Penile Cancer

Overview

• Penile cancer is a rare cancer and it originates in the epithelium of the inner prepuce and glans of penis. Due to hesitancy from patients, most patients present late with advanced disease.
• The psychological impact of the disease is highly significant.
• The cause of penile squamous cell carcinoma is unclear but human papillomavirus (HPV) appears to be a causative factor.

What are the signs and symptoms?

• Patient presents with an ulcer, lump or erythematous lesion over penis.
• Itching or burning sensation below prepuce
• Difficulty in urination in advanced disease
• Inguinal Lymph node swelling in advanced cases.

What are the treatment options?

1. Surgery

Surgical techniques include:

• For small penile lesions: circumcision or wide local excisions are mainstay treatments. Local recurrences over time may occur and re-treatment may be required.
• For glanular and distal penile tumours: it is now possible to preserve much more length, and cosmetic and functional results are far superior to conventional partial penectomy.
• In advance tumours may need total penectomy and perineal urethrostomy
• Regional lymph nodes: lymphadenectomy is the standard treatment of patients with inguinal lymph node metastases.

2. Radiotherapy

• Radiotherapy is most appropriate for small lesions in patients unfit or unwilling to undergo surgery.
• Radiotherapy as treatment of the primary tumour may be delivered either by external beam treatment or brachytherapy
• Radiotherapy for the management of regional lymph node metastases
• Adjuvant radiation to the inguinal lymphatic area has been advocated by some but there is no strong evidence of benefit

3. Chemotherapy

Penile cancer has only a limited response to chemotherapy and used in adjuvant setting

4. Topical agents

Topical agents like 5 FU cream or Laser therapy is used for premalignant lesions and Carcinoma in Situ