Although penile cancer is considered a rare type of cancer, its location in a sensitive area may lead to a delay in its diagnosis. This is due to the fact that most men feel embarrassed when consulting a doctor about reproductive problems or diseases related to masculinity, which may cause serious complications. Therefore, it is necessary to raise awareness about this disease, including its symptoms, causes, and methods of prevention, which we will review in this article by Dalili Medical.

**At what age does penile cancer commonly appear?**

 

Penile cancer is usually diagnosed in people over the age of 55, but it can also affect individuals under the age of 40.

**Does penile cancer affect fertility?**

 

Most types of genitourinary tract cancers negatively affect male fertility. Although testicular cancer is considered the most effective, other tumors such as prostate, bladder, and penis cancer are often detected early and treated. Treatment for penile cancer can lead to infertility, so it is important for the doctor to discuss with the patient the available treatment options, and whether it is possible to freeze sperm before starting treatment, especially if the patient wants to have children later using assisted reproductive techniques such as IVF.

**What are the symptoms of penile cancer?**

 

Symptoms include a lump or sore on the penis, changes in skin color, skin thickening, or discharge. The patient rarely feels pain in the early stages.

**. What are the causes of penile cancer?**

 

Penile cancer is caused by genetic mutations, and there are several factors that increase the risk of developing it, such as infection with the human papillomavirus, smoking, poor hygiene, and not having circumcision.

**. How is penile cancer treated?**

 

Treatment options include surgery to remove the tumor, radiation therapy, chemotherapy, or immunotherapy, depending on the stage of the cancer.

**. How is penile cancer diagnosed?**

 

Penile cancer is diagnosed through a physical examination, tissue biopsies, and imaging techniques such as MRI or CT scans to determine the extent of the disease.

**What are the early symptoms of penile cancer?**

 

Early symptoms include a small sore or non-healing growth on the penis, as well as changes in color or texture. Early diagnosis helps improve outcomes.

**Causes of penile cancer**

The exact cause of penile cancer is unknown in most cases, but there are some factors that may increase your risk, including:

**Human papillomavirus (HPV) infection**About 50% of penile cancer cases are linked to HPV, especially high-risk types (16 and 18). This infection is common in men, and the body usually recovers from it naturally. However, in some individuals, especially uncircumcised men, the infection can become chronic, increasing the risk of penile cancer.

**Not being circumcised** Circumcision (circumcision) in childhood greatly reduces the risk of penile cancer. Men who have not been circumcised are at higher risk of developing this type of cancer, even if they are circumcised after puberty.

**Phimosis** A condition that occurs when the foreskin becomes too tight to pull back is common in uncircumcised men. Research has shown that men with phimosis are at higher risk of penile cancer. Although the cause is not clear, it may be related to a buildup of secretions or infections.

**Poor hygiene** A buildup of secretions and dirt under the foreskin can lead to the formation of a thick, foul-smelling substance called smegma. This buildup can irritate and inflame the skin, increasing the risk of penile cancer.

**Smoking** Men who smoke or use tobacco products are at higher risk of penile cancer. This is due to the toxic chemicals in these products, which can damage the genes in the cells of the penis.

**Age** The risk of penile cancer increases with age, with statistics indicating that about 80% of cases of penile cancer are diagnosed in people over the age of 55.

**Ultraviolet (UV) treatment for psoriasis** Ultraviolet (PUVA) treatment for psoriasis is a factor that increases the risk of penile cancer, but protecting the genitals during treatment can significantly reduce this risk.

**HIV infection** Men with HIV have an increased risk of penile cancer due to their weakened immune system.

**Stages of penile cancer**

The stage of cancer refers to how far it has spread in the body. Based on the results of diagnostic tests, your doctor will determine the current stage of the cancer. This will help develop the most appropriate treatment plan for you and estimate your prognosis.

The criteria for grading penile cancer are as follows:

**Stage 0** The cancer is only in the superficial layer of skin and has not spread to any glands, lymph nodes, or other parts of the body.

**Stage 1** The cancer has spread to the connective tissue just under the skin and has not spread to any glands, lymph nodes, or other parts of the body.

**Stage 2** The cancer has spread to the connective tissue under the skin, as well as to the lymphatic vessels or blood vessels, where the cells look very different from normal cells. The cancer may also have spread to the erectile tissue or urethra. However, the cancer has not spread to any other parts of the body.

**Stage 3** The cancer has spread to the connective tissue under the skin, as well as to the lymphatic vessels or blood vessels, where the cells lookCompletely damaged from normal cells. Cancer may have spread to the erectile tissue or urethra. At this stage, the cancer has spread to one or two lymph nodes in the groin area. However, the cancer has not spread to any other parts of the body.

