Carcinoma of the penis
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(Redirected from Penile cancer)
| Carcinoma of the penis | |
|---|---|
| Classification and external resources | |
| ICD-10 | C60 |
| ICD-9 | 187 |
| MedlinePlus | 001276 |
| MeSH | D010412 |
Penile cancer is a malignant growth found on the skin or in the tissues of the penis.
Contents |
Prevalence [edit]
Penile cancer is a rare cancer in developed nations. The annual incidence is approximately 1 in 100,000 men in the United States,[1] 1 in 250,000 in Australia,[2] and 0.82 per 100,000 in Denmark.[3] In the United Kingdom, fewer than 500 men are diagnosed with penile cancer every year.[4] In some South American countries, Africa, and Asia, this cancer type constitutes up to 10%. Cervical cancer also occurs more frequently in these geographic areas.[5]
The lifetime risk has been estimated as 1 in 1,437 in the United States and 1 in 1,694 in Denmark.[6] Penile cancer accounts for up to 10% of cancers in men in some parts of Asia, Africa, and South America.[7]
Symptoms [edit]
- Redness of the penis[8]
- Rash on the penis[8][9]
- Foul smelling discharge from the penis[8][9]
- Pain in the penis[8]
- Growth or sore on the penis that doesn't heal within four weeks (may look like a wart, ulcer, or blister), may or may not be painful[9]
- Bleeding from the penis or from under the foreskin[9]
- Change in color of the penis[9]
- Phimosis[9]
Staging [edit]
- TX: Primary tumor cannot be assessed
- T0: No evidence of primary tumor
- Tis: Carcinoma in situ
- Ta: Noninvasive verrucous carcinoma
- T1: Tumor invades subepithelial connective tissue
- T2: Tumor invades the corpus spongiosum or cavernosum[10]
- T3: Tumor invades the urethra or prostate[10]
- T4: Tumor invades other adjacent structures[10]
Risk factors and prevention [edit]
- Acquired immune deficiency syndrome (AIDS) - AIDS can increase a man's risk of developing penile cancer.[11] AIDS can be prevented by practicing safe sex or by not having sex with a person who is positive for HIV/AIDS.
- Age - Penile cancer is rarely seen in men under the age of 50. About 4 out of 5 men diagnosed with penile cancer are over the age of 55.[11]
- Balanitis - Balanitis is inflammation of the foreskin and/or the glans penis.[8] It is associated with increased risk of penile cancer.[12] It is usually caused by poor hygiene, allergic reactions to certain soaps, or an underlying health condition such as reactive arthritis, infection, or diabetes.[8] Balanitis can be prevented by washing the penis regularly with water and by avoiding soaps with harsh ingredients.
- Circumcision - Some studies show that circumcision during infancy or in childhood may provide partial protection against penile cancer, but this is not the case when performed in adulthood.[13] It has been suggested that the reduction in risk may be due to reduced risk of phimosis;[11][13] other possible mechanisms include reduction in risk of smegma and HPV infection.[11] Several authors have proposed circumcision as a possible strategy for penile cancer prevention;[14][15][16] however, the American Cancer Society points to the rarity of the disease and notes that neither the American Academy of Pediatrics nor the Canadian Academy of Pediatrics recommend routine neonatal circumcision.[11]
- Human papillomavirus (HPV) - HPV is a risk factor in the development of penile cancer.[12] According to the Center for Disease Control and Prevention (CDC), HPV is responsible for about 800 (about 40%) of 1,570 cases of penile cancer diagnosed annually in the United States.[17][18] About half of men with penile cancer also have genital warts, which are caused by HPV.[4] There are more than 120 types of HPV.[19] Several authors have suggested the use of HPV vaccines such as Gardasil or Cervarix to reduce the risk of HPV and, consequently, penile cancer;[14][15] the use of condoms has also been proposed.[14]
- Poor hygiene - Poor hygiene can increase a man's risk of penile cancer.[15][20] Good genital hygiene involves washing the penis, the scrotum, and the foreskin daily with water.
