Penile Cancer: Symptoms, Diagnosis, and Treatment Insights

Carcinoma-like cancer of the penis usually presents as a skin abnormality or as a palpable lesion on the penis. Most cancers arise in the glans or coronal sulcus or foreskin, in the form of a mass or an ulcer and may be associated with a secondary infection.

To locate it, we will explain that the penis is made up of:

• Body: formed by the skin, subepithelial connective tissue, erectile bodies and the urethra, surrounded by the spongy bodies.
• The glans (the head of the penis): It consists of a more superficial part called the epithelium and below the dermis. Much of the glans is made up of a spongy expansion of the spongy body. At the tip is the urethral meatus that allows you to urinate and expel semen. The most proximal rounded surface of the glans is called the crown and serves as the junction between the glans and the body.
• The foreskin It is an extension of skin that covers the glans at birth.
• Lymph nodes from the penis drain from both the glans and the shaft and form a network of interconnected channels. Drainage proceeds from the superficial inguinal lymph nodes to the deeper inguinal lymph nodes.

Symptoms

• painless lump (more common);
• Ulcer;
• Rash;
• Bleeding.

Penile cancer is typically a disease of men whose mean age at diagnosis is 60 years and whose probability of suffering it increases with age.

Risk factor's

• Epidemiological factors: single and circumcised.
• Medical conditions: genital warts, recurrent urinary tract infections, chronic penile eruptions, urethral stricture, phimosis.
• it is present in 30-50% of men with penile cancer.
• Human immunodeficiency virus (HIV) although the association is unknown.
• Tobacco.
• UVA phototherapy: patients with psoriasis treated with psoralen and UVA phototherapy have an increased incidence.
• Poor hygiene

How is it diagnosed

• Complete physical examination
• Observation of the characteristics (morphology) of the lesion. It should include the diameter of the lesion and its areas, where it is located, the number of lesions present, whether the lesion is nodular / ulcer / flat, and whether it is related to other structures.
• Spread to the nodes it is present between 30-60% at the time of diagnosis, although malignant infiltration of the lymph nodes is only demonstrated in half of the cases. Distant metastases are rare.
• There are no specific tumor markers in laboratory studies for penile cancer. However, patients with advanced penile cancer may have anemia with increased white blood cells (white blood cells) with decreased serum albumin and hypercalcemia.
• The, CT and ultrasound are the most used imaging studies for diagnosis. The study of choice for the evaluation of distant metastases is CT. For the study of the nodes, magnetic resonance imaging with specific contrast is used.
• Biopsy. Typically, an ultrasound / CT-guided puncture is performed. 2930

Types of penile cancer

• Carcinoma type squamous cell (45-65%). Lymph nodes and metastases are present in 25-40%.
• Carcinoma papillary (2-15%): they are usually low grade.
• Carcinoma condylamatous (Warty) (7-10%): these are cauliflower-like tumors and are associated with Human Papillomavirus infection.
• Carcinoma basaloid (4-10%) also related to Human Papillomavirus infection and its presentation is in the form of an irregular ulcer. They are high-grade tumors and more than half of the cases with inguinal metastases.
• Carcinoma warty (3-7%): these are low-grade tumors with infiltration of margins. No metastatic potential, but with risk of recurrence.
• Carcinoma sarcomatoid (1-6%) are very rare tumors, but they are the most aggressive. An ulcer usually appears.
• There are other types: basal cell carcinoma, sarcomas (Kaposi), melanoma, urethral carcinoma, metastasis.

How is it treated

In treatment, the main goal is eliminate malignancy, always preserving its functionality. The European Association of Urology recommends local excision with or without circumcision, laser therapy, Mohs surgery (verrucous carcinoma) or photodynamic therapy for superficial lesions.

• The standard therapy for primary penile cancer is local excision with partial or total penectomy.
• It is reserved for treating patients with metastases or inguinal or pelvic node extension. The most common drugs used include cisplatin, bleomycin, methotrexate, and fluoroacil.
• It can be used as an alternative to surgery in some of the patients. One of the disadvantages is that squamous cell carcinoma is resistant and that high doses of radiation therapy can cause a urethral fistula, necrosis of the penis, pain and edema. Candidate patients for radiation therapy include young patients with a small (<3cm), superficial and exophytic lesion (with external growth) or patients with non-invasive cancers in the glans or coronal groove.
• Carcinoma-like cancer of the penis usually presents as a skin abnormality or as a palpable lesion on the penis.
• Most cancers arise in the glans or coronal sulcus or foreskin, in the form of a mass or an ulcer and may be associated with a secondary infection.
• Spread to the nodes is present between 30-60% at the time of diagnosis, although malignant infiltration of the nodes is only demonstrated in half of the cases. Distant metastases are rare.