What Is Penile Cancer?

Overview

Does your penis have rashes, sores, or any other abnormal growths? Is it bleeding and inflamed? If so, there’s a chance you may have penile cancer.

Penile cancer is a rare form of cancer affecting the penis. The penis is the male sex organ that’s part of the reproductive and urinary systems. It consists of the: 

• Shaft (rod-shaped part)
• Glans (head or tip)
• Foreskin (skin covering the glans in uncircumcised people)

Penile cancer mainly starts on the glans or the foreskin, but it can develop anywhere on the penis. And if not treated promptly, it can spread to the rest of the body as well.^1,2,3

This article explains everything you need to know about penile cancer - from its symptoms and treatments to prevention methods and diagnostic tests. So, read on to find out more. 

Causes of penile cancer

Penile cancer develops when normal cells of the penis become cancerous cells. These cancer cells form tumours and gradually spread to other body parts via the lymph and blood vessels. The exact cause of penile cancer is unknown, but there are risk factors that contribute to the formation of cancer cells.^1,2,3,4 

They are:

• Age:

Penile cancer risk increases with age. It’s more common in people AMAB aged 55 or older and uncommon in people AMAB under 40.^1,2,3

• Not being circumcised:

Circumcision removes a part or all of the foreskin. It reduces penile cancer risk, but its benefits depend on the age of circumcision:

• Adults circumcised at infancy are less likely to develop penile cancer.
• Circumcised teens are safe from penile cancer in adulthood to some extent.
• Circumcision in adulthood does not affect penile cancer risk.^1,2,3
• HPV (Human papillomavirus):

HPV infections are common STIs that cause cervical cancer. About 60% of penile cancer cases also have HPV infections. The strains that infect most penile cancer patients are HPV 16 and 18.^1,2,3

• HIV infection:

Itincreases penile cancer risk by weakening the immune system. HIV patients also have higher chances of contracting HPV infections and are more likely to be smokers.^1,2 

• Phimosis:

It’s a condition that tightens the foreskin making it difficult to retract. It’s more common in uncircumcised infants than adults. But if it lasts till adulthood, it causes infection and inflammation under the foreskin, which increases penile cancer risk.^1,2,3

• Smegma:

Smegma is a cheese-like substance comprising thickened secretions and dead skin cells. It collects under the foreskin and increases penile cancer risk as it causes irritation and inflammation.^1.2.3

• PUVA (Psoralen and ultraviolet A photochemotherapy) treatment:

PUVA is a radiation-based treatment for psoriasis. It increasespenile cancer risk due to radiation exposure.^1,2,3

• Tobacco use:

Tobacco increases the risk of penile cancer by affecting the body’s immunity and causing genetic damage to the cells of the penis.^1,2,3

• Lichen sclerosus:

It’s a disease causing the glans or the foreskin to become itchy and inflamed. It increases the risk of developing penile cancer and contracting HPV.¹

• Weakened immune system: 

A weak immune system is unable to defend the body against infections and cancer cells, thereby increasing the risk of penile cancer.^2,3

• Poor genital hygiene:

Not washing your penis regularly, especially underneath the foreskin, increases the chances of smegma build-up and infection, thereby increasing penile cancer risk.¹

Risk factors only increase the chances of developing penile cancer, not causing it. So, having only one risk factor does not meanyou’ll definitely get penile cancer.^2,3,4

Signs and symptoms of penile cancer

The first symptom of penile cancer is a change in the skin of the penis. It’s mostly seen on the glans and the foreskin but can occur on the shaft too. It includes:

• Discolouration of the penis and foreskin
• Reddish, velvet-like rash on the penis and under the foreskin
• Skin thickening
• Painless lumps and sores (genital warts, ulcers, or blisters) that do not heal within 4 weeks
• Flat blueish-brown growths
• Small, crusty bumps
• Swelling and irritation, mainly at the glans.^1,2,3

Other symptoms of penile cancer include:

