Penile Cancer: Symptoms, Causes, Treatment and More

Penile cancer is relatively uncommon in the United States. According to the American Cancer Society, about 2210 new cases of penile cancer will be diagnosed in 2021 in the US, and 460 deaths are estimated to occur. 

This serious disease affects fewer than one in 100,000 men a year. In fact, penile cancer accounts for 1% of cancers affecting U.S. men. Although it’s a rare cancer, it’s important to learn about penile cancer and the symptoms it causes. 

In this post, you’re going to learn more about penile cancer, from its symptoms and causes to treatment and prevention.

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What is penile cancer?

Penile cancer, or cancer of the penis, is a type of cancer that forms in tissues, the skin, and the foreskin of the penis. Like other cancers, penile cancer occurs when healthy cells become cancerous and start multiplying thus forming a tumor. In many cases, cancer starts on penile skin and reaches tissues inside. 

There are different types of penile cancer, such as:

  • Squamous cell carcinoma (epidermoid carcinoma) – usually starts in the foreskin
  • Sarcoma – develops in tissues such as blood vessels, fat, and muscle
  • Basal cell carcinoma – starts deep in the skin, grows slowly, and is unlikely to spread to other parts of the body
  • Melanoma (skin cancer) – forms in cells that are responsible for your skin color

The most common variant of penile cancer is squamous cell penile cancer and it often requires prompt medical or surgical intervention. Early diagnosis is crucial for favorable outcomes and treatment of this disease, but many men delay going to the doctor. 

Delay is often a result of embarrassment, fear, guilt, and denial. Sometimes patients attempt to self-medicate before seeing a doctor. Read on to learn more about symptoms, when to see a doctor, and how the disease is treated. 

Symptoms

The first symptom of penile cancer men notice is a mass, lump, or ulcer on the penis. The mass may look like an infected sore or a small and insignificant bump. That’s why men often overlook this problem and don’t think it’s something serious. 

In most cases, the lump is found on the foreskin or head of the penis, not on the shaft. The actual appearance of penile cancer may vary. In some cases, the mass may appear as a white-grey bump growing out of penile skin. But in other instances, it can be flat, reddish, and ulcerated. 

The lesions tend to grow slowly along the surface of the skin of the penis and often cover the whole prepuce or glans before reaching the shaft and corpora of the penis.

Besides the lump or ulcer, symptoms of penile cancer may include:

  • Itching

  • Burning sensation

  • Swollen lymph node in the groin area

  • Redness and irritation 

  • Thickening of the penile skin

  • Bleeding

  • Changes in the color of the penis

Again, it is crucial to see the doctor immediately after noticing these symptoms. Timely diagnosis leads to prompt treatment and more favorable outcomes. 

Causes

Like in many other cancers, the exact cause of this disease is unknown. It is not entirely clear why cells become cancerous and start multiplying abnormally. Penile cancer could link with other conditions. Normal, healthy cells produce tumor suppressor gene products to control themselves. These substances prevent cells from becoming cancerous or growing too quickly. 

However, E6 and E7 proteins produced by high-risk types of HPV (human papillomavirus) can inhibit the activity of tumor suppressor gene products in cells. As a result, cells may start growing out of control and multiplying rapidly as they become cancerous cells. Interestingly, HPV causes cervical cancer in women. The rates of penile cancer are still low compared to HPV prevalence. Besides HPV, tobacco use has been associated with the formation of penile cancer. 

Tobacco produces cancer-causing substances that may spread throughout your body. As these chemicals spread, they may reach and damage DNA inside cells, including those in your penis. For your reference, genes are comprised of DNA, and they are in charge of the growth and division of the cells. Therefore, problems with DNA affect genes that regulate cell growth and thereby may contribute to cancer.

Risk factors

Theoretically speaking, any person with a penis can develop penile cancer. But most of them do not. Some factors increase the risk of penile cancer, such as:

Age 

The risk of penile cancer increases with advancing age. The average age of penile cancer diagnosis in the U.S. is 68. Additionally, four in five penile cancers are diagnosed in men who are older than 55 years.

AIDS 

Men with AIDS have a weaker immune system, which could be why they’re more likely to have penile cancer.

Being a smoker 

The chemicals produced with tobacco smoking can damage DNA. Also, they are inhaled into the lungs and then absorbed into the blood, and travel throughout the body. 

Having smegma or phimosis 


Smegma is a thick and smelly substance comprised of secretions that accumulate under the foreskin. Phimosis happens when the foreskin becomes tight and difficult to retract.