**Stage 4B** The cancer has spread to the connective tissues under the skin, as well as to the lymphatic vessels or blood vessels, where the affected cells look very different from normal cells. The cancer may have spread to the erectile tissue or urethra.

The infection extends to several lymph nodes in the groin area.

The cancer has not spread to any other parts of the body.

**Stage 5** The cancer has spread to nearby areas, such as the pubic bone, prostrate, or scrotum, or it may have spread to other areas and organs in the body.

**Types of Penile Cancer**

The penis is made up of a group of tissues that contain different types of cells, so doctors classify penile cancer into several categories based on the type of cells affected. This classification helps determine the severity of the cancer and the most appropriate type of treatment.

The main types of penile cancer include:

**Squamous Cell Carcinoma:**This is the most common type of penile cancer, accounting for about 95% of cases. Tumors of this type usually grow slowly, and if detected in the early stages, the chances of recovery are high. Squamous cell carcinoma of the penis are divided into two types:

Carcinoma in situ is the very early stage of squamous cell carcinoma, where the cancer cells remain confined to the surface layer of the body's skin.

Verrucous carcinoma is similar to genital warts and can grow deep within the tissue, but rarely spreads to other areas.

Basal cell carcinoma is a type of skin cancer that can develop in the deep layers of squamous skin cells in the penis, and is characterized by its slow growth and rarely spreads to other parts of the body.

Melanoma of the Penis: Another type of skin cancer that begins in the cells responsible for producing melanin pigment in the skin of the penis, and is considered more dangerous than the previous types because it grows and spreads quickly.

**Adenocarcinoma:** A very rare type of cancer that forms in the sweat glands located in the skin of the penis.

**Penile Sarcoma:** A very rare type of cancer that arises in the deeper tissues of the penis, such as muscles, blood vessels, or other areas.

What are the signs of penile cancer?

 

Most types of penile cancer affect the skin covering the head of the penis (foreskin) or the head of the penis itself (glans). Signs of male reproductive system cancer include:

**A lump or growth on the penis ** A lump or growth on the penis is a common early sign, and this growth may or may not be painful. It is important to see a health care professional to evaluate any new growth immediately.

**Changes in skin color or texture**Penile cancer can cause changes in the color or texture of the skin of the penis, such as thickening, changes in pigmentation, or sores.

**Persistent redness or rash**Persistent redness, rash, or inflammation that doesn't respond to conventional treatments can be an early sign of penile cancer.

**Unusual discharge or bleeding**Unexplained discharge or bleeding from the penis, especially if it has a foul odor, requires immediate medical attention

A sore that doesn't heal within 4 weeks.

A rash.

Bleeding from the penis or under the foreskin.

Foul-smelling discharge.

A change in the color of the skin of the penis or foreskin, or the skin may become thicker.

A lump on the penis.

Flat, bluish-brown growths.

Swelling at the tip of the penis.

Most of these symptoms can be caused by a bacterial or fungal infection, or even an allergic reaction, and often respond to topical treatments such as antibacterial or antifungal ointments and creams. However, if these symptoms do not respond to treatment or recur, this does not necessarily mean that cancer is present. Medical diagnosis and tests are the most accurate way to confirm penile cancer.

Other symptoms of penile cancer that may affect different areas of the body include:

- Swelling or lumps in the groin area.

- Feeling tired and exhausted.

- Pain in the stomach area.

- Unexplained weight loss.

The earlier penile cancer is diagnosed, the greater the chances of recovery and successful treatment. Therefore, it is essential to consult a doctor if any worrying or unusual symptoms appear.

**Diagnosis of penile cancer**

Accurate diagnosis is vital to developing an effective treatment plan. The diagnostic process usually involves several stages:

**Physical examination**A comprehensive physical examination performed by a healthcare provider is the first step in diagnosing penile cancer. The doctor will examine the penis for any abnormalities or signs.

**Biopsy** If a suspicious lesion is found, a biopsy will be performed. This involves taking a small sample of tissue from the area to examine under a microscope for cancer cells.

**Imaging Tests** Imaging tests such as ultrasound, MRI, and CT scans can be used to determine the extent of the cancer and whether it has spread to other parts of the body.

**Lymph Node Examination** Because penile cancer may have spread to the lymph nodes, a sentinel lymph node biopsy or fine-needle aspiration may be performed to check for cancer cells in these nodes.

