Cancer Treatment
Penile Cancer
The external male genital organ called the penis comprises three tubes, namely, the corpus spongiosum & 2 corpora cavernosa, wherein the corpora cavernosa consists of spongy erectile tissues along with blood vessels and nerves. The corpora spongiosum serves as a protective sheath for the urethra and terminates into the glans penis.
The formation of tumours on the penis tissues called penile cancer initially emerges as blisters on the foreskin, head or shaft of the penis and transforms into a wart-like growth discharging blood or foul-smelling liquid. Infection of Human papillomavirus (HPV)increases the risk of penile cancer and can be prevented with condom use and HPV vaccines.
Symptoms of Penile Cancer:
Non-healing ulcer
Phimosis with swelling developing underneath the glans penis with or without fowl smelling discharge.
Swellings in groin
Change in penile skin thickness or colour
Changes in a pre-existing mole on the penile skin
Cancer Treatment
Types of Penile Cancer
- Squamous cell carcinoma: This is the most common type of cancer and is found in 95% of the cases.
- Basal Cell Carcinoma: These cancers grow slowly and rarely metastasize to other parts of the body.
- Melanoma: The deepest layer of the epidermis consists of melanocytes, the skin cells responsible for producing melanin – a pigment accountable for brown skin colour, which protects us from UV rays. The malignant transformation of melanocytes is called melanoma, which is an aggressive tumour with high chances of lymph nodal and distant metastasis.
- Sarcoma: These tumours are aggressive and develop from connective tissues of the penis.
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Cancer Treatment
Causes of Penile Cancer
- Phimosis and lack of personal hygiene: The inability to retract the preputial skin is called phimosis. The smegma, a by-product of bacterial action on desquamated cells in the preputial sac, causes discomfort and is responsible for malignant transformation.
- HPV infection: Human Papillomavirus (HPV), contracted through unprotected sexual activities with more sexual partners, increases the risk of infection. Some strains of this virus particularly HPV type 16 & 18 are accountable for most of the penile cancers in patients.
- HIV infection: HIV and AIDS compromise the immune system, making the body susceptible to multiple diseases, including the formation of cancer cells.
- Use of tobacco products: Smoking and use of smokeless tobacco (Hans, Gutkha, betel quid etc.) increase the risk of acquiring penile cancer.
- Chronic balanitis: Chronic infection and inflammation of the glans penis is common in immunosuppressed individuals having been diagnosed with diabetes, AIDS, and organ transplant patients, and is associated with an increased risk of penile cancer.
- Lichen sclerosis: Lichen sclerosis is an uncommon condition that leads to patchy-white skin that appears thinner than normal, affecting the genital and anal areas and is associated with an increased risk of acquiring penile cancer.
Neonatal circumcision, maintaining proper hygiene and quitting smoking and tobacco products reduces the risk of acquiring penile cancer.
Prevention of Penile Cancer
Preventive measures to stay safe against penile cancer are:
Neonatal circumcision: Having a circumcision done in the neonatal age group is proven to be protective against penile cancer.
- Maintaining proper hygiene, especially in the genital areas
- Use of protective barriers during sexual intercourse
- Avoiding multiple sexual relations
- Quits smoking and other tobacco products
Tests for Penile Cancer
Once, you see a specialist, the following tests are recommended to confirm the diagnosis:
A physical exam: A thorough physical examination will be carried out, after taking a detailed history of your symptoms.
Biopsy: A biopsy is performed to determine the exact type of penile cancer and the process varies depending on the size of the growth or suspicious area:
Incisional Biopsy: For large ulcerative growths or swellings, a small piece is taken after administering local anaesthesia and sent for histopathological analysis.
Excisional Biopsy: For smaller growths or suspicious areas, the entire area is removed under local anaesthesia.
Lymph Node FNAC: A small needle is used to aspirate cells from the enlarged lymph nodes in the groin to check for the spread of cancer cells.
Imaging Tests:
Ultrasound: In case of early cancers, an ultrasound of the abdomen may be requested to look for any suspicious lymph nodal enlargements in the groin or pelvic region.
CT scan: In patients with clinically suspicious groin lymph nodes, a CT scan of the chest, abdomen and pelvis may be done to determine the spread of cancer into lymph nodes (pelvic, abdominal or mediastinal) or to other organs. This helps to correctly stage the disease; which in turn will help decide the best treatment sequence for a given patient.
PET CECT scan: A PET CT scan may be suggested in advanced or recurrent cases to rule out the spread of cancer to other sites, eg lungs, liver, bone, etc.
Treatment for Penile Cancer
The treatment regimen consists of:
Surgery: Surgery involves the removal of the primary penile tumour with a margin of normal tissue and can be executed with multiple procedures depending on the size of the penile cancer.
- Moh’s micrographic surgery: In case of very small tumours, the tumour is removed layer by layer, preserving a sizeable portion of normal penile tissues as possible.
- Circumcision:In small tumours affecting the preputial skin (foreskin) only a circumcision is executed.
- Glansectomy: For small tumours affecting the glans penis, only the glans is removed and called glansectomy.
- Partial penectomy:For tumours involving the distal part of the penile shaft, a partial penectomy is executed, and the residual penile stump is adequate for passing urine in upright posture and for sexual intercourse with his partner.
- Total penectomy with perineal urethrostomy:For large tumours, wherein an adequate penile stump cannot be left behind, a total penectomy is executed with perineal urethrostomy (creating a new opening for urethra in the perineum for passing urine).
- Groin lymph node dissection: Unilateral or bilateral groin lymph node dissection may be performed for patients with proven or suspicious groin lymph nodal spread.
Non-surgical treatment options: In very old or frail patients who cannot withstand any surgery or in very early cancers, specialists suggest non-surgical options like the use of topical agents, cryosurgery, cryotherapy or laser.
Chemotherapy: Chemotherapy in the form of injections or tablets may be suggested depending on the stage of the disease, comprising 6 cycles, with each cycle consisting of 2- 3 weeks. In some cases, radiation therapy is also given simultaneously and is called concurrent chemo-radiotherapy.
Radiotherapy: Radiotherapy uses high-energy rays to target and destroy cancer cells and may be used as an alternative to surgery or after surgery as adjuvant treatment.
Chemotherapy - Drugs to treat cancer cells are injected into the body, these drugs have tolerable side effects, and the side effects have been minimized with new forms of chemotherapy drugs with the evolving changes in medical and treatment approaches. Chemotherapy is crucial to contain the cancer cells circulating in the blood.
Radiation therapy: Intense energy usually X-rays or proton radiation is aimed directly at the operated area to kill cancer cells to minimize recurrence.
Doctors
Surgical oncology
Dr. Shreedhar G K
MBBS., M.S, M.Ch, DNB, PDF
Surgical oncology
Dr. Saravana Rajamanickam
MS, MCh
Radiation oncology
Dr. Karthick Rajamanickam
MD
Radiation Oncology
Dr. N. Kathiresan
MBBS., M.D.RT
Medical Oncology
Dr. Bhavesh Poladia
DNB, DM