Life Health Sciences – Science Rules it All

Incidence

Squamous cell carcinoma of penis accounts for 10-20 % of male cancers in some parts of Asia, Africa and South America but it is relatively rare in US and Europe. It is found in 40-70 year age group mostly.

Relationship with circumcision

Cancer of penis is very rare in males who are circumcised. Thus it is very rare in Muslims and Jews. It is more common in populations who do not routinely perform circumcision. One theory states that circumcision is associated with better hygiene of genital region. Thus genital region gets less exposure to carcinogens that get absorbed in smegma and gradually build up there. The chances of infection in that area with human papillomavirus (HPV) are decreased.HPV infection has potential of causing cancer in humans.DNA of HPV can be detected in fifty percent of patients with penile cancer. HPV is found in 80% of patients with in situ cancer of penis, but only 10% develop carcinoma of penis. Thus HPV infection and other carcinogens like cigarette smoke can act together to cause penile cancer

Pathology

The cancerous lesion begins on glans penis or on inner surface of prepuce near glans penis. It grows to papillary shape or thickened plaque shape. As the lesion grows in size it ulcerates.  This cancer is a squamous cell carcinoma with various degrees of differentiation.

Symptoms and clinical course

Initially there is no pain, just slow growth of cancer occurs. But gradually lesions increases in size, and ulcerate the mucosa. There is bleeding from the wound and it gets infected. The Patient then feels pain. Enlargement of inguinal and pelvic lymph nodes occur as cancer spreads. Mainly cancer spreads locally, but regional spread to lymph glands also occurs with time.

Investigations

Biopsy of the penile lesions and draining lymph nodes is diagnostic. Other useful tests are complete blood count, x-ray of pelvic region and ultrasonography.

Treatment

Treatment options used for carcinoma of penis include surgery, radiotherapy and chemotherapy. The surgery is partial resection or total resection of penis depending upon the lesion. Radiotherapy and chemotherapy are used to treat local and systemic spread of disease and in case of recurrence.  The combination of treatment are more effective.

Prognosis

It depends upon the stage of the tumor. When lesions are limited and there is no involvement of inguinal lymph nodes, the 5-year survival is 66%. If metastasis has occurred and lymph nodes are involved the 5-year survival is reduced to 27%.

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