Penile%20cancer Signs and Symptoms
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