Penile Cancer: Signs, Symptoms, and Treatment

Penile cancer or cancer of the penis is a sore or a spot on the foreskin, shaft, or head of the penis. Often, men relate this blister to a sexually transmitted disease. Instead, it may occur because of the uncontrolled multiplication of abnormal cells in the skin or tissue of the penis. These cancerous cells form a mass or lump called a penile tumor. 

However, indeed, every blister is not a sign of penile cancer. If you see any abnormal growth or discoloration on the penis, you should immediately consult with the doctor for the early detection of the deadly disease. Most importantly, penile cancer does not stay in the tissue it has begun. Over time, cancer cells can spread to lymph nodes and other organs, damaging healthy cells and tissue. So, prevent the further progression of cancer with the on-time treatment that begins with the recognition of early signs of penile cancer. 

Read the article to learn about penile cancer symptoms, causes, risk factors, diagnosis, and treatment. This thorough article will also discuss survival rates, living with penile cancer, and its preventative measures.

Signs and Symptoms of Penile Cancer

The ulcer, mass, or lump on the penis and its skin discoloration are the first signs of penile cancer. In most cases, they are infected and painful blisters. Watch out for the other penile cancer symptoms: 

• Itching
• Burning sensation
• Small crusty bumps
• Rash
• Skin thickening or changes in the color of the skin
• Bleeding
• Irritation
• Foul-smelling fluid underneath the penis foreskin
• Flat mass that appears blueish-brown in color
• Inflammation and irritation, especially in the head of the penis
• Swollen lymph nodes in the groin area

In short, a small red wart is an early sign of penile cancer. In time, it may reach the depth of the muscle, causing irreversible ulcer. In advanced-stage cases, the foul-smelling or bloody discharge comes from the ulcer or warty mass. This makes the situation more serious and more complicated for the treatment. 

Causes and Risk Factors of Penile Cancer

The researchers are trying to find penile cancer causes, but they have not identified the real cause of the disease. They believe that it results from DNA mutation like other forms of cancer. However, some specific risk factors are there that can increase the risk of developing penile cancer. Take a look at the following risk factors for the cancer of penis:

• Phimosis 

Phimosis is a specific condition of the penis that happens to uncircumcised adults or children. It makes them unable to pull back their foreskin. Having phimosis at any age is not a serious problem until the foreskin of the penis does not catch infection or inflammation. This way, the uncircumcised penis increases the risk of developing cancer cells in the penis. 

• Human Papillomavirus (HPV)

Usually, normal cells restrict themselves from becoming the victim of uncontrollable malignant cell growth by making the substance, tumor suppressor gene products. But, in some cases, HPV produces two proteins (E6 and E7) to block the function of the tumor suppressor gene products in cells. This increases the risk of out-of-control cell growth in the penis. 

• Tobacco 

The next risk factor is tobacco which spreads cancer-causing chemicals to damage DNA cells of the body, including the penis. The damaged DNA negatively impacts the health of genes leading to penile cancer.  According to the Indian Medical Research Report published in 2020, tobacco accounted for about 27% of the cancer in the country and causes premature cancer deaths. 

• Smegma

Sometimes a fluid-like substance builds up underneath the foreskin. If you do not clean the area well, this secretion can build up as a thick and smelly substance called smegma. This is more common in patients with phimosis. Smegma is not a direct cause of penile cancer. The inflammation and infection underneath your foreskin may escalate the risk for the cancer of the penis. 

• UV Light Treatment of Psoriasis 

Men who have undergone UV light treatment because of psoriasis are likely to develop the symptoms of penile cancer. Psoriasis is a skin disease treated with PUVA therapy, i.e. a combination of ultra-violet light treatment and psoralens disease. PUVA therapy increases the possibility of developing cancer cells in the men’s genitals. 

• Age 

Like other cancers, age plays a crucial role in increasing the risk of cancer. In most cases, the patients diagnosed with this disease are above 60.

• HIV/AIDS

Men with AIDS are more susceptible to becoming the victim of penile cancer. This higher risk is the result of their weak immune system. Furthermore, such patients are more prone to get infected by HPV which also causes cancer. 

Role of Being Circumcised in Reducing the Risk of Penile Cancer

Circumcision removes all parts of the penis foreskin. This is an essential act that needs to be done with newborns. Men who were circumcised as infants do not show the signs and symptoms of penile cancer. Conversely, uncircumcised men and children are more prone to become the victim of the cancer of the penis. Understanding the role of circumcision for infants is vital to mitigate the risk of penile cancer. However, some religious and social norms have their varied opinions on the circumcised penile of newborns. 

Diagnosis of Penile Cancer

Here is a brief description of the penile cancer diagnosis to make you aware of diagnostic treatment: 

• Physical Examination and Medical History

When you rush to the doctor after spotting a sore or blister on the penis, your healthcare provider examines your penis. During the physical examination, they find lumps or ulcers in the tissue. Additionally, they also ask about your previous medical history, age, lifestyle, symptoms, and medications. Based on the overall analysis, they analyse whether it is an infection/allergic reaction or the red flag sign of cancer.

• Biopsy

A biopsy is the next diagnosis step to confirm cancer. It involves the removal of affected skin/tissue from the penis. During this procedure, the healthcare provider conducts a laboratory test of the penis specimen. This helps them determine the presence of cancer cells.

• Imaging Tests

If the biopsy procedure confirms the cancer, the doctor proceeds with imaging tests. Their objective is to detect how much the disease has spread. In most cases, penile cancer first spreads to the lymph glands in the groin area. Then, it moves to the glands in the pelvic region. Based on the detailed images of the CT scan, MRI scan, and PET scan, the doctor identifies the advanced form of the cancer. 

