What are Penis Cancer Risk Factors? Symptoms, Diagnosis and Treatment

The penis is an organ for sexual intercourse, reproduction and urination, consisting of 2 cavernous and spongy bodies in men.

As with other organs, there is rare cancer in the penis. Uncontrolled growth of cells in the penis form a mass and can then spread to other organs through blood and lymph.

Penile cancer is a type of cancer that starts from the penile skin and can spread to other layers of the penis. Although it varies from society to society, it is rare. While it can be seen in 1-2 percent of men in undeveloped, uncircumcised communities with poor hygiene, it is rarely detected in half a hundred thousand men in communities with well-developed hygiene.

As with almost all cancers, the exact cause is not clear in the diagnosis of penile cancer. However, it occurs much more frequently in those exposed to risk factors. Conditions that increase the rate of developing any disease, including cancer, are referred to as risk factors. Exposure to risk factors increases the rate of getting the disease, but there is no certainty that it will cause disease. In this context, we can list the risk factors and causes for penile cancer as follows:

1. Chronic penile infection or inflammation: Persistent and persistent infection or inflammation in the penis seriously increases the risk of penile cancer.
2. Phimosis: In uncircumcised people, the penis cannot be withdrawn due to the narrowing of the tip of the foreskin. In this case, chronic infection and inflammation occurs and the risk of penile cancer increases significantly.
3. Not being circumcised: It is more common in uncircumcised men than circumcised men. Being circumcised seriously prevents both infection and sexually transmitted diseases.
4. Age: penile cancer is usually a disease over the age of 50. The risk increases with age.
5. Tobacco products: As with many cancers, it increases the risk of cancer formation in the penis at least 5 times.
6. Having many partners: Penile cancer is more common in those who have sexual intercourse at an early age and have many partners.
7. Poor hygienic conditions: the risk of developing penile cancer is much higher due to the prevalence of both sexually transmitted diseases and penile infections.
8. HPV infection: It is one of the most important risk factors for penile cancer. There are over 100 types that cause warts on the skin of the penis and pass through sexual contact. 30-100% HPV is positive in the tissues of those with penile cancer.
9. Exposure to UV light: UV light therapy applied in some skin diseases such as psoriasis increases penile cancer 9-10 times.

The first symptom of penile cancer is a persistent bleeding, runny wound on the penis. At first, it is thought to be infection and treatment is given, but when it does not respond to these treatments, cancer is suspected. Other symptoms include raised wart-like rash from the skin, scar or hard mass, itching and burning sensation, discharge, and swelling in the groin area.

Early diagnosis and treatment of penile cancer is vital. However, since they are rare cancers and they are confused with other diseases of the penis, the diagnosis is made at a later stage. First, a good examination and then a biopsy should be taken if there is any doubt. According to the result from the pathology, it should be staged in case of cancer.

Penile cancer is diagnosed by biopsy and pathological examination. For staging, ultrasonography (USG), computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET) and cystoscopy should be performed when necessary.

• Stage 0: Cancer is superficial on the penile skin, there is no spread.
• Stage 1: Cancer cells have reached the connective tissue just under the skin of the penis. There is no involvement in lymph and blood vessels.
• Stage 2: Cancer cells have involved blood and lymph vessels in the penis area. In addition, it has kept the cavernous bodies of the penis and the external urinary tract, that is, the urethra.
• Stage 3A: In addition to the deep involvement in the penis, i.e. stage 2, one of the lymph nodes in the groin area is involved.
• Stage 3B: In addition to stage 3A, there is widespread involvement of lymph nodes in the groin area.
• Stage 4: In addition to lymph nodes in the penis and groin area, there is spread to distant organs such as bone, lung, liver.

Treatment principles are determined after the diagnosis of penile cancer and staging. There are basically the following methods in treatment.

1. Surgical treatment
2. Radiotherapy
3. Chemotherapy
4. Other treatments

Surgical treatment is the most common and effective treatment option that can be applied in all stages of penile cancer.

In the early stage of penile cancer, surgical treatment can provide definitive treatment, but cancerous tissue should never be left behind. For this reason, a piece of intact tissue that includes cancerous tissue should be taken and examined in pathology. After the surgical procedure is performed, a new pathological staging is performed, and it is decided whether the patient will receive radiotherapy or chemotherapy or not. Performing the surgery with microsurgery is also important in determining the surgical margins. If cancer and tissues close to cancer cannot be removed, the penis should be removed as it is. In addition, lymph nodes in the groin area should be surgically removed and sent to pathology. According to the result from the pathology, the patient should be given radiotherapy or chemotherapy when necessary.