What is Penile Cancer? Symptoms, Causes and Treatment Methods

Penile Cancer

Penile cancer is the abnormal growth of cells starting in the skin or internal tissues of the penis. These cells can multiply uncontrollably and spread to surrounding tissues and, in later stages, to other parts of the body. The most common type is squamous cell carcinoma, which is the type of cancer that starts in the skin of the penis. In addition to this, rarer subtypes such as adenocarcinoma, melanoma, and sarcoma also exist.

What is Penile Cancer?

Penile cancer is a rare but serious type of cancer that develops through the malignant proliferation of cells starting in the tissues of the penis, the male sexual organ. It usually occurs on the skin or mucosa covering the outer surface of the penis. The most common type is squamous cell carcinoma, which originates from the upper layer of the skin. Such cancers may progress slowly, but if left untreated, they can spread to surrounding tissues and even metastasize to distant parts of the body via the lymph nodes. Penile cancer often manifests itself with non-healing sores, color changes, or lesions on the penis, and since these symptoms are usually painless, they may be overlooked initially. This situation can lead to a delay in diagnosis. In this disease, where environmental factors are more effective than genetic predisposition, elements such as hygiene conditions, HPV infection, smoking, and being uncircumcised play an important role. Although penile cancer is rare, it is of vital importance to detect and treat it in a timely manner because it can deeply affect an individual's physical health as well as sexual, psychological, and social life.

What Are the Symptoms of Penile Cancer?

The symptoms of penile cancer usually manifest themselves with certain changes that can be seen on the skin in the early stages. Penile cancer may present with symptoms such as discharge, foul odor, and wound-like lesions. Symptoms of penile cancer may include:

Non-healing sores, crusting, or wart-like lesions on the cancerous penis,

Color change or thickening of the skin,

Painless lumps formed on the glans or foreskin of the penis,

Abnormally odorous discharges,

Bleeding or tenderness,

Swollen lymph nodes in the groin area.

Symptoms do not always mean cancer, but a urology specialist must be consulted for any changes that do not resolve within 2–3 weeks.

What Causes Penile Cancer?

It is not possible to mention a single cause for the occurrence of penile cancer; it is generally thought that the disease develops with the combination of multiple risk factors. Among the causes of penile cancer are poor hygiene, being uncircumcised, chronic irritation, and HPV infection. HPV is one of the primary factors increasing the risk of penile cancer and can be transmitted through unprotected sexual contact. In particular, certain subtypes of sexually transmitted HPV (types 16 and 18) can cause changes in cells that pave the way for cancer. In addition, not being circumcised, meaning the presence of the foreskin covering the head of the penis, can cause hygiene to become difficult and infections to develop over time. Especially in cases of phimosis, where the foreskin cannot be retracted, the inability to ensure cleanliness can lead to chronic irritation and inflammation, increasing the risk of cancer. Smoking can cause disruptions in cell structure by leading to the accumulation of toxic substances in body tissues. Furthermore, advanced age, poor genital hygiene, long-term irritation, and chronic inflammations are among other factors that elevate the risk of penile cancer. Rarely, genetic predisposition can also be considered, but there is no clear scientific data on this yet. All these factors can cause deviations in the natural cycle of cells, leading to uncontrolled division over time and consequently to cancer.

How is Penile Cancer Diagnosed?

The diagnosis of penile cancer usually begins with the patient's complaints. Initial symptoms of penile cancer may include bumps, scaling, or wart-like formations on the skin. In a person who consults a doctor with symptoms such as a non-healing sore, skin changes, or a mass on the penis, the first step is the evaluation of the suspicious area with a physical examination. During this process, the doctor pays attention to the size, shape, color, and spread of the lesion. Stages of penile cancer are determined according to the spread of the tumor to the tissue, lymph node involvement, and the presence of metastasis. If there is a suspicious structure, a biopsy must be performed to confirm the diagnosis. A biopsy involves taking a small sample from the abnormal tissue and examining it under a microscope. The pathology specialist analyzes this tissue sample to determine the presence of cancer cells. If the biopsy result confirms cancer, the stage of the disease, meaning how far it has spread, must be determined. For this purpose, imaging methods such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), or PET are utilized. In addition, the inguinal lymph nodes, which are the first place cancer can spread to, are carefully evaluated. If necessary, a biopsy can also be taken from this region. A multidisciplinary approach is adopted in the diagnostic process; cooperation between the urologist, oncologist, radiologist, and pathologist ensures that the most accurate and comprehensive diagnosis is made for the patient. Making the diagnosis at an early stage significantly increases the chance of success in the treatment process.

How is Penile Cancer Treated?

Penile cancer treatment may include surgery, radiotherapy, or chemotherapy options depending on the stage of the tumor. The HPV vaccine, known as the penile cancer vaccine, reduces the risk by providing protection specifically against types 16 and 18. In the treatment of male penile cancer, the primary goal is to completely remove cancerous cells from the body and prevent the spread of the disease, but while achieving this goal, preserving the patient's quality of life as much as possible is a priority. The treatment to be applied is planned individually according to the size of the tumor, degree of spread (stage), cell type, and the patient's general health status. Although treatment often starts with surgical methods, radiation therapy (radiotherapy) or drug therapy (chemotherapy) may also be necessary in some cases.

