Cancer of the penis, a rare kind of cancer, is a disease in which cells are found on the skin and in the tissues of the penis.

Men who are not circumcised at birth may have a higher risk for getting cancer of the penis. A circumcision is an operation in which the doctor takes away part or all of the foreskin from the penis. The foreskin is the skin which covers the tip of the penis. A circumcision is done on many baby boys before they go home from the hospital.

A doctor should be seen if there are any of the following problems: growths or sores on the penis, any unusual liquid coming from the penis (abnormal discharge), or bleeding.

If there are symptoms of cancer, the doctor will examine the penis and feel for any lumps. If the penis doesn’t look normal or if the doctor feels any lumps, a small sample of tissue (called a biopsy) will be cut from the penis and looked at under a microscope to see if there are any cancer cells.

The chance of recovery and choice of treatment depend on the stage of the cancer (whether it is just in the penis or has spread to other places), and the patient’s general state of health.

Stages of cancer of the penis

Once cancer of the penis is found, more tests will be done to find out if the cancer has spread from the penis to other parts of the body (staging). A doctor needs to know the stage of the disease to plan treatment. The following stages are used for cancer of the penis:

Stage I

Cancer cells are found only on the surface of the glans (the head of the penis) and on the foreskin (the loose skin that covers the head of the penis).

Stage II

Cancer cells are found in the deeper tissues of the glans and have spread to the shaft of the penis (the long, slender cylinders of tissue inside the penis that contain spongy tissue and expand to produce erections).

Stage III

Cancer cells are found in the penis and have spread to nearby lymph nodes in the groin. (Lymph nodes are small bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells).

Stage IV

Cancer cells are found throughout the penis and the lymph nodes in the groin and/or have spread to other parts of the body.

Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the same area or in another place.

How cancer of the penis is treated

There are treatments for all patients with cancer of the penis. Four kinds of treatment are used:

• Surgery (taking out the cancer in an operation)
• Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells and shrink tumours)
• Chemotherapy (using drugs to kill the cancer cells)
• Biological therapy (using the immune system to fight cancer)

Surgery is the most common treatment of all stages of cancer of the penis. A doctor may take out the cancer using one of the following operations:

• Wide local excision takes out only the cancer and some normal tissue on either side.
   
• Microsurgery is an operation that removes the cancer and as little normal tissue as possible. During this surgery, the doctor uses a microscope to look at the cancerous area to make sure all the cancer cells are removed.
   
• Laser surgery uses a narrow beam of light to remove cancer cells.
   
• Circumcision is an operation that removes the foreskin.
   
• Amputation of the penis is an operation that takes out the penis. It is the most common and most effective treatment of cancer of the penis. In a partial penectomy, part of the penis is taken out. In a total penectomy, the whole penis is removed. Lymph nodes in the groin may be taken out during surgery.

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumours. Radiation may come from a machine outside the body (external radiation) or from putting materials that contain radiation through thin plastic tubes into the area where the cancer cells are (internal radiation). Radiation may be used alone or after surgery.

Chemotherapy uses drugs to kill cancer cells. Fluorouracil cream (a chemotherapy drug put on the skin of the penis) is sometimes used for very small surface cancers of the penis. Chemotherapy may also be given by pill or by a needle in a vein. When chemotherapy is given in this way, it is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells outside the penis.

Biological therapy tries to get the body to fight cancer. It uses materials made by the body or made in a laboratory to boost, direct, or restore the body’s natural defences against disease. Biological treatment is sometimes called biological response modifier (BRM) therapy.

Treatment by stage

Treatment of cancer of the penis depends on the stage of the disease, the type of disease, and the patient’s age and overall condition.

Stage I Penile Cancer

If the cancer is limited to the foreskin, treatment will probably be wide local excision and circumcision.

If the cancer begins in the glans and does not involve other tissues, treatment may involve:

• Fluorouracil cream
• Microsurgery

If the tumour begins in the glans and involves other tissues, treatment may involve:

• Amputation of the penis (partial penectomy). Lymph nodes in the groin may also be removed.
• External radiation therapy
• Microsurgery

Clinical trials of laser therapy for stage I penile cancer are also being conducted.

Stage II Penile Cancer

Treatment may be amputation of the penis (partial, total, or radical penectomy) or radiation therapy followed by amputation of the penis. Clinical trials of laser therapy for stage II penile cancer are also being conducted.

Stage III Penile Cancer

Treatment may be amputation of the penis, followed by removal of lymph nodes on both sides of the groin or amputation of the penis followed by radiation therapy. Clinical trials of chemotherapy and chemotherapy with radiation therapy are also being conducted.

Stage IV Penile Cancer

Treatment will be designed to reduce symptoms and may include wide local excision, microsurgery, amputation of the penis, or radiation therapy. Clinical trials of chemotherapy combined with surgery or radiation therapy are also being conducted.

Recurrent Penile Cancer

If the cancer has come back (recurred), treatment may include amputation of the penis or radiation therapy. Clinical trials of chemotherapy or biological therapy are also being conducted

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CARE OF THE UNCIRCUMCISED PENIS