Penile Cancer

Risk Factors for Penile Cancer

Several factors increase the risk of developing penile cancer, including:

1. Poor genital hygiene
2. Multiple sexual partners and unprotected intercourse
3. Infection with human papillomavirus (HPV)
4. Smoking

Early Signs of Penile Cancer

Penile cancer typically originates from the foreskin or glans penis. Be aware of the following symptoms:

1. Red discoloration of the glans or foreskin
2. Painless or painful ulcers on the penis
3. Unusual growths or lumps on the penis

If you notice any of these symptoms, consult a urologist immediately.

Stages of Penile Cancer

Many patients in India seek medical attention at a late stage due to poor hygiene, lack of awareness, and embarrassment. Initially, the cancer may appear as a red patch, ulcer, or small tumor on the foreskin or glans. If untreated, it can invade deeper tissues of the penis, spread to the lymph nodes in the thigh, and eventually affect vital organs such as the lungs and liver.

Diagnostic Tests and Imaging

To diagnose penile cancer, doctors may recommend:

1. Contrast-enhanced CT scans to assess lymph nodes, especially in obese patients
2. Chest X-rays
3. Comprehensive physical examination by a urologist

Role of Biopsy

A biopsy of the lesion is essential to confirm the diagnosis. This procedure can be performed under local anesthesia if the patient is cooperative.

Treatment for Sexually Active Patients

For patients with small lesions who wish to preserve sexual function, radiotherapy may be an option. However, it may impact cosmetic appearance and functionality. Radiotherapy is suitable for:

1. Motivated patients
2. Tumors smaller than 2 cm
3. Early-stage cancer (T1 and T2)

Treatment Options

The primary treatment for penile cancer is surgical removal of the affected part. This procedure, called partial penectomy, aims to leave enough of the penis intact for urination while standing and sexual activity.

If the cancer spreads deeper and wider, complete removal of the penis may be necessary. In such cases, a new urinary opening is created between the scrotum and anus, requiring the patient to urinate in a seated position.

Post-Surgery Follow-Up

Regular follow-ups with a urologist are essential after surgery. Patients should watch for warning signs such as:

1. Bleeding or ulceration at the surgical site
2. Swelling in the groin region (inguinal lymph nodes)

Treatment of Inguinal Lymph Nodes

If the cancer is high-grade or has spread to deeper penile tissues (corpora spongiosa and cavernosa), surgery is required to remove inguinal lymph nodes, even if they are not palpable. The gold standard treatment is open surgery using the Modified Catalona Technique, which includes frozen section analysis. If results are negative, deeper pelvic lymph nodes may be spared.

Role of Robotic Surgery

For patients with non-fixed, smaller inguinal lymph nodes, robot-assisted video endoscopic inguinal lymphadenectomy (VEIL) is an option.

Survival and Prognosis

Early diagnosis and proper treatment by a qualified urologist significantly improve the chances of a cure. Management of inguinal lymph nodes is crucial for a successful outcome. In advanced cases where the lymph nodes remain untreated, the prognosis worsens, and the disease may become fatal.

Chemotherapy and Radiation Therapy

For advanced stages where large, fixed inguinal lymph nodes are present or the cancer has spread beyond the groin, chemotherapy is recommended and should be administered by a medical oncologist. Radiation therapy may be used for pain relief and controlling metastasis.

Key Takeaway

Maintaining proper penile hygiene and being vigilant about early warning signs can prevent and ensure early detection of penile cancer, making it highly curable.