- Smegma - Smegma, a whitish substance that can accumulate beneath the foreskin, is associated with greater risk of penile cancer.[11][21] The American Cancer Society suggests that smegma may not be carcinogenic, but may increase the risk by causing irritation and inflammation of the penis.[11]
- Lichen sclerosus - Lichen sclerosus is a disease causing white patches on the skin. Lichen sclerosus increases the risk of penile cancer.[22] As the exact cause of lichen sclerosus is unknown, there is no known way to prevent it.
- Paraphimosis - Paraphimosis is a medical condition where the foreskin becomes trapped behind the glans. It is considered a risk factor for the development of penile cancer.[11] Paraphimosis can be prevented by not leaving the foreskin retracted for prolonged periods of time.
- Phimosis - Phimosis is a medical condition where the foreskin cannot be fully retracted over the glans. It is considered a risk factor in the development of penile cancer.[12] Phimosis may also be a symptom of penile cancer.[9] Phimosis can be prevented by practicing proper hygiene and by retracting the foreskin on a regular basis.
- Tobacco - Chewing or smoking tobacco increases the risk of penile cancer.[12] Smoking cessation has been proposed as a prevention strategy.[14][15]
- Ultraviolet light (UV light) - Men with psoriasis who have been treated using UV light and a drug known as psoralen have an increased risk of penile cancer.[11][23]
Pathology [edit]
- A. Precancerous Dermatologic Lesions
- B. Carcinoma in Situ (Bowen's disease, Erythroplasia of Queyrat)
- C. Invasive Carcinoma of the Penis
Like many malignancies, penile cancer can spread to other parts of the body. It is usually a primary malignancy, the initial place from which a cancer spreads in the body. Much less often it is a secondary malignancy, one in which the cancer has spread to the penis from elsewhere. The staging of penile cancer is determined by the extent of tumor invasion, nodal metastasis, and distant metastasis. The AJCC staging guidelines are as follows:[24]
- Stage I - The cancer is moderately or well differentiated and only affects the subepithelial connective tissue.
- Stage II - The cancer is poorly differentiated, affects lymphatics, or invades the corpora or urethra.
- Stage IIIa - There is deep invasion into the penis and metastasis in one lymph node.
- Stage IIIb - There is deep invasion into the penis and metastasis into multiple inguinal lymph nodes
- Stage IV - The cancer has invaded into structures adjacent to the penis, metastasized to pelvic nodes, or distant metastasis is present.
Prognosis can range considerably for patients, depending where on the scale they have been staged. Generally speaking, the earlier the cancer is diagnosed, the better the prognosis. The overall 5-year survival rate for all stages of penile cancer is about 50%.
Treatment [edit]
There are several treatment options for penile cancer, depending on staging. They include surgery, radiation therapy, chemotherapy, and biological therapy. The most common treatment is one of five types of surgery:
- Wide local excision - The tumor and some surrounding healthy tissue are removed
- Microsurgery - Surgery performed with a microscope is used to remove the tumor and as little healthy tissue as possible
- Laser surgery - laser light is used to burn or cut away cancerous cells
- Circumcision - cancerous foreskin is removed
- Amputation (penectomy) - a partial or total removal of the penis, and possibly the associated lymph nodes.
Radiation therapy is usually used adjuvantly with surgery to reduce the risk of recurrence. With earlier stages of penile cancer, a combination of topical chemotherapy and less invasive surgery may be used. More advanced stages of penile cancer usually require a combination of surgery, radiation and chemotherapy. In addition to all the above, treatment of the underlying disease like brucellosis,[citation needed] is important to limit disease recurrence.
See also [edit]
- Male breast cancer
References [edit]
- ^ The American Cancer Society: Penile Cancer: What is penile cancer? American Cancer Society, Last revised: January 8, 2012
- ^ [www.racp.edu.au The Official Website of the Royal Australasian College of Physicians], Published September 2010
- ^ Frisch M, Friis S, Kjær SK, Melbye M. Falling Incidence Of Penis Cancer In An Uncircumcised Population (Denmark 1943-90). BMJ: British Medical Journal. 1995;311(7018):1471.
