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definition - Carcinoma of the penis

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Carcinoma of the penis

                   
Carcinoma of the penis
Classification and external resources
ICD-10 C60
ICD-9 187
MeSH D010412

Penile cancer is a malignant growth found on the skin or in the tissues of the penis.

Contents

  Prevalence

Penile cancer is a rare cancer in developed nations. The annual incidence is approximately 1 in 100,000 men in the United States,[1] 1 in 250,000 in Australia,[2] and 0.82 per 100,000 in Denmark.[3] In the United Kingdom fewer than 500 men are diagnosed with penile cancer every year.[4] The lifetime risk has been estimated as 1 in 1,437 in the United States and 1 in 1,694 in Denmark;[5] among uncircumcised males, 1 in 600.[6] Penile cancer accounts for up to 10% of cancers in men in some parts of Asia, Africa, and South America.[7]

  Symptoms

  • Redness of the penis[8]
  • Rash on the penis[8][9]
  • Foul smelling discharge from the penis[8][9]
  • Pain in the penis[8]
  • Growth or sore on the penis that doesn't heal within four weeks (may look like a wart, ulcer, or blister), may or may not be painful[9]
  • Bleeding from the penis or from under the foreskin[9]
  • Change in color of the penis[9]
  • Phimosis[9]

  Pathology

  • A. Precancerous Dermatologic Lesions
  • B. Carcinoma in Situ (Bowen Disease, Erythroplasia of Queyrat)
  • C. Invasive Carcinoma of the Penis

  Staging

Like many malignancies, penile cancer can spread to other parts of the body. It is usually a primary malignancy, the initial place from which a cancer spreads in the body. Much less often it is a secondary malignancy, one in which the cancer has spread to the penis from elsewhere. Doctors use the extent of metastasis to estimate what stage the disease is in, to aid in treatment decisions and prognosis. The stages are assessed as follows(Jackson's staging):

  • Stage I - Cancer has only affected the glans and/or foreskin.
  • Stage II - Cancer has spread to the shaft of the penis.
  • Stage III - Mobile (operable) inguinal lymph nodes
  • Stage IV - Fixed (inoperable) inguinal lymph nodes or distant metastasis.
  • Recurrent - Cancer that has returned after treatment.

Prognosis can range considerably for patients, depending where on the scale they have been staged. Generally speaking, the earlier the cancer is diagnosed, the better the prognosis. The overall 5-year survival rate for all stages of penile cancer is about 50%.

  Treatment

There are several treatment options for penile cancer, depending on staging. They include surgery, radiation therapy, chemotherapy, and biological therapy. The most common treatment is one of five types of surgery:

  • Wide local excision - The tumor and some surrounding healthy tissue are removed
  • Microsurgery - Surgery performed with a microscope is used to remove the tumor and as little healthy tissue as possible
  • Laser surgery - laser light is used to burn or cut away cancerous cells
  • Circumcision - cancerous foreskin is removed
  • Amputation (penectomy) - a partial or total removal of the penis, and possibly the associated lymph nodes.

Radiation therapy is usually used adjuvantly with surgery to reduce the risk of recurrence. With earlier stages of penile cancer, a combination of topical chemotherapy and less invasive surgery may be used. More advanced stages of penile cancer usually require a combination of surgery, radiation and chemotherapy. In addition to all the above, treatment of the underlying disease like Brucellosis, is important to limit disease recurrence.

  Risk factors and prevention

  • Age - Penile cancer is rarely seen in men under the age of 50. About 4 out of 5 men diagnosed with penile cancer are over the age of 55.[10]
  • Lack of circumcision - Circumcision during infancy or in childhood provides partial protection against penile cancer, but this is not the case when performed in adulthood.[12] It has been suggested that the reduction in risk may be due to reduced risk of phimosis;[12][10] other possible mechanisms include reduction in risk of smegma and HPV infection.[10] Several authors have proposed circumcision as a possible strategy for penile cancer prevention;[13][14][15] however, the American Cancer Society point to the rarity of the disease and note that neither the American Academy of Pediatrics nor the Canadian Academy of Pediatrics recommend routine neonatal circumcision.[10]
  • Poor hygiene - Poor hygiene can increase a man's risk of penile cancer.[14][19] Good genital hygiene involves washing the penis, the scrotum, and the foreskin daily with water.
  • Smegma - Smegma, a whitish substance that can accumulate beneath the foreskin, is associated with greater risk of penile cancer.[10][20] The American Cancer Society suggests that smegma may not be carcinogenic, but may increase the risk by causing irritation and inflammation of the penis.[10]
  • Lichen sclerosus - Lichen sclerosus is a disease causing white patches on the skin. Lichen sclerosus increases the risk of penile cancer.[21] As the exact cause of lichen sclerosus is unknown, there is no known way to prevent it.
  • Paraphimosis - Paraphimosis is a medical condition where the foreskin becomes trapped behind the glans. It is considered a risk factor for the development of penile cancer.[10] Paraphimosis can be prevented by not leaving the foreskin retracted for prolonged periods of time.
  • Phimosis - Phimosis is a medical condition where the foreskin cannot be fully retracted over the glans. It is considered a risk factor in the development of penile cancer.[11] Phimosis may also be a symptom of penile cancer.[22] Phimosis can be prevented by practicing proper hygiene and by retracting the foreskin on a regular basis.
  • Tobacco - Chewing or smoking tobacco increases the risk of penile cancer.[11] Smoking cessation has been proposed as a prevention strategy.[13][14]