• Constriction of the foreskin
• Foul-smelling discharge
• Bleeding from the penis, underneath the foreskin, or from penile ulcers/sores.^1,2,3

Other rare symptoms indicating advanced penile cancer include:

• Lump in the groin 
• Tiredness 
• Abdominal pain
• Pain in the bones
• Weight loss.^2,3

Management and treatment for penile cancer

The treatment options for penile cancer depend on the cancer type and stage. The healthcare team for penile cancer treatment includes your doctor, an oncologist, a urologist, and a dermatologist.^1,2,3,4

The standard treatment options for penile cancer include:

• Surgery:

It treats penile cancer of all stages. Unlike advanced cancers, treatment of early-stage cancers does not drastically affect the penis.^2,4 The surgical options for penile cancer are :

• Circumcision: It treats cancers present only in the foreskin. It’s done before radiation therapy since radiation causes tightening and swelling of the foreskin^1,2
• Excision: It’s a surgery that removes the tumour and surrounding normal tissue. It has two techniques - Simple and wide local excision^2,4
• Mohs microsurgery: Tumours are cut layer by layer until no cancer cells are left. It preserves normal tissue. It only treats penile cancersrestricted to the top layers of the penile skin or early-stage penile cancers^1,2,4 
• Laser surgery/Laser ablation: It’s a surgery that uses a laser beam to remove tumours or kill cancer cells via intense heat^1,4
• Cryosurgery/Cryotherapy: It’s a surgery that destroys tumours and abnormal tissues by freezing the area^1,4
• Glansectomy: It’s a surgery that treats small tumours on the glans by removing all or part of it²
• Glans resurfacing surgery: It’s a surgery that removes the top layers of glans tissue. It treats penile intraepithelial neoplasia (PeIN) and small, low-grade cancers³
• Penile amputation: It treats advanced penile cancers. It’s divided into –
• Partial penectomy: The removal of a part of the penis. It treats penile cancer that’s spread into the erectile tissue (Spongy tissue with blood vessels. It makes up most of the penis)
• Total penectomy: It’s the complete removal of the penis. It’s performed when penile cancer cells invade the base of the penis or grow deep within it^1,3,4
• Lymph node surgery (Lymphadenectomy): It’s a surgery that removes nearby lymph nodes in the groin if cancer has spread to them^1,4

fter surgery, penile cancer patients undergo radiation therapy or chemotherapy to eliminate any remaining cancer cells⁴

• Radiation therapy:

It uses high-energy beams like X-rays or other forms of radiation to kill cancer cells or inhibit their growth. It’s divided into –

• External radiation therapy: A machine irradiates the area with the cancer from outside the body
• Internal radiation therapy: Needles, wires, seeds, or catheters containing radioactive compounds irradiate the cancer when placed near or in it^1,3,4

• Chemotherapy: 

It uses drugs that kill cancer cells or prevent cell division. Drugs destroy cancer cells eitherhroughout the body when administered orally or parenterally (systemic chemotherapy), or, of a specific organ or region they’re administered to (regional chemotherapy)^2,4 

• Immunotherapy:

It uses and boosts the patient’s immune system and its mediators to destroy cancer cells.⁴

• Topical treatments
• Medicated creams: Topical chemotherapy and immunotherapy drugs applied to the penis¹
• Photodynamic therapy (PDT): It uses a combination of drugs and laser light to treat penile cancer²

Besides undergoing standard penile cancer treatment, patients can enroll themselves in clinical trials testing novel treatments. Patients can enter clinical trials at any stage of their treatment or if they have persistent or recurring cancers.⁴

FAQs

How is penile cancer diagnosed

There are no penile cancer-specific screening tests.^2,3  Penile cancer is diagnosed by performing :

• Physical examination and medical history assessment:  

Healthcare providers might check the patient’s penis and groin for abnormal skin changes, swelling, and growths.  They also assess the patient's risk factors, symptoms, previous illnesses, and hygiene habits to confirm a penile cancer diagnosis.

