Penile cancer is a rare malignancy where abnormal cells begin to grow in the tissues of the penis, most often affecting the skin or foreskin. In its earliest stages, a primary tumor or lesion associated with penile cancer is frequently not painful, which can lead to delays in seeking medical attention. Pain often arises later if the cancer is advanced, if it has developed an infection, or if the tumor has caused a significant ulceration. Recognizing early physical changes, even those without accompanying pain, is therefore important for a prompt diagnosis.
Recognizing the Early Signs
The first indication of penile cancer is usually a noticeable change in the skin, which may appear on the head of the penis, the foreskin, or the shaft. This change often manifests as a persistent sore, ulcer, or growth that fails to heal within a four-week period. These lesions can look like a wart, blister, or crusty bump, and may be accompanied by bleeding or a foul-smelling discharge from underneath the foreskin.
Other symptoms include a thickening of the skin or a change in its color, sometimes appearing as a reddish or bluish-brown flat growth. Swelling at the tip of the penis or difficulty in pulling back the foreskin, a condition called phimosis, can also be a sign. While these symptoms can also be caused by less serious conditions, any persistent abnormality warrants a medical evaluation.
Factors Increasing Risk
Several factors are associated with an increased likelihood of developing penile cancer, with some relating to chronic inflammation and cellular changes. Infection with the Human Papillomavirus (HPV) is a primary risk factor, as the virus produces proteins that interfere with tumor suppressor genes in healthy cells. Advanced age is also a factor, as the majority of cases are diagnosed in men over the age of 55.
Poor genital hygiene, especially in uncircumcised men, can lead to the buildup of smegma—a substance of dead skin cells and oils—under the foreskin. This chronic irritation and inflammation, often compounded by a tight foreskin (phimosis), increases the risk of developing malignant changes. Additionally, tobacco use is a factor, as smoking can damage cells and hinder the body’s ability to fight infections.
How Penile Cancer Is Identified
The diagnostic process begins with a thorough physical examination, during which a healthcare provider will visually inspect the penis and feel the groin area for enlarged lymph nodes. If a suspicious lesion is found, a biopsy is the only definitive way to confirm a penile cancer diagnosis. This procedure involves removing a small sample of the abnormal tissue for examination under a microscope by a pathologist.
The type of biopsy performed can be incisional, taking only a portion of the growth, or excisional, removing the entire area. If the cancer is confirmed, imaging tests such as CT scans, MRIs, or ultrasounds are used to determine the stage of the disease. These scans help assess the depth of tumor invasion into the penile tissues and check if the cancer has spread to nearby lymph nodes or distant organs.
Treatment Approaches
Treatment for penile cancer is individualized and depends on the stage, size, and location of the tumor. For very early-stage cancers, like carcinoma in situ, non-surgical options are sometimes utilized, including the application of topical chemotherapy creams or laser ablation. When the cancer is confined to the foreskin, a simple circumcision and wide local excision may be sufficient to remove the tumor.
More advanced cancers often require surgical intervention, which can range from Mohs microsurgery, which precisely removes layers of tissue to preserve healthy surrounding tissue, to a partial or total penectomy. Radiation therapy, delivered externally or internally through brachytherapy, is an alternative treatment, particularly for patients who wish to avoid surgery or who are not candidates for an operation. Chemotherapy, either systemic for widespread disease or topical for superficial lesions, may be used in combination with other treatments, especially in cases where the cancer has spread to the lymph nodes.