HPV infection 

HPV is a group of over 150 viruses. Some types of HPV can infect the genital area and cause genital warts called condylomas (condyloma acuminata). Keep in mind HPV spreads from one person to another via skin-to-skin contact and sexual activity.

UV light treatment of psoriasis

Men with psoriasis often receive psoralens and UVA (ultraviolet A) light source i.e. PUVA therapy. Men who have this kind of treatment could be more likely to develop penile cancer.

Other risk factors for penile cancer may include chronic inflammation, balanitis (swollen or sore head of the penis), penile trauma, poor hygiene, history of sexually transmitted diseases, and lichen sclerosus (skin disorder affecting genitals).

Diagnosis and testing

As mentioned above, you should not ignore symptoms of penile cancer. You shouldn’t self-medicate or think they’re going to disappear on their own. Instead, you need to see the doctor and report all symptoms you’re experiencing. They will take the necessary steps and also provide cancer information. 

Based on the symptoms and present lump, the doctor may suspect penile cancer is the problem, but they need to order a biopsy to confirm the diagnosis. For the purpose of biopsy, small tissue is removed from the penis and analyzed under a microscope. If the biopsy shows the presence of cancer, the healthcare professional may perform a cystoscopy to determine whether the cancer has spread. 

During the cystoscopy procedure, the doctor inserts a cystoscope gently into the opening of the penis and through your bladder. This test allows doctors to evaluate different areas of the penis and its surrounding structures. 

The doctor may order MRI to determine whether cancer has reached deeper tissues, but this test is not always performed. In some cases, a CT scan may be necessary. HPV DNA may be useful for men in high-risk groups.

Upon diagnosis of penile carcinoma, the healthcare professional also gives stage and grade to indicate how advanced the disease is and how much cancerous tissue a patient has. 

For example:

Stage 0 

Cancer is present on the skin but hasn’t spread to glands and lymph nodes i.e. you have normal tissue.

Stage 1 

Cancer reached connective tissue below the skin, but hasn’t spread to glands, lymph nodes, and other parts of the body.

Stage 2 

Cancer affects connective tissue below the skin, lymph/blood vessels or cells, urethra, or erectile tissues, but hasn’t spread to other parts of the body.

Stage 3A

Cancer affects connective tissue, lymph/blood vessels or cells, urethra, erectile tissues, and one or two lymph nodes in the groin area, but hasn’t reached other parts of the body.

Stage 3B 

Same as 3A, but cancer has spread to multiple lymph nodes in the groin area and hasn’t reached other parts of the body.

Stage 4 

Cancer affects surrounding tissues such as the prostate, pubic bone, scrotum, and other parts of the body.

Treatment

Penile cancer can be invasive or noninvasive. The latter refers to cases when the disease hasn’t spread to other tissues and parts of the body. Invasive penile cancer has reached other tissues.

Treatment for noninvasive penile squamous cell carcinoma may include several approaches such as circumcision, adjuvant chemotherapy, topical chemotherapy, laser therapy, cryosurgery, and radiation therapy. The role of biologic therapy requires further research.

Major surgery is necessary for the treatment of invasive penile cancer care. Surgical procedures may include removing the tumor or penile lesion, penis, and affected inguinal lymph nodes. 

In other words, penile cancer treatment procedures the doctor may recommend include:

  • Excisional surgery – to remove the primary tumor from the penis

  • Moh’s microsurgery – to remove the lowest amount of tissue while eliminating all tumor cells

  • Partial penectomy – to remove a part of the penis

Inguinal lymphadenectomy is the procedure where lymph nodes are removed. Most men diagnosed with penile cancer achieve a full recovery. The key is to see the doctor immediately because timely diagnosis leads to improved cancer treatment success.

Penile cancer prevention

Actually, there is no foolproof way to prevent any type of cancer, and penis cancer is not the exception. However, there’s a lot you can do to minimize the risk of developing this disease.

For example:

  • Practice proper hygiene, wash your penis regularly

  • Use protection when having intercourse

Conclusion

Penile cancer isn’t that common in the U.S., but it’s useful to learn everything about it. While a serious disease, cancer of the penis is manageable. It’s crucial to get an early diagnosis and timely treatment. 

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Sources

  1. Clark PE, Spiess PE, Agarwal N, et al. Penile cancer: Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4042432/
  2. Engelsgjerd JS, LaGrange CA. Penile Cancer. [Updated 2020 Sep 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499930/

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