• Biopsy: 

A tissue sample is takenfrom the affected area of the penis so that a pathologist can check for cancer cells. Lymph nodes are biopsied to check if cancer cells have spread deep within the penis.

• Imaging tests: 

Doctorscan use X-rays, sound waves, magnetic waves, or radioactive drugs to map the body and determine if penile cancer cells have spread. These imaging testsinclude PET, PET-CT, and CT scans, MRIs, ultrasounds, and chest X-rays.^1,2,4

How can I prevent penile cancer

The best way to prevent penile cancer is to avoid its risk factors.² The preventive measures include:

• Circumcision: It reduces penile cancer risk in adults who underwent the procedure as infants. Uncircumcised people should practice genital hygiene to lower their penile cancer risk^1,2
• Phimosis treatment: Phimosis increases the risk of smegma build-up. Doctors prescribe an ointment or cream or make a small cut in the foreskin (dorsal slit) to help retract it¹
• HPV vaccination: HPV infections are common and asymptomatic at times. So, people should get the HPV vaccine when they’re 9 -26 years old or before they become sexually active^1,2
• Safe sex: Using condoms and dental dams correctly during sexual interactionsand not having multiple sexual partners reduces the risk of contracting HPV¹
• Genital hygiene: Regularly washing your penis with mild soap and warm water prevents infections. If you’re uncircumcised, pull your foreskin back and clean the glans to prevent smegma build-up^1,2 
• Stop tobacco use: Avoid or quit smoking as it increases the risk of many cancers, including penile and neck cancer^1,2

Who is at risk of penile cancer

According to the National Cancer Institute, the risk factors that predispose people to develop penile cancer are:

• Age 60 or older
• Phimosis
• Poor genital hygiene
• Multiple sexual partners
• Use of tobacco products
• HPV infections⁴

What are the types of penile cancer

Penile cancer types depend on the type of cells the cancer develops from. More than 95% of penile cancers are squamous cell carcinomas / squamous cell cancer (SCC). They’re the most common penile cancer type. They develop in squamous skin cells and are usually curable if found early.^1,2,3

The other rare penile cancer types that account for 10% of the cases are:

• Basal cell carcinoma (BCC): It develops in the basal cells in the deepest skin layer of the penis. It’s a slow-growing penile cancer type that rarely spreads to other organs
• Melanoma: It develops in melanocytes (cells that control skin pigmentation). It’s an aggressive penile cancer type
• Sarcoma: It develops in the smooth muscles, blood vessels, and other connective tissues of the penis. It’s a rare yet fast-growing penile cancer type
• Adenocarcinoma (Paget disease of the penis): It develops in the cells of sweat glands found in the skin of the penis. It’s a rare penile cancer type^1,2,3

How common is penile cancer

Penile cancer is rare in the UK. According to Cancer Research UK, only 700 people AMAB are diagnosed with it yearly.³

It’s also rare in the US as it only accounts for less than 1% of cancers in people AMAB, according to the American Cancer Society.²

It’s more common in Africa, Asia, and South America. It accounts for more than 10% of cancers in people AMAB in these countries.¹

When should I see a doctor

Always consult your doctor when you notice any abnormal skin changes on your penis. Even though these symptoms do not always indicate penile cancer, it could be an infection or allergy that could increase your penile cancer risk.

Detecting penile cancer early makes it easy to treat with little to no damage to your penis. So while it may be embarrassing to discuss these symptoms with your doctor, do not be afraid because it’ll benefit you immensely in the long run.^1,2,3,4

Summary

Penile cancers are rare urologic cancers where cancer cells mainly develop in the glans and foreskin of the penis. The most common symptoms of penile cancer are abnormal skin changes and growth. Although these symptoms may point to other diseases, do not put off consulting your doctor when you notice them. Early detection of penile cancer prevents it from spreading further and ensures faster and more effective treatment.