Penile cancer

Penile cancer is a rare pathology. Among the malignant tumors of the penis, squamous cell carcinoma is the most common (94%), which is localized on the glans or foreskin. Other forms of tumors are rare (6% of all cases). Speaking of localization, cancer of the glans is registered in 48% of cases, and 21% of cases involve the foreskin. Oncology of the body of the organ is even less common. Provided timely diagnosis is made, treatment of the disease gives good results.

• Long-term papillomavirus infection. The probability of contracting papillomavirus through sexual contact is 63-67%; in addition, it is proportional to the number of sexual partners. In studies, the virus is detected in 50% of men, but it mostly regresses on its own, without special treatment. Most papillomavirus infections are benign. However, the long-lasting form caused by oncogenic HPV types (16 and 18) leads to cancer of the oncogenital area. Oncogenic types of the virus are detected in 50% of penile cancer cases, and in the case of the basal type of neoplasm, the rate is 90%.
• High risk in the following diseases: erythroplasia of Keir, intraepithelial neoplasia, Bowen's disease.
• Smoking. Tobacco smoke contains toxic and carcinogenic substances that affect DNA. This effect is most dangerous when a man is infected with the papillomavirus.
• Inflammatory processes of the glans penis or foreskin.
• Formation of a large amount of smegma (lubricant). With insufficient hygienic care, bacteria accumulate in the fatty secretions, causing constant inflammation.
• AIDS. Significantly increases the risk of cancer due to a decrease in immunity.
• Phimosis. In 25% of patients, this pathology leads to cancer. Foreskin circumcision performed in childhood reduces the risk of developing the disease by 70%.

Usually, tumors of this organ are located superficially, so they are accessible for examination. However, at the beginning of the disease, the manifestations may be absent or almost invisible. For example, in case of phimosis, when the process is localized under the foreskin, or if the tumor appears in the furrow area.

Most often, the primary tumor is found on the foreskin (from its inner surface) and the glans, and lastly on the body of the organ. The size of the primary focus ranges from 2 to 4.5 cm. Usually, the pathological area has a changed color and appearance, erosion, nodes or plaques. Over time, the tumor grows and becomes dense, and phimosis with abnormal profuse discharge may develop. The focus gradually grows into the cavernous bodies. In the absence of timely treatment, the malignant tumor becomes infected with the development of phlegmon, urethral fistula and bleeding, and there is a risk of sepsis. Pain is not a characteristic symptom of this disease.

Excessively enlarged inguinal lymph nodes may be associated with metastasis or the development of infectious lymphadenitis. Penile cancer is characterized by bilateral lymph node involvement. In case of metastasis, the inguinal lymph nodes are affected first, and later, enlarged pelvic lymph nodes are detected on CT scan. Even later - distant metastases, but this is extremely rare.

Lymph nodes merge with each other into conglomerates that grow into the skin and form fistulas. Impaired lymph drainage causes swelling of the lower extremities. With edema, significant lymphostasis and painful enlarged lymph nodes are determined. In case of late detection of the tumor, weight loss, weakness, and fatigue are detected.

Therefore, any suspicious neoplasm on the penis (white spot or other discoloration, wart, thickening, ulcer) should be alarming and should be a reason to visit a doctor.

Most tumors of this organ are detected at an early stage during an external examination. In the future, the patient is offered an examination.

• blood tests;
• immunochemical examination of tumor markers.

A cytological examination of the material is also performed. Biopsy of the tumor and lymph nodes is performed with a needle, which makes it possible to determine the type of cancer and the degree of anaplasia.

As a result of the examination, stage 0-IV is determined, on the basis of which doctors develop a treatment option. However, many patients delay their visit to an oncologist, which leads to late diagnosis. An average of 5 months pass from the moment of the first complaints to the time of visiting a doctor. Early detection of pathology allows for effective therapy.

When drawing up an action plan, doctors take into account the type of tumor, the stage of the process, age, and assess the general condition of the patient. With this in mind, such therapeutic techniques as: surgery, chemotherapy and radiation treatment can be used.

Surgical intervention in this case can be organ-preserving or radical. In case of small non-germinating lesions, an organ-preserving technique with removal of the focus is used. For this purpose, microsurgical operations are performed: laser or cryodestruction, circumscription or excision of the penile skin, replacing it with scrotal tissue.

Thanks to adjuvant (adjuvant) therapy with the use of chemotherapy (including local) and radiation treatment, it is possible to avoid radical surgery. Only in some cases is penectomy or partial amputation (of the head or part of it) indicated. The indication is a recurrence of large cancer. In case of total penectomy, a urethrostomy is applied (formation of a new urethra for urination). Later, a reconstructive surgery is performed - phalloplasty. Removal of inguinal nodes is the most effective treatment for metastases. Chemotherapy is recommended when more than one inguinal and pelvic lymph nodes are involved in the process.

The prognosis for malignant tumors of this organ is considered favorable. Early consultation with an oncologist is important for effective treatment and complete cure. The sooner the patient gets to the doctor's appointment, the more opportunities there will be to achieve a positive result. After treatment, it is recommended to undergo an examination 3-4 times a year to detect local relapses in time.

Prevention measures for this disease are not complicated and quite feasible. Given that penile cancer in 50% occurs due to the human papillomavirus, which is transmitted during sexual intercourse, effective measures to prevent infection will be

use of protection during sexual intercourse;

avoiding casual and multiple sexual relations.

Hygiene procedures reduce the risk of inflammation and additional secondary infection. Prevention of infection with the virus is vaccination, which is carried out for boys who have not yet begun sexual activity.

The role of HPV vaccination

An effective prevention of this type of cancer is HPV vaccination, which is recommended for boys aged 9–14 years, before the onset of sexual activity. The vaccine prevents infection with oncogenic types of the virus, which also cause cancer of the anal canal, oral cavity and throat. In most countries (including Ukraine), HPV vaccination for boys is included in national preventive programs. It is recommended:

• to undergo a vaccination course of two doses (for children 9–14 years old) or three doses (for those over 15 years old);
• to choose a vaccine registered in Ukraine (Gardasil-9 or Cervarix).

Article author - Kopchak Konstantin Volodymyrovych

Article reviewer - Zadorozhna Kristina Olegivna