Currently, the exact cause of penile cancer is unknown; however, doctors have found a strong correlation between the cancer in question and factors such as: cigarette smoking, human papilloma virus infections, AIDS and poor hygiene. intimate.
To signal the onset of penile cancer is the formation, usually on the glans penis or foreskin, of a lump or ulcer, associated with symptoms such as: pain, redness, itching, burning, changes in skin color, etc.
The success of penile cancer therapies depends on the timeliness of diagnosis: the earlier the diagnosis is, the greater the chances of recovery.
Failure to treat or delayed treatment is usually fatal, due to the spread of the tumor to other organs.
Brief anatomical review of the Penis
The penis is the male reproductive organ.
Cylindrical in shape and covered with skin, it can be anatomically divided into 3 main parts, which are: the root, the shaft (or body) and the glans.
- Root: located between pubis and perineum, it represents the point of origin of the penis.
- Auction: it is the central part of the penis as well as the most considerable; the two corpora cavernosa and the corpus spongiosum participate in its formation, three structures made up of erectile tissue and wrapped in connective tissue.
The cavernous arteries run inside the corpora cavernosa; instead, the urethra passes through the corpus spongiosum. - Glans: it is the most distal portion of the penis; including the urinary meatus for the expulsion of urine and sperm, it is provided with a flap of sliding skin called the foreskin.
In spite of the numerous researches on the subject, doctors have not yet identified the precise causes of the aforementioned genetic mutations; however, they are pretty sure that factors such as:
- Cigarette smoke;
- Infections caused by the human papilloma virus (or HPV);
- AIDS, that is the infection produced by the human immunodeficiency virus (or HIV);
- Poor intimate hygiene.
Who is most at risk for Penis Cancer?
Based on what emerged from several statistical studies, experts have deduced that they are more at risk of penile cancer:
- Men uncircumcised (i.e. with the foreskin), who suffer from phimosis and / or recurrent smegma.
Phimosis is the anomaly of the penis, as a result of which the foreskin has a narrowing that prevents it from sliding backwards and uncovering the glans; phimosis constitutes an impediment to erection and, in the most severe cases, also to expulsion of the sperm.
The smegma, on the other hand, is a secretion product of the penis, which is typically formed under the foreskin and in which dead epithelial cells, sebum and moist substances of urinary origin take part; being rich in proteins, smegma represents an ideal replication and growth medium for many microorganisms, both bacterial and fungal. - Men with psoriasis who have received ultraviolet light treatment;
- Men who live in areas of the world where sanitary conditions are poor;
- Men who do not take sufficient care of their intimate hygiene;
- Men over the age of 60;
- Smoking men;
- Men with AIDS or who have contracted the human papilloma virus. Regarding human papilloma virus infections, statistical studies have shown that these unpleasant circumstances are more common in uncircumcised men; this means that circumcision protects against the infecting action of the human papilloma virus;
- Men with a past history of recurrent balanitis. Balanitis is inflammation of the glans.
Types of Penis Cancer
Penile cancer can originate from various cells that make up the skin of the penis or the particular tissues of this organ; the cell of origin is important, because it is on it that doctors base the typological classification of penile cancer.
Going more specifically into the aforementioned typological classification, a penile tumor can originate from:
- A squamous cell and represent an example of squamous cell carcinoma;
- A Merkel cell and constitute an example of Merkel cell carcinoma;
- A melanocyte has the typical features of a melanoma;
- A basal cell and constitute an example of basal cell carcinoma;
- A so-called "small cell" and represent an example of small cell carcinoma;
In 95% of cases, penile cancer is squamous cell carcinoma; in the remaining 5%, it is one of the other three types of cancer described above (therefore either a Merkel cell carcinoma or a melanoma or a small cell carcinoma).
;
- Loss of blood;
- Skin color changes
- Skin thickening;
- Irritation.
It is also important to note that penile cancer can cause, following its onset, phimosis and enlargement of the inguinal lymph nodes.
Complications
Penile cancer is, like many malignant tumors, a neoplasm capable of infiltrating neighboring tissues and lymph nodes, and spreading some of its cells into the bloodstream - the so-called tumor metastases or metastases - thus "contaminating" even organs distant from the penis .
Readers are reminded that the spread of metastases by a malignant tumor is a process of significant clinical severity, which is often fatal for those who suffer from it.
When to see a doctor?