• Cystoscopy

Cystoscopy is also a method to view the different areas of the penis to recognize the aggression of cancer cells growth. During this procedure, the doctor inserts a thin tube with a camera on the end of the penis. 

How Prompt Penile Cancer Diagnosis Improves Prognosis

Your chance of recovery increases with a prompt penile cancer diagnosis. If the cancer is in the early stage, the experienced surgeon recommends the best treatment plan to remove it from its root. They ensure it should not reach other healthy organs and cells. Conversely, advanced-stage cancer does not improve the signs of recovery. Despite the robotic surgical procedure, the survival rate is low for the last stage of penile cancer. 

Penile Cancer Treatment Options

Cancer treatment is distressing for the patient and his family. The integrated cutting-edge technology in surgical procedures makes penile cancer treatment less painful if the symptoms are recognized in the early stage. Otherwise, the drastic operation focused on the advanced stage of cancer brings depression, anxiety, and fear during the treatment and post-operation. 

For patients with penile cancer, the healthcare provider recommends one or a combination of treatments based on their preferences and the size of tumor:

• Systematic Chemotherapy

Systematic chemotherapy is used for penile cancer treatment when it reaches distant lymph nodes and other organs. In this therapy, the doctor uses cancer-killing drugs to inject them into a vein. This way, drugs reach cancerous cells in the penis to destroy them. In most cases, doctors perform this therapy post-surgery to improve the survival rate and prevent the issue of penile cancer reoccurrence. 

• Radiation Therapy

An alternative to surgery, radiation therapy is an effective treatment to kill smaller penile cancer. In this treatment, heat waves are used to kill cancer cells if the cancer has spread to lymph nodes and other organs. Additionally, doctors perform this therapy post-surgery to remove lymph nodes to mitigate the risk of second penile cancer. 

• Surgery

If the cancer cells growth is too small, the surgeon removes tumor without removing the partial penis. However, there are various surgical options available as per the stage of penile cancer. The penile-sparing technique is the most common among them. It includes limited surgeries and local treatments with a focus on preserving the sexual organ penis. 

Circumcision

If the cancer is in the foreskin, circumcision surgery is the best cure for penile cancer. This is done before the radiation therapy as the therapy can cause swelling and tightening of the skin. This makes circumcision surgery harder. 

Simple Excision

The tumor is removed along with nearby normal skin. It intends to prevent the further progression of cancer cells to other organs.

Microscopically Controlled Surgery (Mohs Surgery)

Though Mohs surgery is slow, it aims to save as much as normal skin possible. In this surgery, the surgeon removes a layer of the cancer where the cancer has invaded and checks it under the microscope. If there is cancer, they remove the next layer. This way, they repeat the procedure until they remove all the skin layers affected by the penile cancer. 

Glansectomy

If the tumor is only in the glans, the partial or all glans is removed. The surgeon ensures the penis skin grafts rebuild the glans on the pensis post-operation.

Partial or Total Penectomy

Based on the cancer stage and tumor size, the operation is done to remove a partial or complete penis. For life-threatening penile cancer, the surgeon cuts the testicles along with the penis to save the patient’s life. 

Lymph Node Surgery

Patients with T2 stage or level cancer undergo lymph node surgery. In this procedure, the surgeon removes some lymph nodes in the groin to restrict the cancer growth. 

Ablation TherapyOut of these treatments, ablation therapy is an innovative technique to treat penile cancer. It is a less invasive, less complicated, and bloodless method to cure penile cancer. This treatment focuses on the use of laser beams to destroy cancer cells. Cryosurgery is also the part of this therapy in which extreme cold beams freeze cancer cells to kill them. It is highly effective for the early stage of penile cancer. 

Cure and Survival Rates for Penile Cancer

Penile cancer affects uncircumcised males the most in India. Patients who are diagnosed with stage 1 and stage 2 cancers have a 5-year survival rate of 87% and 67% respectively. Conversely, the late detection of symptoms causes more complexities in penile cancer surgery. The loss of penis and sexual life can make them depressed post-surgery.

Living with and Preventing Penile Cancer

Learning to live after penile cancer surgery requires a positive approach to seeing life in a new way. Don’t expect that everything will be like before. Understand the importance of spending time with family or friends and making new choices. Fears may grip you over and over again. Accept your fears. Consult with a doctor and have open communication with the most trustworthy friend. The wounds of the heart will heal away over time if you do self-care and self-love.

Here are some preventative measures that you should opt for:

• Go to regular follow-up visits
• Quit smoking and alcohol
• Eat a healthy diet
• Drink plenty of fluid
• Do the exercise
• Be physically active
• Manage your stress
• Don’t take symptoms lightly

Why Choose Dr. Prabhudev Salanki for Penile Cancer?

Dr. Prabhudev Salanki is a highly respected urologist in Bangalore with an impressive array of qualifications, including MBBS, MS, FRCS, DNB (Urol), FRCS (Urol), FEBU, and a Diploma in Laparoscopic Urology. He is also a Fellow of the International College of Robotics Surgeons. His comprehensive cutting-edge services cover a wide range of critical conditions, including prostate, bladder, testicular, kidney, and other urological cancers. 

Dr. Salanki performs expert surgeries laparoscopic surgery, RIRS (Retrograde Intrarenal Surgery) with intracorporeal lasers, and PCNL (Percutaneous Nephrolithotomy) with advanced level precision. Therefore, the doctor is listed among the topmost urological surgeons across the country. Most importantly, his proactive approach, personalized attention, and paying attention to minute details make him an ideal surgeon for expert care and treatment. 

Book an appointment today with Dr. Prabhudev Salanki if you are experiencing early signs of penile cancer. Experience top-notch medical care and treatment from a dignified professional. 

Medically Reviewed by Dr. Prabhudev Salanki