Penile Cancer Treatment in Delhi, India

Cancer of the penis, otherwise known as penile cancer, occurs when abnormal penile cells grow in an uncontrolled manner. It usually begins in the skin cells and works its way inside. It’s rare, but it can be treated.

Associated Anatomy of Penile Cancer

Penis

Causes of Penile Cancer

Causes for Penile cancer include:

• HPV: Infection with the Human Papilloma Virus contributes to the development of penile cancer.
• Age: Penile cancer is most common in those above 50 years.
• Phimosis: Phimosis (tight foreskin) may increase the risk of developing penile cancer.
• HIV/AIDS: Infection with human immunodeficiency virus (HIV) is a risk factor.
• Being Uncircumcised: Fluids can collect under the foreskin, which may lead to cancer growth.
• Smoking: Tobacco use may increase the risk of developing penile cancer.
• Psoriasis Treatment: The drug psoralen taken for psoriasis combined with ultraviolet light is known to increase the risk of penile cancer.

Penile Cancer Symptoms

Signs or symptoms of penile cancer are seen on the foreskin of uncircumcised men, on the penis tip (glans), or the shaft. These signs include:

• Lumps under the skin of the groin
• Changes in the skin color or thickness
• Smelly discharge under the foreskin
• Bleeding under the foreskin
• A reddish, velvety rash under the foreskin
• A bleeding sore or ulcer
• Small, crusty, flat, bluish-brown growths or bumps
• Swelling at the end of the penis

Stages of Penile Cancer

There are various stages in penile cancer:

• Stage 0: This carcinoma in situ (CIS) and verrucous carcinoma, both in the top layers of skin. CIS on the foreskin can often be treated with circumcision, but those in the glans may be treated with laser or cryotherapy. Verrucous carcinoma can often be treated with laser or cryotherapy.

• Stage I: These tumors have grown below the skin of the penis but not into deeper layers. Treatment may include circumcision glansectomy, removal of part of the penis, or radiation therapy.

• Stage II: This includes tumors that have grown deep into the tissues of the penis, but have not spread to nearby lymph nodes. A partial or total penectomy may be needed, with or without surgery, to remove the lymph nodes.

• Stage III: This is when cancer has reached nearby lymph nodes in the groin. Partial or total penectomy may sometimes be recommended as a course of treatment. In some cases, chemotherapy (chemo) or chemo plus radiation may be used first to shrink the tumor.

• Stage IV: In some stage IV cancers, the main tumor has grown into nearby tissues, like the prostate, bladder, or abdominal wall. Treatment includes surgery, which is often a total penectomy preceded by chemotherapy to shrink the tumor.

Penile Cancer Diagnosis

• Doctors begin by reviewing medical history and conducting a physical exam.
• If symptoms suggest penile cancer, other tests will be required. These might include biopsy and imaging tests. Sometimes a Computed tomography (CT) scan and Magnetic resonance imaging (MRI) are done to detect the size of the tumor.
• Ultrasound and chest X-rays may also be done to check the spread of cancer.

Possible Treatment of Penile Cancer

Treatment for Penile Cancer involves a multidisciplinary approach that includes:

Laser And Cryotherapy

Laser therapy is used for some patients with early-stage penile cancer and cryosurgery uses liquid nitrogen to freeze and kill cells.

Circumcision

This method is used if the cancer is only on the foreskin.

Excision

This involves the removal of the tumor and some surrounding healthy tissue

Penectomy

This is the surgical removal of part or all of the penis and is commonly performed when penile cancer has grown inside of the penis.

Lymph Node Dissection

This involves the removal of the lymph nodes in the groin and/or pelvis.

Radiation Therapy

Radiation Therapy involves the use of high-energy x-rays to destroy cancer cells.

Chemotherapy

Chemotherapy involves the use of drugs to destroy cancer cells, and can either be Topical (for small, noninvasive cancers); or Systemic (given directly into the bloodstream).

Medication

Commonly used systemic drugs for penile cancer include Cisplatin (available as a generic drug), Methotrexate (multiple brand names), and so on.

Risk Factors of Penile Cancer

Risk factors for penile cancer include:

• Age: Penile cancer is most common in people above the age of 50.
• Being Uncircumcised: Fluids can collect under the foreskin, which may lead to cancer growth.
• HPV: Infection with the Human Papilloma Virus contributes to the development of penile cancer.
• HIV/AIDS: Infection with human immunodeficiency virus (HIV) is a risk factor.
• Smoking: Tobacco use may increase the risk of developing penile cancer.
• Psoriasis Treatment: The drug psoralen taken for psoriasis combined with ultraviolet light may increase the risk of penile cancer.
• Phimosis: People with phimosis (tight foreskin) have an increased risk of developing penile cancer.

Possible Complication of Penile Cancer

Early complications of penile cancer include seroma, skin flap necrosis, wound infection, phlebitis, and pulmonary embolus. Late complications include lymphedema of the scrotum and lower extremities.

Penile Cancer Prevention

Primary Prevention for Penile Cancer

Primary preventative measures include circumcision, smoking cessation, genital hygiene, and human papillomavirus (HPV) prevention.

Secondary Prevention for Penile Cancer

Personal and genital hygiene is a must for prevention. Carefully cleaning under the foreskin regularly can lower the risk of developing penile cancer. Avoid smoking and sexual practices that could lead to an HPV or HIV/AIDS infection.

Epidemiology of Penile Cancer

Penile cancer is rare. Higher rates are seen in the developing world where neonatal circumcision is low and socioeconomic conditions predispose people to risk factors such as phimosis, smoking, and psoralen UV-A phototherapy.

Expected Prognosis of Penile Cancer

Survival rates depend on factors such as the stage of the disease when diagnosed and so on. The survival rate (5 years) for penile cancer is 65%.

Natural Progression of Penile Cancer

Survival rates depend on factors such as the stage of the disease when diagnosed and so on. Penile cancer’s five-year survival rate is 65%. The natural progression of the cancer is Stage 0 (where the carcinoma exhibits in the top layers of skin); Stage I (tumors have grown below the skin of the penis); Stage II (tumors have grown deep into the tissues of the penis); Stage III (when cancer has reached nearby lymph nodes in the groin); Stage IV (the main tumor has grown into nearby tissues, like the prostate, bladder, scrotum, or abdominal (belly) wall).

Pathophysiology of Penile Cancer

There are two carcinogenic pathways — HPV-mediated and HPV-independent — that may cause the development of penile cancer. HPV DNA has been found in up to 60–80 % of penile carcinoma.