- ^ a b Cancer Research UK: Penile Cancer: Risks and causes of penile cancer Cancer Research UK
- ^ http://oncolex.org/en/Penile
- ^ Cold CJ, Storms MR, Van Howe RS (April 1997). "Carcinoma in situ of the penis in a 76-year-old circumcised man". J Fam Pract 44 (4): 407–10. PMID 9108839.
- ^ The American Cancer Society: Penile Cancer: What are the key statistics about penile cancer American Cancer Society, Last revised: January 18, 2012
- ^ a b c d e f PubMed Health PubMed, Last Reviewed: September 16, 2011
- ^ a b c d e f g Cancer Research UK: Penile Cancer: Symptoms of penile cancer Cancer Research UK
- ^ a b c http://oncolex.org/en/Penile/Background/Staging
- ^ a b c d e f g h i The American Cancer Society: Penile Cancer: "What are the risk factors for penile cancer?" The American Cancer Society
- ^ a b c d Pow-Sang MR, Ferreira U, Pow-Sang JM, Nardi AC, Destefano V (August 2010). "Epidemiology and natural history of penile cancer". Urology 76 (2 Suppl 1): S2–6. doi:10.1016/j.urology.2010.03.003. PMID 20691882.
- ^ a b Larke NL, Thomas SL, dos Santos Silva I, Weiss HA (August 2011). "Male circumcision and penile cancer: a systematic review and meta-analysis". Cancer Causes Control 22 (8): 1097–110. doi:10.1007/s10552-011-9785-9. PMC 3139859. PMID 21695385.
- ^ a b c d Bleeker MC, Heideman DA, Snijders PJ, Horenblas S, Dillner J, Meijer CJ (April 2009). "Penile cancer: epidemiology, pathogenesis and prevention". World J Urol 27 (2): 141–50. doi:10.1007/s00345-008-0302-z. PMID 18607597.
- ^ a b c d Minhas S, Manseck A, Watya S, Hegarty PK (August 2010). "Penile cancer--prevention and premalignant conditions". Urology 76 (2 Suppl 1): S24–35. doi:10.1016/j.urology.2010.04.007. PMID 20691883.
- ^ de Souza KW, dos Reis PE, Gomes IP, de Carvalho EC (March 2011). "[Prevention strategies for testicular and penile cancer: an integrative review]". Rev Esc Enferm USP (in Portuguese) 45 (1): 277–82. PMID 21445520.
- ^ National Cancer Institute: Penile Cancer National Institutes of Health
- ^ http://www.cdc.gov/cancer/hpv/statistics/penile.htm HPV-Associated Penile Cancer Rates by Race and Ethnicity] Center for Disease Control and Prevention
- ^ Brandel France de Bravo, MPH, Maushami DeSoto, PhD, Krystle Seu Stop Cancer Fund: HPV: Q & A Cancer Prevention and Treatment Fund, Published April 2009
- ^ Reis AA, Paula LB, Paula AA, Saddi VA, Cruz AD (June 2010). "[Clinico-epidemiological aspects associated with penile cancer]". Cien Saude Colet (in Portuguese). 15 Suppl 1: 1105–11. PMID 20640268.
- ^ Morris BJ, Gray RH, Castellsague X, et al. (2011). "The Strong Protective Effect of Circumcision against Cancer of the Penis". Adv Urol 2011: 812368. doi:10.1155/2011/812368. PMC 3113366. PMID 21687572.
- ^ Micali G, Nasca MR, Innocenzi D, Schwartz RA (March 2006). "Penile cancer". J. Am. Acad. Dermatol. 54 (3): 369–91; quiz 391–4. doi:10.1016/j.jaad.2005.05.007. PMID 16488287.
- ^ NewYork-Presbyterian: Penile Cancer: Overview NewYork–Presbyterian Hospital
- ^ http://www.cancer.gov/cancertopics/pdq/treatment/penile/HealthProfessional/page3
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