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Understanding Penile Cancer

Overview of Hong Kong

Penile Cancer Incidence and Survival Rate: Cancer Data

As a vital male reproductive organ, the penis, like other parts of the body, is not immune to the risk of cancer. However, the incidence is relatively low, especially in Western countries. According to data from the American Cancer Society, in Europe and North America, fewer than 1 in every 100,000 men are diagnosed with penile cancer each year; in the United States, penile cancer accounts for less than 1% of all male cancer cases.

However, there is a trend in the incidence of penile cancer among men. Statistics from the association indicate that the average age of men diagnosed with penile cancer in the United States is 68 years old; alternatively, about 80% of diagnosed cases are in men aged 55 or older. Both sets of data reflect that the risk of developing penile cancer increases with age.

Regarding survival rates, penile cancer is not particularly difficult to treat, but the effectiveness depends on the timing of diagnosis. According to data from the American Society of Clinical Oncology, the overall 5-year survival rate for penile cancer is 67%, but the situation varies greatly depending on the stage. If cancer cells have not yet begun to spread at the time of diagnosis, the 5-year survival rate can be as high as 82%; if cancer cells have spread to surrounding tissues, organs, or lymph nodes, the 5-year survival rate drops to about 50%; if cancer cells have spread to distant organs, the 5-year survival rate is only about 12%.

Cells exist on both the surface and inside of the penis, and abnormal growth of these cells can lead to tumors, which may be benign; if malignant, it is what is commonly referred to as “penile cancer.” In other words, cancer can occur both inside and outside the penis, but in fact, the vast majority of cases are caused by mutations in cells on the surface of the penis. Common types of penile cancer include:

  • Squamous Cell Carcinoma:
    This accounts for nearly 95% of penile cancer cases and can occur in any part of the penis, but mainly grows on the foreskin (in uncircumcised men) or the glans. These cancer cells grow relatively slowly, and if detected early, they are generally curable.
  • Verrucous Carcinoma:
    A rarer form of squamous cell carcinoma, it can grow in different parts of the skin. Although it grows slowly, it can become quite large and invade nearby tissues, but it generally does not spread to other body parts.
  • Carcinoma in Situ:
    The earliest stage of penile squamous cell carcinoma is where cancer cells are located in the outermost layer of the skin and have not yet grown into deeper tissues.
  • Basal Cell Carcinoma:
    This accounts for a small number of penile cancer cases. Cancer cells grow slowly and rarely spread to other parts of the body.
  • Melanoma :
    A part of the skin appears brownish-black, growing and spreading relatively quickly, making it more dangerous than the aforementioned two types of cancer. However, melanoma usually occurs on skin that is exposed to sunlight for long periods, so it is possible but indeed less likely to grow on the skin of the penis.
  • Adenocarcinoma:
    A rare type of penile cancer that grows from the sweat glands of the penile skin. Since it is similar to carcinoma in situ of squamous cell carcinoma, it is generally difficult to distinguish between them.
  • Sarcoma:
    A minority of penile cancer cases belong to the sarcoma category, growing in the blood vessels, smooth muscles, or other connective tissues of the penis.

Symptoms of Penile Cancer

Common Penile Cancer Symptoms: Warning Signs of Glans Ulcers and Discharge

So far, the exact cause of penile cancer remains unknown, but scientists have identified several factors closely related to penile cancer. If you meet the following conditions, you may have penile cancer:

  • Human Papillomavirus (HPV)
    HPV can be transmitted through sexual contact, but this is not the only way to contract the virus. Most men’s bodies can clear the HPV virus on their own, but in some cases, the virus does not disappear and becomes a chronic infection, which may even lead to cancer, including penile cancer. The American Cancer Society states that HPV can be found in about half of penile cancer cases.
  • Uncircumcised
    Some scholars believe that circumcision in infancy can significantly reduce the risk of penile cancer. The causal relationship between circumcision and cancer is still inconclusive. Still, uncircumcised men may experience phimosis (tight foreskin that is difficult to retract) or accumulate smegma, which can irritate the penis, cause inflammation, and increase the risk of cancer.
  • Smoking
    Although this behavior has no direct relation to the penis, any form of tobacco contains harmful and even carcinogenic substances. These carcinogens enter the lungs and are absorbed into the bloodstream, travelling throughout the body via blood vessels, which may then lead to penile cancer.
  • Psoriasis UV Light Therapy
    If a man has psoriasis (a skin condition characterised by excessive cell growth, resulting in dry, itchy scales), he may need UV light therapy. If his genitals are exposed to excessive UV light, there is a chance of developing penile cancer. However, most men undergoing this treatment now cover their genital area to minimise the risk of cancer.
  • AIDS
    People with AIDS are also at a higher risk of developing penile cancer, presumably because the disease weakens the immune system.

