penile%20cancer
PENILE CANCER

Penile cancer is a rare type of malignant growth that occurs on the skin or tissues of the penis.

It often presents as a palpable visible penile lesion w/ signs that may include pain, bleeding, discharge or a foul odor.

The lesion may be fungating, nodular or ulcerative and may be concealed by phimosis.


Introduction

  • An uncommon malignancy with a rate of <1 per 100,000 men in the United States & Europe but is more common in Asia, Africa & South America
    • Incidence varies according to ethnicity, geographical location & racial group 
  • Typically occurs in older men with rates steadily increasing with age, between 50 & 70 years, though it may occur in younger men
  • >95% of penile cancer cases are of squamous cell origin & subtypes include verrucous carcinoma, warty carcinoma (verruciform), & basaloid carcinoma
    • Growth pattern may be through superficial spreading, nodular or vertical-phase, & verrucous
    • Warty carcinoma & basaloid carcinoma are less common but appear to be more associated with human papilloma virus (HPV), specifically HPV 16
    • High-risk squamous cell carcinoma variants with early metastases & high mortality rate include adenosquamous, basaloid, sarcomatoid, & poorly differentiated types

Definition

  • Carcinoma in situ of the penis occurring on the glans is referred to as erythroplasia of Queyrat & that occurring on the penile shaft is Bowen’s disease or Bowenoid papulosis
    • Erythroplasia of Queyrat has the highest potential of developing squamous cell carcinoma

Signs and Symptoms

  • Often presents as a palpable visible penile lesion with signs that may include pain, bleeding, discharge or a foul odor
    • The lesion may be fungating, nodular or ulcerative & may be concealed by phimosis

Risk Factors

  • A correlation is suggested by some studies between human papillomavirus (HPV) infection & penile cancer
    • Types 16 & 18 are the most common HPV subtypes in penile cancer & cancer risk is increased with condyloma acuminata
    • Mediation by HPV increases the incidence of penile cancer in HIV-infected individuals
  • Circumcision is associated with a lower risk of penile cancer & observational studies demonstrated that circumcised men have a lower prevalence of penile HPV
  • Other risk factors for penile cancer include the following:
    • Poor personal hygiene
    • First intercourse at early age
    • Multiple sexual partners
    • Tobacco smoking
    • Psoralen & ultraviolet A (PUVA) photochemotherapy
    • Phimosis
    • Penile trauma or tear
    • Urethral stricture
    • Lichen sclerosus
    • Chronic inflammation, balanitis
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