Penile cancer is a malignant tumor that affects the tissues of the penis, most often the foreskin or the head of the organ. The disease is characterized by the appearance of a tumor formation (node, ulcer, plaque), the development of phimosis, pathological secretions, local skin discoloration. Diagnosis is based on external examination data, biopsy of the altered area, ultrasound of the penis, MRI. Pathology treatment may include circumcision or penectomy with lymph dissection; radiation therapy, brachytherapy, chemotherapy.
General information
Penile cancer is one of the rare oncological diseases in modern oncourology and andrology. Among the neoplasms of the male genitourinary organs, it is about 2-4%. Most often, the neoplasm occurs in men over the age of 60 years. The course of cancer of this localization is quite aggressive; in a third of patients, metastases are detected already at the first stage of the cancer process.
Causes
The etiology of penile cancer is multifactorial. The relationship between smoking, hygiene habits, local pathological processes and the development of penile cancer is traced. Male smokers have a greater risk of malignant neoplasms of the genitourinary system. This is due to the carcinogenic effect of tobacco combustion products on the cells of the urinary and genital organs and the weakening of the immune system, unable to provide local protection.Gorenje
Failure by a man to observe personal hygiene leads to the accumulation of preputial lubricant (smegma) and sloughed cells under the foreskin leaf, which maintain constant irritation and inflammation of the glans penis, which can further cause its oncological lesion. In a quarter of patients, penile tumors are accompanied by phimosis. Circumcision of the foreskin performed in infancy has been found to reduce the likelihood of penis cancer by 70%.
Important importance in the etiology of cancer is attached to the hygiene of sexual life: it is known that early (up to 18-20 years) the beginning of sexual life and frequent change of partners increase the risk of developing penis neoplasia by 4-5 times. Oncological lesions of the genital organ are closely related to STDs leading to chronic balanoposthitis. In 30-80% of patients, the neoplasm is caused by human papillomavirus, in particular its oncogenic strains HPV-6, HPV-11 and HPV-16, HPV-18. Homosexuals with AIDS and men who have unprotected casual sexual relations are in a special risk group.
Precancerous lesions of the penis include cutaneous horn, obliterating xerotic balanitis (sclerosing lichen), Bowen’s disease, Keir’s erythroplasia, leukoplakia, genital warts. It is noted that penis cancer can develop in men who have undergone PUVA therapy for psoriasis with psoralen in combination with long-wave ultraviolet irradiation.
Classification
Penis cancer can occur in various clinical forms. The most common ulcerative form is characterized by rapid destructive growth, invasion of cavernous bodies and early appearance of metastases in regional lymph nodes. With nodular form, superficial and infiltrative tumor growth occurs, a relatively slow course. The papillary form has a more favorable development: a long course and later metastasis. For the rarest, edematous form, rapid tumor growth, early metastasis to lymph nodes and distant organs is typical.
Histologically, the lesion of the penis in 95% of cases is represented by flat keratinizing cancer. According to the type of growth, endophytic (ulcerative, nodular, edematous forms) and exophytic (papillary form) tumors are distinguished. According to the TNM classification, the following stages of penile cancer are distinguished:
- T1 is a limited tumor less than 2 cm in diameter with no signs of infiltrative growth
- T2 is a tumor of 2-5 cm in size, spreading to subepithelial structures
- T3 is a tumor more than 5 cm in diameter or smaller, sprouting a cavernous body
- T4 – tumor germination of the urethra, prostate and other neighboring organs
- N1 – single metastasis to the superficial inguinal node
- N2 – multiple lesions of the superficial inguinal lymph nodes on one or two sides
- N3 – lesion of deep lymph nodes (iliac, pelvic)
- M0 – no distant metastases
- M1 – metastases are detected in distant organs.
Metastasis of the neoplasm is mainly lymphogenic with damage to the regional inguinal and iliac lymph nodes. Hematogenous metastases can be detected in the lungs, bones, liver, brain and spinal cord, heart.
Penile cancer symptoms
At an early stage, the appearance of a small limited flat or exophytic focus is noted. Most often, cancer is localized in the glans (85%), less often – on the foreskin (15%), the trunk of the penis and in the coronal furrow (0.32%). The altered area of the skin may look like erosion, ulcers, plaques, nodules, warts, mushroom-like growth in the form of “cauliflower, pigmented spots, etc. In the future, the pathological focus increases in size and thickens, which can lead to the development of phimosis.
The presence of a local destructive process is accompanied by the development of itching, pain syndrome, painful urination, bleeding from an altered focus, the appearance of purulent-purulent fetid secretions from the prepucial sac. With an edematous form, there is pronounced lymphostasis and cancerous lymphangitis, soreness of enlarged inguinal lymph nodes. In the later stages, weight loss, weakness, chronic malaise and fatigue progress. In advanced cases, autoamputation of the penis may occur.
Diagnostics
Manifestations of penile cancer are not very specific, therefore they require differentiation with benign formations of the penis (angiomas, papillomas, nevi, etc.), STIs (genital herpes, syphilis, etc.), allergies. It is important to examine a man by an oncologist or andrologist, palpation of the tumor, assessment of its location, displacement, size. The main methods of differential diagnosis include cytological examination of the excretory pathological focus, biopsy of the penis and sentinel lymph node with the morphology of the biopsy.
A biopsy of the neoplasm allows you to determine the form and stage of neoplasia, determine the tactics of subsequent treatment. In case of lesion of the foreskin, they resort to performing diagnostic circumcision. With the help of ultrasound of the penis, the depth of the tumor germination, its spread to the cavernous bodies and the spongy body is estimated. In a number of cases, the execution of prostate TRUS is indicated. To exclude distant metastases, CT (MRI) of the pelvis, ultrasound of the abdominal cavity, chest X-ray are performed.
Penile cancer treatment
Surgical treatment of neoplasms can be organ-preserving or radical. Organ-preserving techniques are used for small non-invasive lesions of the extremity of the flesh and head. In this case, laser destruction or cryodestruction of the tumor can be performed, its removal within healthy tissues, circumcision, scalping of the penis with subsequent plasty of the trunk with a skin scrotal flap.
Organ–preserving operations lead to a natural increase in the frequency of local relapses, therefore, penis amputation – penectomy is recognized as a standard intervention. At the same time, if only the head and the distal part of the trunk are involved in the process, partial penectomy of the penis is possible 2 cm below the edge of the tumor. After partial amputation, the remaining stump of the penis may be suitable for standing up and performing sexual function.
In the case of total penectomy, perineal urethrostomy is performed to urinate. Reconstructive phalloplasty is possible after surgery. To suppress metastatic foci of cancer, radiation therapy with external and internal sources of radioactive radiation (brachytherapy), chemotherapy is carried out.
Prognosis and prevention
The overall survival rate for 5 years after various types of treatment is 70-100% at the T1N0M0 stage; 66-88% at T2N1M0; 8-40.3% at T3N2M0 and less than 5% at T4M1. After splenectomy, provided there are no metastases, the five-year survival rate reaches 70-80%. Endophytic growth, ulcerative form of cancer, and regional metastasis are associated with an unfavorable prognosis. Preventive measures should include compliance with hygiene standards, the exclusion of casual sexual relations and STDs, and smoking cessation. As a specific prevention, it is currently proposed to vaccinate boys against HPV.