The above factors can increase the risk of cancer, but other reasons may also cause penile cancer. Therefore, men must always pay attention to their bodies and seek medical advice if abnormalities are detected. Generally speaking, symptoms of penile cancer include:

  • Swelling and pain in the penis lasting more than four weeks
  • Bleeding from the base of the penis or foreskin
  • An unusual odor from the penis or foreskin
  • Thickening of the penile skin or foreskin, causing phimosis
  • Discoloration of the penis or foreskin
  • Rash at the base of the penis or foreskin

If any of the above conditions occur, regardless of whether there is pain, itching, or other discomfort, one should seek medical attention to determine whether penile cancer is present. Even if it is not cancer but another penile-related disease, delayed diagnosis can make treatment much more difficult.

Common Diagnostic Methods

Penile Cancer Diagnosis Methods: Biopsy and Imaging Evaluation

If a doctor suspects that a patient may have penile cancer, they will use various methods to examine and understand the development of cancer cells (if any). Additional examination forms may be required if more signs are detected or more accurate information is needed. For penile cancer, the primary diagnostic methods are as follows:

  • Medical History and Physical Examination:
    As mentioned in the risk factors section, penile cancer is closely related to HPV, AIDS, etc., so doctors may need first to understand whether the patient has had related diseases in the past to determine the likelihood and cause of penile cancer.
    In addition, doctors will carefully examine the patient’s genitals to look for any signs of penile cancer, such as swelling, rashes, etc. Doctors may also gently press on the patient’s groin (the area on both sides of the penis and below the abdomen) to check for swelling.
  • Biopsy:
    This is the only way to confirm whether a patient has penile cancer, as doctors will directly take tissue from the patient’s body to test for cancer cells. There are several types of biopsies, including:
    • Excisional Biopsy – Doctors will only remove a small part of the tissue suspected of containing cancer cells, usually for patients with larger areas that are ulcerated or where cancer cells appear to have penetrated deep into the penis.
    • Excisional Biopsy – If the lesion is small in area or volume, such as a lump or plaque, doctors will remove the entire tissue of the area.
    • Lymph Node Biopsy – If cancer cells have spread extensively in the penis, doctors may need to check nearby lymph nodes to determine the stage of cancer, which can be done by needle aspiration or surgery.
  • Imaging Examinations:
    These tests reflect the patient’s internal conditions and can be divided into the following types:
    • Computed Tomography (CT) Scan– This scan uses X-rays to create cross-sectional images of the body, showing the size of the tumour and whether it has spread to lymph nodes or other areas.
    • Magnetic resonance imaging (MRI) – Similar to CT in principle, but MRI uses radio waves and strong magnetic fields to reflect the condition of soft tissues in the body. If the patient’s penis is erect, the effect is better, so doctors may inject prostaglandins into the patient for scanning.
    • Ultrasound – As the name suggests, it uses sound waves to create images of the patient’s internal organs and other substances, helping to determine the extent to which cancer cells have invaded the penis. The patient will not be exposed to radiation during the process.

Generally speaking, after doctors perform the above biopsies or imaging tests, they can determine the stage of the patient’s cancer based on factors such as the size of the tumour and the extent of spread. However, if the patient has undergone surgery to examine nearby lymph nodes, doctors can use more detailed criteria to measure the stage of the patient’s cancer, as follows:

StageDescription
0Cancer cells are only in the outer layer of the penis and have not grown deeper or spread to nearby lymph nodes.
ICancer cells have grown into the tissue under the outer layer of the penis but have not entered blood vessels, lymphatic vessels, or nerves, and have not spread to nearby lymph nodes.
IIACancer cells have grown into the tissue under the outer layer of the penis and have entered blood vessels, lymphatic vessels, or nerves, but have not spread to nearby lymph nodes.
Or
Cancer cells have grown into the corpus spongiosum (the tissue along the bottom of the penis to the glans), but have not spread to nearby lymph nodes.
IIBCancer cells have grown into the corpus cavernosum (one of the two upper tissues of the penis), but have not spread to nearby lymph nodes.
INCancer cells have grown into the tissue under the outer layer of the penis and may have entered the corpus spongiosum or corpus cavernosum; they have spread to 1 to 2 lymph nodes on the same side of the groin, but have not spread to more distant areas.
IBCancer cells have grown into the tissue under the outer layer of the penis and may have entered the corpus spongiosum or corpus cavernosum; they have spread to 3 or more lymph nodes on the same side of the groin, or have spread to lymph nodes on both sides of the groin, but have not spread to more distant areas.
IVCancer cells have invaded the scrotum, prostate, or pubic bone, regardless of whether they have spread to nearby lymph nodes, but have not spread to other body parts.
Or
Cancer cells have not grown into deeper parts of the penis or nearby structures, but have spread to nearby pelvic lymph nodes, or have broken through lymph nodes and grown into surrounding tissues, but have not spread to more distant areas.
Or
Cancer cells have not grown into deeper parts of the penis or nearby structures, and regardless of whether they have spread to nearby lymph nodes, but have spread to more distant parts of the body.

Primary Treatment Methods

Penile Cancer Treatment Methods: Local Excision and Organ-Preserving Surgery

Dividing cancer into stages according to the above criteria helps patients better understand their condition and enables doctors to more accurately grasp the patient’s condition and achieve the best treatment results. Like most cancers, there is no uniform treatment for penile cancer. In addition to the above cancer stages, doctors will also choose the most appropriate treatment plan based on the patient’s health condition and personal wishes, including:

  • Surgery
    This is the most commonly used method for treating penile cancer, especially when cancer cells are still small in volume and have not yet spread. Patients do not need to have part of the penis removed. If cancer cells have developed to a later stage at the time of diagnosis, the patient’s entire penis may need to be removed. Of course, doctors will try to minimise the amount of tissue removed based on the situation. In addition, if cancer cells have penetrated deeper into the penis, nearby lymph nodes (mainly in the groin) also need to be partially removed.

    It is worth noting that since lymph nodes in the groin help drain fluid, patients may experience drainage problems after undergoing related lymph node removal surgery, leading to abnormal swelling, that is, lymphedema. However, in most cases today, doctors will not remove lymph nodes on both sides of the patient’s groin, so the likelihood of this side effect is significantly reduced.
  • Radiation Therapy

High-energy rays or particles can be irradiated into the patient’s body to attack cancer cells. However, for penile cancer, this is not the most common or preferred option. As mentioned above, surgical removal of the tumour is generally considered first. However, before surgery, radiation therapy can be used to suppress or shrink cancer cells, reducing the amount of tissue that needs to be surgically removed. After surgery, radiation therapy can further remove lymph nodes and reduce the likelihood of cancer recurrence. In addition, some more advanced cases can also use radiation therapy to slow the growth of cancer cells and relieve symptoms.

In fact, not only for penile cancer, but also for the treatment of any cancer with radiation therapy, there are risks. In particular, high-energy rays may damage normal tissues near the irradiation target. Some patients may experience skin patches or shedding at the irradiated site after radiation therapy, or a burning sensation in the penis during urination, or even tumor growth. In more severe cases, the skin or tissue at the end of the penis may die; the urethra may contract, causing difficulty in urination, or even incontinence due to the opening between the urethra and the skin.

  • Chemotherapy

This is a treatment plan that uses drugs to attack cancer cells, and the form of treatment depends on the stage of cancer. Suppose cancer cells are still in the early stages of development at diagnosis. In that case, patients can receive topical chemotherapy, applying ointment to the skin at the site of the cancer cells, without the need for oral intake. Suppose cancer cells have developed to a more advanced stage. In that case, doctors may prescribe oral or injectable drugs for the patient, allowing the drugs to travel through the bloodstream throughout the body to eliminate cancer cells. This is common in cases where cancer has spread to the lymph nodes. Some patients may also receive chemotherapy before surgery to reduce the difficulty of the operation.

The principle of chemotherapy is that drugs can attack cells that divide rapidly. However, in addition to cancer cells, the human body has other similar cells, such as those in the bone marrow, mouth, and intestines. These normal cells may also be killed along with cancer cells during chemotherapy, which may lead to side effects such as hair loss, oral pain, loss of appetite, nausea, and diarrhoea.