Especially when he falls into a risk category (eg: smoker with a history of HPV infection or elderly with AIDS), a man should always contact his doctor immediately or go to the nearest hospital if he develops a lump or a " ulcer on the penis, lump or ulcer associated with symptoms such as: pain, redness, itching, burning, etc.
Early diagnosis of penile cancer is very important, as it allows the condition to be treated early, before it gives rise to serious complications (metastases).
and biopsy on a sample of cells belonging to the presumed tumor (tumor biopsy).
After the diagnosis of penile cancer, your doctor may want to investigate the situation with radiological tests, such as a CT scan or MRI of the pelvic area.
Tumor biopsy
A tumor biopsy consists of taking and subsequent laboratory analysis of a sample of cells belonging to a tumor.
In the case of penile cancer, the tumor biopsy is the investigation necessary for the diagnostic confirmation of what has only been hypothesized up to that moment as well as the examination that allows to establish an important characteristic of malignant tumors: the so-called staging (or stage).
What is the staging of a malignant tumor?
The staging of a malignant tumor includes all the information, collected during the biopsy, concerning the size of the tumor mass, its infiltrating power and its metastasizing capacity.
WHERE IS THE LOCATION OF THE WITHDRAWAL?
To biopsy confirm the presence of penile cancer, the diagnostician must have laboratory tests conducted on a sample of cells taken from the lump or ulcer present on the penis.
It is the least severe stage.
The tumor is limited to the surface and is also called carcinoma in situ.
Stage I.
It is a stage of mild severity.
The tumor has invaded the connective layer under the skin, but has not contaminated any neighboring lymph nodes or organs.
After the connective tissue, the tumor has invaded the lymphatic vessels and blood vessels, and may also have contaminated the erectile tissue and / or urethra.
The tumor is the same as stage II, with the addition of its spread to one or two inguinal lymph nodes.
The tumor is the same as stage II, with the addition of its spread to more than two inguinal lymph nodes.
After the connective tissue, the erectile tissue, the urethra and inguinal lymph nodes, the tumor has invaded neighboring organs (eg: prostate, pubic bone, etc.) and / or some distant ones.
Radiological examinations
After the diagnosis of penile cancer, radiological examinations of the pelvic area are used by the doctor to verify whether or not the neoplasm has invaded the neighboring organs and tissues.
These investigations are particularly important in the presence of mid-to-late stage penile cancer.
Laser therapy
Also known as laser ablation, laser therapy is indicated when penile cancer is stage 0 squamous cell carcinoma (i.e. in situ).
Surgery
The surgical approach includes various treatments, such as circumcision, cryosurgery, excision and penectomy.
CIRCUMCISION
Circumcision is the surgery to remove the foreskin.
In the context of penile cancer, its implementation is indicated when the neoplasm is limited to the foreskin and is not in an advanced stage.
CRYOSURGERY
Cryosurgery is a particular surgical treatment, which involves the application of liquid nitrogen directly on the tumor mass in order to freeze it and cause the death of its constituent cells.
In a context of penile cancer, its implementation is indicated when the neoplasm is in the very early stages and is located on the glans penis.
SURGICAL EXCISSION
The surgical excision of a penis tumor consists in the removal of the tumor mass and the surrounding normal tissues, performed with the classic surgical scalpel and after the application of a local anesthetic.
Surgical excision can be adopted when the tumor is in its early stages or has just passed the first stages.
The implications of surgical excision include the application of a few stitches and, if the removal involved a "large area of normal tissue," grafting a skin graft.
PENECTOMY
Penectomy is the partial or total removal of the penis.
In the context of penile cancer, its implementation is reserved for the most advanced cases, in which cancer cells have contaminated the organ more or less widely and are about to spread elsewhere.
Chemotherapy
Chemotherapy is the administration of drugs capable of killing rapidly growing cells, including cancer cells.
In a context of penile cancer, chemotherapy can be of a topical nature and represent the decisive treatment, if the neoplasm is in the very early stages, or of a systemic nature and constitute a supportive therapy for surgery, if the neoplasm has a certain extent.
Radiotherapy
Radiotherapy involves exposing the tumor mass to a certain dose of high-energy ionizing radiation (X-rays), which are designed to destroy neoplastic cells.
In the context of penile cancer, radiotherapy can represent:
- The decisive treatment, if the neoplasm is in the very early stages;
- A post-surgical treatment, when it is necessary to consolidate the benefits of surgery;
- A palliative treatment to relieve symptoms, when the neoplasm is at a very advanced stage and it is impossible, thanks to the patient's precarious health conditions, to carry out surgery.