**Preparing for Penile Cancer Procedures**

Preparing for penile cancer procedures requires a thorough medical history, informed consent, and commitmentM. Pre-procedure instructions.

**A. Medical history and physical examination** Understanding the patient’s medical history and performing a physical examination helps the healthcare team assess the patient’s overall health, identify potential complications, and design the procedure accordingly.

**B. Informed consent** Informed consent ensures that the patient understands the nature of the procedure, its potential risks, and its benefits. This consent is a basic legal and ethical requirement before any medical intervention.

**C. Pre-procedure instructions** Clear instructions help the patient prepare mentally and physically before the procedure. These instructions may include guidelines on diet, personal hygiene, and certain restrictions.

**D. Fasting requirements** Fasting before some procedures, such as surgery or biopsy, is common to reduce the risk of complications such as aspiration. It is important to provide clear instructions about the duration of fasting required.

**E. Medication adjustments** Certain medications may need to be adjusted or temporarily stopped before the procedure. This includes blood thinners and nutritional supplements that may affect the procedure.

**Penile Cancer Treatment**

Treatment methods for penile cancer vary depending on the stage of the disease. In the early stages, non-surgical treatments such as chemical creams or laser therapy may be used. In advanced stages, surgery, radiation therapy, or chemotherapy may be required.

**Surgery**Surgery is the most common treatment option for all stages of penile cancer, and the available options include:

**Mohs surgery:**This technique is used to remove skin cancer from the penis in stages, where the doctor gradually removes thin layers of the affected tissue, layer by layer, until he reaches the healthy tissue. In this way, as much healthy tissue as possible is preserved.

**Laser surgery:**Laser beams are used to remove superficial tumors or to make small incisions without bleeding.

*Cryosurgery:**A special instrument is used to freeze and destroy abnormal masses or tissue.

**Circumcision:**When the cancer is confined to the foreskin, it is removed completely or partially.

**Removal of the tumor only:**The tumor is removed along with a small portion of the surrounding healthy tissue.

**Penile amputation:**In advanced cases, it may be necessary to remove part of the penis or even the entire penis. In such cases, cosmetic surgery can be performed to replace the removed tissue with others taken from the skin and muscle.

**Removal of lymph nodes:**If the cancer has spread to the lymph nodes, some of them may need to be removed.

After surgery, the doctor may recommend chemotherapy or radiation to ensure that any remaining cancer cells are eliminated, which helps reduce the risk of the cancer returning in the future.

**Treatment using creams:**This type of treatment can be used in the very early stages of penile cancer, where topical creams are applied directly to the area of ​​the cancer. Among the creams used are:

- **Fluorouracil (5FU) cream:** A topical chemotherapy cream that aims to kill cancer cells directly in the skin.

- **Imiquimod cream:** An immunomodulatory cream that stimulates the body's immune system to attack and eliminate cancer cells.

**Radiotherapy**Radiotherapy uses high-energy rays to target and kill cancer cells. In the case of penile cancer, radiotherapy can be used in several contexts:

- As an adjuvant treatment alongside chemotherapy.

- As an alternative to surgery.

- To get rid of any remaining cancer cells after surgery.

- To treat lymph nodes in the pelvic area if there is a high risk of the cancer returning.

- To relieve symptoms if the cancer has spread to other parts of the body (palliative treatment).

You can use external radiation therapy, where rays are directed from outside the body to the site of the cancer, or internal radiation therapy, which involves implanting radioactive materials directly into the site of the cancer. Your doctor may also prescribe medications known as radiosensitizers, which work to increase the sensitivity of cancer cells to radiation therapy, which enhances the effectiveness of the treatment.

**Chemotherapy**Chemotherapy drugs work by killing cancer cells or stopping them from dividing. They can be used as a local treatment in the very early stages, or as pills or injections given to the whole body.

Chemotherapy is usually used in cases of penile cancer as follows:

- As an adjuvant treatment alongside radiation therapy.

- To reduce the size of the tumor before surgery.

- To eliminate any remaining cancer cells after surgery.

- As a palliative treatment if the cancer has spread to other parts of the body

Prevention and risk reduction strategies:

**Human papillomavirus (HPV) vaccination:**The HPV vaccination helps reduce the risk of penile cancers associated with this virus.

**Safe sex practices:**Practicing safe sex, including using condoms, is an effective way to reduce the transmission of sexually transmitted infections that can lead to penile cancer.

**Regular checkups:**Regular medical checkups help detect potential health problems early, allowing timely intervention.

**Early detection and intervention:**Regular self-examinations and prompt reporting of any abnormal changes to health care providers can contribute to early detection and effective intervention.