cancer ones.

In a context of penile cancer, chemotherapy can be topical in nature and represent the decisive treatment, if the neoplasm is at the very early stages, or of a systemic nature, and constitutes a supportive therapy for surgery, if the neoplasm has a certain extension.

Radiotherapy

Radiation therapy involves exposing the tumor mass to a certain dose of high-energy ionizing radiation (X-rays), which are intended to destroy neoplastic cells.

In a context of penile cancer, radiotherapy can represent:

• The resolving treatment, if the neoplasm is at the very first stages;
• A post-surgical treatment, when it is necessary to consolidate the benefits of surgery;
• A palliative treatment to alleviate symptoms, when the neoplasm is at a very advanced stage and it is impossible, thanks to the patient's precarious health conditions, to perform surgery.

Prognosis

The prognosis in case of penile cancer depends mainly on:

• Timeliness of diagnosis . An early diagnosis increases the chances of success of the therapy, therefore also the chances of recovery;

• The patient 's age and / or general state of health . If the patient is healthy and / or young, he is more likely to endure therapy, which in some cases may be invasive.

Penile Tumor Survival Rate

According to statistics, for penile tumors at the beginning (without contamination of the neighboring lymph nodes), the 5-year survival rate from the diagnosis is 85%; instead, for penile tumors that have contaminated the neighboring lymph nodes, it is equal to 59%.

Prevention

Not smoking, vaccinating against human papilloma virus, practicing safe sex, taking care of one's own hygiene and providing for circumcision in case of phimosis are the main rules, recommended by doctors, for the purpose of preventing penile cancer.