Healthy Living

Post-Penile Cancer Surgery Care: Wound Care and Function Maintenance

Given the side effects mentioned above, patients must closely monitor their physical condition after treatment and take good care of themselves. This includes maintaining hygiene at all times to prevent wound infection; maintaining good lifestyle habits, such as getting enough rest and proper nutrition, and quitting bad habits like smoking. On the one hand, this helps to boost the immune system, and on the other hand, it reduces the risk of cancer recurrence. Of course, the most important thing is to strictly follow the doctor’s instructions, including regular follow-up visits, so that the doctor can keep track of the patient’s recovery progress and monitor any signs of cancer recurrence.

Prevention Methods

Penile Cancer Prevention: Circumcision and HPV Vaccine

There is no apparent cause of penile cancer, so it is difficult to determine what methods can eliminate the risk of developing cancer. However, based on the risk factors mentioned above, specific measures may help reduce the incidence of penile cancer. For example, quitting any form of tobacco can reduce the intake of carcinogens in the body; maintaining regular cleanliness of the penis and taking safety precautions before sexual intercourse to prevent penile infections; parents should also actively consider circumcising newborn boys to avoid conditions such as phimosis in the future.

Frequently Asked Questions

Penile Cancer FAQs

How is Penile Cancer different from other sexually transmitted diseases?

First, let’s talk about the causes of infection. Penile cancer originates from cell mutations that proliferate and eventually become malignant tumours. HPV and AIDS are mainly transmitted through bodily contact, such as engaging in sexual intercourse with patients of these diseases or sharing needles. In addition, penile cancer and other sexually transmitted diseases have different impacts on patients. The former can spread to nearby lymph nodes or other tissues, not only affecting bodily functions but also potentially being fatal if not diagnosed and treated in time. AIDS mainly affects the patient’s immune system, making them more susceptible to various rare diseases. HPV can cause more complications related to sexually transmitted diseases, but more cases can heal on their own.

How can Penile Cancer be detected early?

Early symptoms of penile cancer include swelling, bleeding, rashes, and unusual odours. Since these symptoms may not necessarily be caused by penile cancer, if you notice such conditions, you should pay more attention, for example, by keeping a daily record of the situation and observing any changes. However, suppose the condition persists for a long time (about 4 weeks) without improvement or even worsens significantly. In that case, you should seek medical attention promptly to understand the underlying cause and avoid delaying the diagnosis of penile cancer and missing the best treatment opportunity.

Does Penile Cancer affect sexual function?

Penile cancer is a malignant tumour of cells. If not detected and treated early, it is very likely to continue growing and spreading to other parts of the penis, destroying surrounding tissues, and ultimately preventing the penis from functioning normally in terms of sexual activity, and even daily urinary functions may be impaired. Even if we set aside the functional damage, penile cancer itself can cause symptoms such as swelling and rashes. Without proper treatment, engaging in sexual intercourse becomes much more difficult for the patient.

Does treatment for Penile Cancer affect sexual function?

The impact of treatment on sexual function depends on the type of treatment and the stage of cancer. For example, some patients need to have their entire penis removed surgically, which will significantly impair sexual function. In addition, even if the patient does not undergo surgical treatment, if the condition is severe and cancer cells have spread to other parts of the penis, damaging normal tissues, sexual function will also be affected to some extent. For patients with milder conditions, as long as they follow the doctor’s instructions after treatment, take good care of themselves, and wait for the side effects to subside, sexual function can gradually recover.

Is the recurrence rate of Penile Cancer high?

The risk of recurrence largely depends on the patient’s condition. For example, in some cases where the condition has become more severe and the treatment effect is limited, only symptom relief can be provided, and it is difficult to completely prevent normal tissues from being affected by cancer cells. In such cases, the chance of penile cancer recurrence is relatively high. On the other hand, if a patient resumes risk factors related to penile cancer after recovery, including continuing to smoke, getting re-infected with HPV or AIDS, etc., there is also a possibility of penile cancer recurrence. Therefore, patients must maintain good hygiene and care even after treatment.



▣ The information on this website has been reviewed by the HEAL Medical Team and is regularly updated according to the most recent clinical evidence. All content is provided for general informational purposes only and should not replace professional medical advice. Please consult your doctor or another qualified healthcare professional for personalized medical guidance.

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