About Penile Cancer
Penile Cancer Screening and Diagnosis
In order to determine if an abnormality on the penis is cancer, a biopsy is needed in which a sample of skin tissues is removed for laboratory testing. If cancer is confirmed, tests to determine the extent of the cancer will be recommended, including:
- Fine needle aspiration: In this type of biopsy, cells are removed through a thin needle that has been placed directly into the mass.
- Ultrasound: This procedure uses sound waves to help determine how deeply a tumor has invaded into the penis.
- CT Scan or MRI: A CT scan or MRI may reveal the presence of enlarged lymph nodes—an indication that the cancer has spread.
- Lymph node dissection or sentinel lymph node biopsy: These procedures are used to surgically remove lymph nodes in the groin to determine if the cancer has spread. Sentinel lymph node biopsy uses a radioactive tracer to find the first lymph node that may be cancerous. This minimizes the number of lymph nodes that need to be removed for analysis and therefore minimizes side effects of the lymph node dissection.
The exact cause of most penile cancer is unknown. While many men who develop penile cancer have no known risk factors, it may be associated with the following:
- Human papillomarvirus (HPV) infection: This type of infection is considered the most important avoidable risk factor for penile cancer because the virus can cause warts which are passed along during sexual contact
- Having unprotected sexual relations with multiple partners, which increases risk of contracting HPV
- Smoking: Smoking is thought to damage the DNA of cells in the penis and contribute to the development of penile cancer, especially in men with HPV infection
- Psoriasis treatment in men: Men who have been treated for psoriasis with a of a drug called psoralen and exposure to ultraviolet light have a higher rate of penile cancer.
- Poor hygiene: Oily secretions from the skin and dead skin cells, which accumulate under the foreskin, can result in a substance called smegma. While not proven, it has been suggested that smegma may contain cancer-causing substances.
It had been believed that men who are circumcised have a lower risk of developing penile cancer, however, this has not been proven.
Early symptoms of penile cancer include the appearance of a painless nodule, a warty growth or ulcer on the penis, especially on the glans or foreskin, or swelling at the end of the penis. Any abnormality of the penis, including warts, blisters, sores, ulcers, white patches, rash or bumps, should be evaluated by a physician. Most penile cancers do not cause pain, but can cause ulceration and bleeding in later stages. A number of benign conditions, such as genital warts or infections, can have similar symptoms, but it is important to discuss these with a physician promptly since penile cancer detected and treated in early stages can be curable.
It is thought that penile cancer is a preventable disease since there are wide variations in the incidence of this cancer around the world. In general, it is best to avoid the known risk factors mentioned previously. Reducing the chance of developing penile cancer includes avoiding sexual practices that are likely to result in human papillomavirus infection, limiting the number of sexual partners, and quitting smoking. In addition, practicing good genital hygiene by retracting the foreskin (in uncircumcised men) and cleaning the entire penis is important since some, but not all, studies suggest that a substance called smegma could contain cancer-causing elements.
It is still questionable whether circumcision reduces the risk of developing penile cancer; especially since penile cancer risk is low in some uncircumcised populations.