  See also

  References

  1. ^ The American Cancer Society: Penile Cancer: What is penile cancer? American Cancer Society, Last revised: January 8, 2012
  2. ^ [www.racp.edu.au The Official Website of the Royal Australasian College of Physicians], Published September 2010
  3. ^ Frisch M, Friis S, Kjær SK, Melbye M. Falling Incidence Of Penis Cancer In An Uncircumcised Population (Denmark 1943-90). BMJ: British Medical Journal. 1995;311(7018):1471.
  4. ^ a b Cancer Research UK: Penile Cancer: Risks and causes of penile cancer Cancer Research UK
  5. ^ Cold CJ, Storms MR, Van Howe RS (April 1997). "Carcinoma in situ of the penis in a 76-year-old circumcised man". J Fam Pract 44 (4): 407–10. PMID 9108839. 
  6. ^ Kochen M, McCurdy S (May 1980). "Circumcision and the risk of cancer of the penis. A life-table analysis". Am. J. Dis. Child. 134 (5): 484–6. DOI:10.1001/archpedi.134.5.484. PMID 7377156. 
  7. ^ The American Cancer Society: Penile Cancer: What are the key statistics about penile cancer American Cancer Society, Last revised: January 18, 2012
  8. ^ a b c d e f PubMed Health PubMed, Last Reviewed: September 16, 2011
  9. ^ a b c d e f Cancer Research UK: Penile Cancer: Symptoms of penile cancer Cancer Research UK
  10. ^ a b c d e f g h i The American Cancer Society: Penile Cancer: "What are the risk factors for penile cancer?" The American Cancer Society
  11. ^ a b c d Pow-Sang MR, Ferreira U, Pow-Sang JM, Nardi AC, Destefano V (August 2010). "Epidemiology and natural history of penile cancer". Urology 76 (2 Suppl 1): S2–6. DOI:10.1016/j.urology.2010.03.003. PMID 20691882. 
  12. ^ a b Larke NL, Thomas SL, dos Santos Silva I, Weiss HA (August 2011). "Male circumcision and penile cancer: a systematic review and meta-analysis". Cancer Causes Control 22 (8): 1097–110. DOI:10.1007/s10552-011-9785-9. PMC 3139859. PMID 21695385. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3139859. 
  13. ^ a b c d Bleeker MC, Heideman DA, Snijders PJ, Horenblas S, Dillner J, Meijer CJ (April 2009). "Penile cancer: epidemiology, pathogenesis and prevention". World J Urol 27 (2): 141–50. DOI:10.1007/s00345-008-0302-z. PMID 18607597. 
  14. ^ a b c d Minhas S, Manseck A, Watya S, Hegarty PK (August 2010). "Penile cancer--prevention and premalignant conditions". Urology 76 (2 Suppl 1): S24–35. DOI:10.1016/j.urology.2010.04.007. PMID 20691883. 
  15. ^ de Souza KW, dos Reis PE, Gomes IP, de Carvalho EC (March 2011). "[Prevention strategies for testicular and penile cancer: an integrative review]" (in Portuguese). Rev Esc Enferm USP 45 (1): 277–82. PMID 21445520. 
  16. ^ National Cancer Institute: Penile Cancer National Institutes of Health
  17. ^ http://www.cdc.gov/cancer/hpv/statistics/penile.htm HPV-Associated Penile Cancer Rates by Race and Ethnicity] Center for Disease Control and Prevention
  18. ^ Brandel France de Bravo, MPH, Maushami DeSoto, PhD, Krystle Seu Stop Cancer Fund: HPV: Q & A Cancer Prevention and Treatment Fund, Published April 2009
  19. ^ Reis AA, Paula LB, Paula AA, Saddi VA, Cruz AD (June 2010). "[Clinico-epidemiological aspects associated with penile cancer]" (in Portuguese). Cien Saude Colet 15 Suppl 1: 1105–11. PMID 20640268. 
  20. ^ Morris BJ, Gray RH, Castellsague X, et al. (2011). "The Strong Protective Effect of Circumcision against Cancer of the Penis". Adv Urol 2011: 812368. DOI:10.1155/2011/812368. PMC 3113366. PMID 21687572. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3113366. 
  21. ^ Micali G, Nasca MR, Innocenzi D, Schwartz RA (March 2006). "Penile cancer". J. Am. Acad. Dermatol. 54 (3): 369–91; quiz 391–4. DOI:10.1016/j.jaad.2005.05.007. PMID 16488287. 
  22. ^ Cancer Research UK: Penile Cancer: Symptoms of penile cancer Cancer Research UK
  23. ^ NewYork-Presbyterian: Penile Cancer: Overview NewYork–Presbyterian Hospital
   
               

 

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