What Causes Penile Cancer?

Penile cancer is a rare disease, with an incidence of 0.3-0.8 cases per 100,000 men. It is most prevalent in Latin America and parts of Africa and least common in countries with early circumcision practices. The main causes are sexually transmitted diseases, human papillomavirus infection, chronic inflammation, and smoking. Phimosis, a condition where the foreskin is tight and cannot be pulled back, is found in 40 to 60% of penile carcinoma patients. It leads to the accumulation of smegma under the foreskin, causing chronic inflammation and the formation of carcinogenic substances during its decomposition.

Understanding Penile Tumors

Penile tumors are mostly squamous cell carcinomas with varying degrees of differentiation. Melanoma, lymphoma, and sarcoma are rare occurrences. Prognostic factors include the depth of invasion, involvement of lymphatics and blood vessels. Typically, the tumor is located on the surface of the glans or foreskin, rarely on the body of the penis.

Diagnosis of Penile Cancer

Early diagnosis is crucial when patients have no symptoms. Physicians perform a physical examination of the penis and palpation of the inguinal lymph nodes. Suspicion of malignancy leads to histological examination. X-ray examination of the lung and bone system is done to detect distant metastases. Biopsy is taken for enlarged inguinal nodes and penile tumor. Antibiotics are administered for four weeks before biopsy to affect inflammatory enlarged inguinal lymph nodes and detect metastatic ones. Only histological examination confirms the presence of metastatic lymph nodes and determines the disease stage.

Metastasis of Penile Cancer

Penile carcinoma primarily metastasizes through the lymphatic system, affecting the inguinal lymph nodes first, followed by the iliac and para-aortic lymph nodes. Hematogenous metastases occur late, mainly in bones and lungs.

Treatment Options

Treatment depends on the stage of the carcinoma. Surgery, either total or partial resection combined with lymph node removal, is the main approach. It can be complemented with chemotherapy and radiotherapy. Radiotherapy is an alternative for patients who refuse surgery. Brachytherapy is suitable for tumors with a diameter of less than 4 cm. Chemotherapy options include methotrexate, bleomycin, cisplatin, paclitaxel, and ifosfamide.

Prognosis and Prevention

The prognosis is favorable with early diagnosis and timely treatment. Prevention focuses on eliminating predisposing factors, such as maintaining good hygiene, timely surgical treatment of phimosis, managing chronic inflammatory diseases of the penis, and seeking immediate medical attention for any concerns.