Penile cancer surgery removes cancerous tissue from the penis. This procedure aims to eliminate the malignancy while preserving as much of the organ’s function as possible. The primary objectives are to achieve a complete cure for the cancer and maintain urinary and sexual capabilities. The specific surgical approach depends on the tumor’s size, location, and the cancer’s stage.
Types of Surgical Procedures
Surgical options for penile cancer vary, ranging from minimally invasive techniques for early-stage disease to more extensive procedures for advanced tumors. Procedures are selected based on the depth and spread of the cancerous cells.
For very early-stage or superficial cancers, organ-sparing surgeries may be considered. Mohs micrographic surgery involves removing thin layers of skin containing the tumor, examining each layer under a microscope immediately, and continuing until no cancer cells are detected. Wide local excision removes the tumor along with a margin of healthy surrounding tissue, and the remaining skin is then stitched together. Laser therapy uses a focused beam of light to destroy cancer cells, often employed for small, early-stage tumors or precancerous conditions.
If the cancer is confined to the foreskin, a circumcision may be sufficient to remove the cancerous tissue. This procedure removes the foreskin just below the head of the penis, leaving the glans uncovered. For tumors located solely on the head (glans) of the penis, a glansectomy is performed, which involves removing the glans while retaining as much of the penile shaft as possible. After a glansectomy, the head of the penis can sometimes be reconstructed using a skin graft from another part of the body, such as the thigh.
When the cancer has grown deeper into the penile tissue or shaft, a partial penectomy may be necessary. This operation removes the end of the penis, leaving a portion of the shaft intact. The surgeon aims to leave enough of the remaining shaft to allow for standing urination and to preserve some sexual function. If the cancer is extensive, located deep within the penis, or at its base, a total penectomy is required, involving complete removal of the penis. In such cases, the urethra is rerouted to a new opening, often situated between the scrotum and the anus.
Lymph Node Removal
Penile cancer can spread to the lymph nodes, particularly those located in the groin and pelvis. Surgical removal of these nodes, known as lymphadenectomy or lymph node dissection, is performed to check for cancer spread and to treat any existing metastasis. This helps accurately stage the cancer and guide further treatment decisions.
One approach is the sentinel lymph node biopsy, a less invasive procedure used when there are no palpable lymph nodes in the groin. During this biopsy, a special dye or radioactive substance is injected near the tumor, which then travels to the first few lymph nodes the cancer would likely reach, known as the sentinel nodes. These nodes are then removed and examined for cancer cells; if they are clear, further extensive lymph node removal may not be needed, thus reducing potential complications.
If cancer is found in the sentinel nodes, or if lymph nodes are already enlarged and palpable, a more extensive surgery called an inguinal lymphadenectomy is performed. This procedure involves removing a larger group of lymph nodes from the groin area through an incision. For more advanced cases where cancer has spread further, a pelvic lymph node dissection may also be necessary to remove nodes in the pelvic region. A potential consequence of lymph node removal is lymphedema, a condition causing swelling in the groin, legs, or scrotum due to impaired lymphatic fluid drainage.
Preparing for the Operation
Preparing for penile cancer surgery involves several steps to ensure patient readiness. This preparation begins with consultations with the surgical team and an anesthesiologist to discuss the procedure, potential risks, and anesthesia options. Patients receive explanations of what to expect during and after the operation.
Pre-operative medical tests are conducted, which may include blood tests, a chest X-ray, and an electrocardiogram (ECG) to assess overall health and fitness for surgery. These evaluations help identify any underlying conditions that might affect the operation or recovery. Patients are also given specific instructions regarding eating and drinking restrictions, requiring fasting for about six hours before the procedure.
Information is also provided on managing current medications, with guidance on which ones to stop or adjust before surgery, particularly blood thinners that could increase bleeding risks. Patients are encouraged to ask questions and address any concerns with their healthcare team during these pre-operative appointments. Additionally, they may be advised on breathing and leg exercises to perform before and after surgery to help prevent complications like chest infections and blood clots.
Recovery and Post-Surgical Life
After penile cancer surgery, the immediate recovery phase involves a hospital stay, the length of which depends on the extent of the procedure. Patients may have a urinary catheter in place for several days to a week or more, which helps drain urine while the surgical site heals. Pain management is provided through prescribed painkillers to ensure comfort during this initial period.
Long-term adjustments after penile cancer surgery vary based on the type of procedure performed. Urinary function may be affected; for instance, after a total penectomy, patients need to sit to urinate because the urethra is redirected to a new opening. Partial penectomy can allow for urination while standing, although some changes in stream may occur.
Sexual function is a concern, and its impact depends on the amount of penile tissue removed. Organ-sparing surgeries like wide local excision or glansectomy may have less impact on sexual pleasure, with men able to return to sexual activity within a few months. After a partial penectomy, the remaining shaft can still achieve an erection and allow for penetration, though the absence of the glans may alter sensation. Intercourse is not possible after a total penectomy, but alternative methods of intimacy and sexual satisfaction can be explored.
Reconstructive options, such as phalloplasty, may be available at a later stage for those who have undergone a total penectomy, creating a new penis using tissue from other body parts. This complex procedure involves multiple stages and aims to improve cosmetic appearance, though sensation and natural erections are not restored without additional interventions like a penile prosthesis. Psychological support and counseling are recommended to help individuals and their partners adjust to physical changes and emotional impacts on self-image and quality of life.