Cancer of the Penis: Is it Possible?

The Multi-Purpose Penis
The penis is the external male organ used to pass both urine and semen. At birth, a piece of skin covers the head of the penis (glans). Often, the foreskin is removed in an operation known as a circumcision a few days after birth.

Traditionally, this procedure was first performed in biblical times, on the baby’s eighth day. It served as a sign of the covenant between God and the Israelites. Today, it is still done for that reason, but also because many (not all) medical professionals consider it to be healthier and easier to keep clean.

The penis is made up of three chambers of expandable erectile tissue (including muscle, nerves, blood vessels and skin). These cylinder-shaped chambers contain a soft, spongy network of blood vessels. They are known as the corpora cavernosa (plural form of corpus cavernosum) and the corpus spongiosum. An erection occurs when a man’s nerves signal excitement; his body gets a message to store blood in the chambers and the tissue expands and stiffens. The blood flows back to the body after ejaculation, and the penis returns to its former soft and flexible state.

The corpus cavernosa is made up of the two chambers that lie next to each other on the dorsal (upper) side of the penis. The corpus spongiosum lies beneath them on the ventral (under) side and surrounds the urethra and widens at the end to create the head.

The urethra is the last part of the urinary tract. It is a tube that passes urine from the bladder to the meatus (the opening at the tip of the penis). It is also used to ejaculate semen (fluid containing sperm cells). The sperm is produced in the testes and propelled up two ducts known as the vas deferens, which join the urethra inside the prostate gland. The semen is then expelled through the penis.

Cancer of the Penis
Cancer (carcinoma) occurs when normal cells in the human body take on irregular patterns of reproduction. A random cell begins to multiply at a much faster rate than normal. When that cell divides itself and reproduces two more, they carry the abnormal traits. And so it goes on through each generation descended from that one cell. When the excess of dysfunctional cells gather together, they create a mass known as a tumor. A tumor is either malignant (cancerous) or benign (non-cancerous).

The tissues of the penis contain several different cell types. Each cell can develop a different type of penile cancer. The possibilities are adenocarcinoma, verrucous carcinoma, epidermoid carcinoma, basal cell penile cancer, melanoma, and sarcomas.

Adenocarcinoma develops in the sweat glands in the skin of the penis. This type of penile cancer is extremely rare. When adenocarcinoma cells are found in the penile skin, the condition is known as Paget disease (not the same as Paget bone disease).

Verrucous carcinoma is an uncommon squamous cell cancer. It is not exclusive to the penis, but also shows up (appearing very similar to a wart) on the mouth, larynx, anus, skin, and other genital areas of both men and women. When the tumor is on the genital area, it is sometimes referred to as a Buschke-Lowenstein tumor. These tumors rarely spread to other parts of the body (metastasize), but can spread very deeply into surrounding tissue.

Epidermoid carcinoma develops in flat skin cells known as squamous cells. These penile cancers most often develop on the head or on the foreskin (of men who have not circumcised), but can appear anywhere on the penis. Approximately 95% of all penile cancers develop in squamous cells. If discovered at an early stage, these slow-growing tumors can usually be cured.

Basal cell penile cancers are slow-growing tumors that rarely metastasize. These are very rare and account for less than 2% of penile carcinomas.

Melanomas are cancers that begin in the pigment-producing (skin-tone creating) cells known as melanocytes. Melanomas grow very quickly and spread very fast, making them one of the most dangerous forms of cancer. Melanomas tend to develop in areas that receive a lot of exposure to the sun, but still account for approximately 2% of penile cancers.

Sarcomas develop in smooth muscle, blood vessels, and other connective tissue cells in the penis. These account for just 1% of all penile carcinomas.

Stages and Treatment
Penile cancer, like most others, is treated according to its stage at the time of diagnosis. The stage of the cancer refers to the patient’s overall health and how far the cancer has spread; the lower the stage, the earlier it has been caught. There are five stages of penile cancer, and treatment plans consist of one or more of the following: surgery (removing the infected tissue in an operation), radiation (using high-energy rays to destroy cells and shrink tumors), chemotherapy (anti-cancer drugs), and biological therapy (use of the patient’s own immune system).

At all stages of penile cancer, surgery is the most common treatment.

• Microsurgery involves the use of microscope while removing the cancer, which helps the doctor to remove as little normal tissue as possible.
• Circumcision is a removal of the foreskin. Excision takes out the cancer and some surrounding healthy tissue.
• Cryosurgery uses liquid nitrogen to freeze and destroy the cancerous cells. This is used for precancerous conditions and cancers diagnosed in a very early stage.
• A penectomy is the removal of the entire penis. A new opening is created for the urethra between the scrotum (testicle sacs) and the anus, and the ability to control urination remains.
• A partial penectomy is the removal of a portion. Laser surgery removes cells with a narrow beam of light and is being used in many clinical trials.

