Scientists currently believe that penile tumors are caused by cancer-producing
effects of secretions that become trapped within the foreskin if
they are not washed away on a regular basis. It is not surprising,
therefore, that this particular malignancy is extraordinarily common
in South and Central America, as well as other Third World countries,
where public health and personal hygiene often are lacking. Also,
circumcision, a practice that could improve hygiene, is not regularly
performed. In the United States, penile cancer is a relatively unusual
cancer, probably due to the country's superior sanitary and hygienic
conditions along with commonly practiced circumcision. However,
scientists are currently studying other causes of penile cancer,
particularly the role of human papilloma virus (HPV), which already
has strong links to cervical cancer. Antibodies to HPV-16, a specific
type of papilloma virus also implicated in cervical cancer, have
been found in many patients with penile cancer.
How is penile
Unfortunately, early diagnosis of penile cancer is often missed
because it is so rare in the United States that general physicians
and even urologists may only see two or three cancers in a practice
lifetime. Also, patients are often reluctant or embarrassed to call
attention to their genitalia and may be afraid of surgical procedures
or treatment of the penis. But the earlier the diagnosis, the more
effective the therapy and the better the chance for cure. If diagnosis
is delayed and the disease progresses, therapy may be less successful
and more disfiguring. So, it is very critical that any skin erosion,
ulcer, sore, irritation, discoloration that is noticed on the foreskin,
the skin of the shaft of the penis or the surface of the head of
the penis be brought to the attention of the physician by the patient
and be promptly evaluated. Chances are good that most such lesions
are linked to a bacterial or fungal infection or even an allergic
reaction, all of which will respond readily to antibacterial or
antifungal ointments and creams. But growths or areas that return
or do not heal must be considered malignant until proven otherwise.
The appropriate evaluation includes biopsy where the tissue is removed
for examination under a microscope. If a precancerous or cancerous
condition is found, prompt treatment and systematic, regular follow
up are very important.
How is penile
Early detection and identification of penile cancer are very valuable
because the treatments that can provide successful outcome are indeed
low risk. If the tumor appears on the skin surface, your urologist
may be able to treat the problem with a topical cream that has minimal
side effects. If the lesion is larger, but still limited to about
pea-size, a small local excision or a type of surgery that continues
to shave layers of abnormal tissue until normal tissue is reached
(Moh's surgery) may be performed. With these procedures, there is
essentially no loss of form or function to the penis. However, careful
follow up is critical to identify early recurrence. In the removal
of these small lesions, it is very unlikely that cancer has spread
to lymph nodes and, therefore, removal of the lymph nodes is usually
not necessary. With larger lesions, it is necessary to remove greater
amounts of tissue and also to consider removal of the draining lymph
nodes in the groin in order to achieve a cure. In these circumstances,
a combination of surgery, radiation and chemotherapy may be necessary.
It is also important to note that external beam radiation is an
alternative therapy, specifically for small lesions. Again, the
critical importance of early detection not only ensures a better
outcome for the treatment supplied but also provides more treatment
options that can be applied.
be expected after treatment for penile cancer?
Your post-treatment experience will be directly tied to the stage
of your cancer when it is diagnosed. Cure is almost certainly ensured
when lesions are detected early. But it is less certain as the tumor
becomes more advanced. Treatment is also increasingly more debilitating.
Since your penis is readily accessible — you can visualize it easily
and you touch it regularly during urination — you can help yourself
greatly in detecting early disease by reporting any lesions that
you see or feel. While patients at greatest risk are those who are
not circumcised, every man should be on the lookout for penile lesions
as they need prompt attention.
cancer contagious? Can I pass it onto others?
Until recently, the general consensus was that penile cancer was
caused by chemical irritation and there was no concern about transmitting
it. But recent data have implicated the HPV in both penile and cervical
cancers. There appears to be increased incidence of these cancers
in the spouses of people with this sexually transmitted disease.
Thus, while penile cancer is not directly transmissible, if you
or your partner has HPV, you need to use protection during intercourse,
be aware of any lesions, and, if you are the woman, have frequent
cervical examinations. Not only are efforts to eliminate or minimize
the infection important but so are discussions with a urologist
or other specialist about its link to penile cancer.
operation on the penis mean that I will be unable to stand to empty
If your cancer is detected early, the surgical procedures should
not impact your ability to stand when you urinate. When the cancer
is more advanced, the required surgical procedures may require you
to urinate in the sitting position.
interfere with my ability to have sex?
Early detection and minimal surgical procedures should not interfere
with normal sexual function. More extensive procedures might, however.
male children be circumcised soon after birth to prevent penile
This question creates much debate. Some experts believe that sexual
sensation is diminished after circumcision, even though evidence
points to a lower incidence of urinary tract infections and penile
cancer in men who have had the procedure. Parents should discuss
the risks and benefits of circumcision with the child's doctor.
If a male
has not been circumcised soon after birth, will later circumcision
as a teenager or young adult protect him from penile cancer?
There is now evidence that circumcision soon after birth is the
most reliable protection from subsequent penile malignancies. A
procedure performed in young adults does not have nearly the protective
effect as when it is done in infants. Population studies suggest,
for instance, that the incidence of penile cancer is: extraordinarily
rare in Jewish males where circumcision at birth is an accepted
ritual. more common in the Muslim population where circumcision
at puberty is the established ritual. But it is not as common as
in those individuals who have never been circumcised.