Penile Cancer

Cancer of the penis is very rare in the western world; there are around 650 cases in the UK each year. It is most often diagnosed in men over the age of 60 years however men in their 30s and 40s can also be affected and research has suggested that 25% of cases in the UK occur in males younger than 50.

It is is usually a slow growing cancer and if caught early before further spread the chances of survival are high and around 75% of men diagnosed with penile cancer will survive the disease.Unfortunately most men tend to ignore potential penile cancer symptoms for some time which leads to a delay in diagnosis.

Penile Anatomy

Penile Anatomy
The penis is made up of three chambers of spongy tissue that contain muscle, blood vessels and nerves. The corpora cavernosa makes up two of the chambers that are located on both sides of the upper part of the penis and expands to form the head of the penis, or glans. The corpus spongiosum surrounds the urethra or water pipe. The opening of this on the head of the penis is called the meatus.

Causes and Prevention

Human Papilloma Virus (HPV)

There are over 140 different types of HPV.
HPV is a viral infection that can be spread from person to person. Common forms of the HPV virus which spread by skin to skin contact may cause warts and verruca’s and are not associated with an increased risk of cancer.

Around 40 types of HPV however are spread directly through anal, vaginal, or oral sex, or through other close skin-to-skin touching during sexual activity. It is thought that the majority of sexually active people will get infected with HPV at some point in their lives. HPV can be transmitted by having sex with someone who is infected with HPV and can be spread even when an infected person has no visible signs or symptoms.

Most of the time HPV infections resolve and do not cause any health problems. However, if the infection does not resolve, symptoms may occur months or years after becoming infected. Some types of HPV which last in this way can cause genital warts or increase the risk of certain types of cancer to develop although it is not fully known why some people develop health problems from HPV and others do not.

These include cervical cancer in women, penile cancer in men, and anal cancer in both women and men. HPV can also cause cancer in the back of the throat.These types of cancer may develop slowly and may not be diagnosed until years, or even decades, after a person initially becomes infected and at present there is no way to know who will develop cancer.

The risk of developing these types of HPV related cancers is greater in men with weak immune systems such as those with HIV and men who receive anal sex.

Although girls are routinely offered an HPV vaccine to reduce the risk of related cancers, in the UK it has only recently been offered to men who practice sex with other men.

Practising safe sex correctly using condoms is thought to reduce but not eliminate the risk altogether.

Individual HPV viruses are classified by giving them a number and HPV 16 and 18 are linked to the development of penile cancer. Around 50% of men diagnosed with the most common type of penile cancer show evidence of infection with one of these types. This does not mean that men have somehow been at fault in their past lifestyle as HPV can stay dormant for many years and can be transmitted via one sexual partner.

The presence of the foreskin

Penile cancer is virtually unknown in men who have been circumcised as a child. Men who are circumcised in later life or as an adult do not  have a reduced incidence of developing penile cancer. The risk of uncircumcised men developing penile cancer is greater in the presence of phimosis (below).

Phimosis

This is the inability to pull back or retract the foreskin fully. It can occur as a result of skin irritation or inflammation or affect some men from birth. It will reduce the ability of a man to clean the penis thoroughly or notice any abnormal changes and may lead to a build-up of substances that could later contribute to the development of penile cancer. Research suggests that men with phimosis are around 10 times more at risk of developing penile cancer.

Smoking

Some studies have suggested that smoking may increase the chance of developing penile cancer. This may be because harmful chemicals found in cigarettes  interact with secretions that can build up under the foreskin resulting in abnormal cell changes in the penis.

Psoralen-UV-A Photochemotherapy (PUVA)

A treatment called Psoralen-UV-A Photochemotherapy (PUVA) which is used to treat some forms of the skin disease psoriasis, as well as some types of cancer.

Possible Symptoms

Symptoms of penile cancer may include the following listed below. However there are also several non-cancerous conditions that can affect the penis and initially cause similar appearances.