Penile cancer surgery can range from local excision to penectomy depending on the size of the tumor. If the disease is caught at an early stage and the tumor is only on the surface of the skin, only the tumorous area can be removed with a laser or a minor surgical procedure called local excision. If the tumor has spread to deeper tissues or a large area of the penis, larger-scale surgeries are needed. In these cases, partial penectomy (removal of a part of the penis) or total penectomy (removal of the entire penis) can be applied. These operations are quite effective in terms of controlling the disease. Some changes may be experienced regarding urination and sexual functions after surgery. If necessary, a new penile structure can be created with reconstructive surgery; this is particularly important in terms of psychological well-being.

If the disease is not limited to the penis and has spread to the lymph nodes, the lymph nodes in the groin area may also need to be surgically removed. This procedure is called "lymph node dissection." In more advanced stages of the disease or in cases where surgery is thought to be insufficient, radiotherapy (radiation therapy) or chemotherapy comes into play. Radiotherapy aims to target and destroy cancer cells, especially in patients who do not want surgery or cannot undergo surgery. Chemotherapy, on the other hand, is aimed at systematically destroying cancer cells with intravenously administered drugs; it is generally preferred in advanced disease or cases with lymph node involvement.

Frequently Asked Questions

Penile cancer is quite rare. It accounts for less than 1% of male cancer cases worldwide, but being rare does not mean it can be ignored. It is treatable if caught early. Penile cancer symptoms often start with visible lesions, so there is a chance of early detection. Penile cancer is very rare at a young age, but the probability increases in the presence of risk factors such as HPV positivity. It is generally seen more frequently in men over 60 years of age. It has been observed to be more common in societies where hygiene conditions are poor and circumcision rates are low. It is usually painless in the early stages. This can make it difficult to notice the disease. As it progresses, pain may be felt as the lesion grows or inflammation develops. Especially if accompanied by bleeding, odor, or tenderness, this can be a serious symptom. Penile cancer often gives its initial signs with small changes on the skin, but these changes can be missed because they are usually painless and progress slowly. Many men do not care about a small redness, bump, or sore-like appearance occurring in the genital region, mistaking it for ordinary irritation, fungal infection, or a pimple. Awareness is very important at this point because early symptoms in penile cancer are actually quite visible and palpable. It is not contagious itself, but HPV, one of the most important risk factors, is a sexually transmitted virus. Therefore, sexual hygiene, condom use, and the HPV vaccine are important for prevention. There is a strong link between HPV and penile cancer. Especially HPV types 16 and 18 play a role in a significant portion of penile cancer cases. The most effective way to combat this sexually transmitted virus is the HPV vaccine and regular check-ups. The most effective treatment is usually surgery. While only the area where the tumor is located can be removed in the early stage, broader surgical procedures may be required in advanced stages. Post-surgery reconstructive surgery (reshaping) options are also available. Penile cancer may recur in some patients despite treatment. This condition is medically called recurrence, but the risk of recurrence varies depending on the stage at which the disease was first diagnosed, the scope of the treatment applied, and the regularity of the post-treatment follow-up process. In cases diagnosed at an early stage, where the tumor is only superficial and completely removed by surgery, the probability of recurrence is quite low. If the disease is diagnosed at a more advanced stage, meaning it has spread to deep tissues or lymph nodes, the risk of recurrence increases.

Regular check-ups are of great importance to check whether the cancer has recurred in the post-treatment period. In these check-ups, imaging tests may be requested in addition to physical examinations. Especially the first 2–3 years are considered the most sensitive period when the disease can re-emerge. During this period, check-ups performed at intervals recommended by the doctor allow rapid intervention in any case of recurrence. The life expectancy of patients diagnosed with penile cancer mostly depends on how early the disease is detected, the success of the treatment, and the degree of spread of the cancer. In patients diagnosed at an early stage, when the cancer is limited only to the penile tissue, the 5-year survival rate after treatment is high. This rate indicates that the life expectancy can be quite long when the disease is noticed in time and treated effectively. If the cancer has spread to the inguinal lymph nodes or other parts of the body, the survival rate begins to drop. This rate may decrease in patients with lymph node involvement, and if there is distant metastasis (for example, spread to organs such as the lungs, liver), the 5-year survival rate decreases even further. Therefore, early diagnosis and prompt intervention are directly effective factors on life expectancy.

An important point to note here is this: Statistics regarding life expectancy are based on generalizations. That means every individual's disease, the body's response to treatment, and psychological resilience are different. Some patients can live healthily for many years with a successful treatment process even if they are diagnosed at an advanced stage. In any abnormal situation regarding the penis, a urology specialist should be consulted first. If deemed necessary, oncology, radiology, and pathology departments are also included in the process. A multidisciplinary approach increases the success of treatment.

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