Stage I
Cancerous cells are found only on the surface level of the penis head or the foreskin. If the cancer is only in the foreskin, treatment will most likely be circumcision and/or excision. If it is only in the glans, fluorouracil cream (chemotherapy applied to the skin), microsurgery, may be used. If it is in the glans and other tissues, the treatment may involve partial penectomy, external radiation, and/or microsurgery. Lymph nodes in the groin will be removed if need be.

Stage II
Cancer cells are found in the deeper layers of the glans and have spread to the shaft (the three cylinders). Treatment may be radiation therapy followed by a penectomy, or surgery alone.

Stage III
Cancer cells that originated in the penis have spread into nearby lymph nodes (pockets of infection-fighting cells in the body). Treatment for this stage may involve a penectomy, lymph node removals, radiation therapy, and/or chemotherapy (in addition to the cream, chemotherapy medications can be administered through the mouth, vein, or spine).

Stage IV
Cancer cells that originated in the penis have spread to the lymph nodes in the groin and/or have metastasized (spread) to other body parts. This is a very advanced stage and treatment at this point will be designed to reduce symptoms. Any of the methods may be used in combination to attain this goal.

Recurrent
This is a term used for cancers that were treated once but have returned. It may return to another area or the same place.

Risk Factors
There are certain risk factors associated with this disease, but there are also men who have no known risk factors and yet they develop penile cancer. Personal hygiene is considered a factor. Men who have not been circumcised must take extra care to see that the area beneath the covering is kept clean. Sometimes secretions build up underneath and the foreskin becomes difficult to retract. This condition is called phimosis.

When oily skin secretions, bacteria, and dead skin cells accumulate under the foreskin, the result is a thick, smelly substance known as smegma. Medical science does not agree on whether smegma contains cancer-causing substances, but many professionals feel that a man who neglects cleanliness in this area is more likely to develop penile cancer.

Another risk factor is infection with human papillomavirus (HPV). Scientists have identified more than 100 types of viruses that fall under the HPV umbrella. Different HPVs cause different types of warts (papillomas) to appear in various parts of the body, including the genitals. Approximately 30 types are spread through sexual contact, and it is estimated that about 80% of sexually active adults have been infected with some sort of HPV at some time in their sexual history.

Cigarette smokers are at higher risk for every type of cancer, including penile. A smoker’s body is exposed to many cancer-causing chemicals. The toxic substances are absorbed into the blood via the lungs, and carried through the bloodstream into the whole body.

AIDS (acquired immunodeficiency syndrome) may also contribute to a higher risk factor because of the compromised immune system.

Over 50% of penile cancers are diagnosed in men over the age of 68, making age a risk factor.

Some doctors also believe that a circumcised man is at less risk than a man with his foreskin in tact. This is not considered a proven fact.

Find it Early
Sometimes symptoms do not appear until the cancer has reached an advanced stage. The important thing is to make note of any changes on the penis and report them immediately to a doctor. These changes include, but are not limited to, bleeding, warts, sores, blisters, ulcers, white patches, changes in color, skin thickening, rash, bumps, abnormal discharge (possibly with a foul odor), and swelling of the head. They may or may not be accompanied by pain and discomfort. It is also possible that they are not cancer, but signs of another medical condition. It is important to let a doctor make the call; self-diagnosis is rarely a good thing.

If they are tumors, they might be benign (non-cancerous). It is important to follow your doctor’s suggestions on benign tumors as they can be precancerous. Left untreated, it is possible for them to involve into invasive cancer. They can develop anywhere on the penis but frequently appear on the foreskin or the glans.

The only way to be absolutely certain of the diagnosis is to do a biopsy. A sample of the suspicious tissue is cut out and observed under a microscope. There are two different types of biopsies, which one the doctor performs depends on the size and appearance of the area in question. The entire lesion is removed in an excision biopsy (usually for smaller tumors), and a portion of the suspicious area is removed in an incision (usually for larger spreads). Both biopsies can be done in the doctor’s office, a medical clinic, or as a same-day surgery in the hospital.

If you are an American man, you will be happy to know that this form of cancer is extremely rare in the United States. Only 0.2% of the cancers diagnosed in American men are penile, and because most of those are found in the early stages of the disease, penile cancer accounts for only 0.1% of cancer-related deaths among men in this country. These are some of the best cancer statistics that I’ve ever run across. It’s almost enough to give this female leukemia survivor a case of penis envy. Almost.