  • A growth or ulcer on the penis, especially on the glans or foreskin.
  • Changes in the colour of the penis.
  • Skin thickening on the penis.
  • Persistent discharge with foul odour beneath the foreskin.
  • Blood coming from the tip of the penis or under the foreskin.
  • Unexplained pain in the shaft or tip of the penis.
  • Irregular or growing bluish-brown flat lesions or marks beneath the foreskin or on the body of the penis.
  • Reddish, velvety rash beneath the foreskin.
  • Small, crusty bumps beneath the foreskin.
  • Irregular swelling at the end of the penis.
  • Any of the above symptoms with unexplained lumps in the groin due to enlarged lymph nodes (please see below)

Cancer can develop anywhere in the penis but the most common places are under the foreskin and on the glans.

If a man has any of these symptoms and is prescribed a treatment that does not cause an improvement within two weeks they should be referred to a hospital specialist called a urologist for further assessment. In the majority of cases other non-cancerous conditions of the penis (such as those listed below) will be the cause of the symptoms.

Penile Health (Non Cancerous Conditions)

Balanitis

This is a term used to describe inflammation of the penis and is much more common in uncircumcised men. The glans may become swollen, red and painful due to irritation and uncircumcised men may find it difficult to retract the foreskin. It can be caused by the yeast infection candida (which causes vaginal thrush in women and can be passed between partners) and infection including those which are sexually transmitted (STIs). Other causes can be vigorous penile activity causing too much friction (for instance sexual intercourse) or chemical irritants from toiletries.

Balanitis can be treated by using an anti-yeast cream and tablets if due to candida or sometimes steroidal cream to reduce inflammation in in other causes of irritation. In some cases antibiotics may be needed to treat STIs.
For more information on Balanitis from the Embarrassing Bodies website please click here

Condyloma (Genital warts)

These may appear in the form of cauliflower shaped, pinkish growths around the penis. They may or may not cause itching, soreness or irritation and are a direct result of becoming infected with a strain of the Human Papilloma Virus (HPV) during sexual intercourse. This strain of HPV does not directly cause penile cancer although it may increase the risk of developing the disease in men. Condylomas can be treated using special creams and ointments. They can also be frozen or burned off using additional medical procedures if necessary. Unfortunately none of the treatments is a definitive cure and they may reoccur in the future. Practicing safe sex with a condom is thought to reduce the risk.
For more information on genital warts from NHS Choices please click here

Cysts

Cysts can occur anywhere on the body including the shaft of the penis and may appear as small lumps. They are formed of semi fluid substances that are not cancerous and  are usually painless.If they are causing symptoms they can be surgically removed.

Lichen Planus

This may appear as a mauve, itchy rash which more commonly occurs on the wrists or shins. It will usually resolve without any treatment.
For more information on Lichen Planus form NHS Choices please click here

Pearly Penile Papules

Around 10-20% of men may notice these small pearl like bumps which usually affect the crown of the penis. They are not infectious and do not require any treatment.

For more information on Pearly Penile Papules form Embarrassing Bodies please click here ( site contains pictures of male genitalia).

Peyronies disease

This is a rare non-cancerous condition that can cause the shaft of the penis to curve due to hardened tissue forming. This may cause the penis to bend on erection and make sexual intercourse painful. It can be treated with surgical and non-surgical procedures.

For more information on Peyronies disease please click here for information from the British Association of Urology Surgeons (BAUS).

Lichen sclerosus et atrophicus (Balanitis Xerotica Obliterans; BXO)

This is the formation of white lesions which can lead to phimosis in uncircumcised men. It is found in a small percentage of men with penile cancer but has not been definitively linked as a causative factor in its development.

Sexually Transmitted Infections (STIs)

For comprehensive information from NHS Choices detailing STIs please click here

 

If you are concerned about any sign, symptom or abnormality such as those conditions listed above please talk with your GP.

Last updated 10/2/16 Review due 10/8/16

 

References available on request.

 

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