Penile Cancer

The growth of a cancerous lesion almost always occurs on the glans or foreskin of the penis.  It can appear as a bump, a warty-type growth, a lesion that has failed to heal, or patches of red skin (click HERE to see an example).  In many cases, the lesions will bleed.  In some cases, the folds of the foreskin can hide a cancerous growth for some time, allowing it to grow and spread.  It often appears as a non-healing bump or lesion on the penis, especially if uncircumcised or if circumcised as teenager or adult.  Any lesion should be looked at by a medical professional to ensure it isn’t cancer.   

Penile cancer is fairly rare, occurring in less than 1 in 100,000 men in North America.[i]  Penile cancer almost always starts as cancer on the skin of the penis. 

The most common skin area for cancers to start is the foreskin; hence, men who are circumcised have a greatly reduced chance of developing penile cancer.  If unchecked, the cancer can spread and overtake the tissues of the penis altogether (click HERE to see an image).  In fact, a review[ii] of multiple studies found that penile cancer rates were almost zero in countries where circumcision was performed for religious reasons when boys were first born.   Countries where circumcision is uncommon (Europe, Asia, Africa, and Latin America) have penile cancer rates two to seven times more often.   This may be due to the fact that the highest risk factor for penile cancer is having a history of phimosis, a condition where the foreskin gets trapped over the head of the penis.  Men who have had phimosis had the highest rate of penile cancer.[iii]  This is thought to be due to infections trapped by the foreskin causing changes in the skin of the penis.  Since phimosis traps the foreskin over the glans, it’s not surprising that the glans is the second most common spot where penile cancers start. 

 

Cancer growth is often slow and early detection is key to increasing survival.  Penile cancer is usually seen as men age.  It is rare before age 40 and most common between ages 50-69.  Since skin growths that often lead to cancer grow on the foreskin of the penis, regularly examining the foreskin (especially under the foreskin) is an important measure men can take to identify an abnormality that could be penile cancer.  It’s often quick and easy to add an inspection of the penis skin in all men, circumcised or not, during the monthly testicular exam to look for changes in the penis skin.

 

Symptoms

Penile cancer often begins as an abnormal growth on the skin.  The following symptoms are outlined by the American Cancer Society[iv]:

  • Changes in skin thickness in areas on the penis

  • Changes in skin color

  • A lump on the penis

  • A sore or ulcer that may bleed

  • Crusty, small bumps

  • Blue to brown growths that are flat

  • Bleeding at the foreskin

  • Smelly discharge from the foreskin

  • A reddish rash under the foreskin

  • Swelling at the head of the penis or difficulties retracting the foreskin can also be a sign of cancer

 

In short, any skin changes on the penis that don’t go away within a month should be looked at by a healthcare provider – especially if the skin change worsens.  Since many of these bumps and skin changes don’t hurt, men may be tempted not to seek treatment.  

 

As penile cancer spreads, it often goes to the lymph nodes of the groin, so the lymph nodes may swell.  Anytime a man can feel swollen lymph nodes in the groin, it’s a good idea to get those checked out by a healthcare provider.   Cancer can then spread from the lymph nodes to the rest of the body.

 

Survival from penile cancer depends on whether or not it is caught early.  In men who catch the cancer when it is still confined to the skin of the penis, nearly nine in ten will survive since the area can be treated or removed while the lesion is still small.  Survival drops to about six in ten men if the cancer spreads to the lymph nodes of the groin.  If the cancer spreads from the lymph nodes to the body, survival is closer to only one in ten.

 

The main reason why men don’t seek treatment is fear of embarrassment by having a healthcare provider examine their penis.  Not seeing a provider can increase the chances of not surviving penile cancer, so it’s always better to be safe than sorry.  Another reason men don’t seek treatment is that the skin changes often occur under the foreskin.  If regular inspection of the foreskin is not performed, a cancer can grow hidden for some time until it spreads to the lymph nodes.

 

Prevention

 

Circumcision, especially performed as a child, is perhaps the greatest preventative measure that can be taken to avoid the risk of penile cancer.  The incidence of penile cancer in men circumcised right after birth is almost zero.   

 

For men who are not circumcised good genital hygiene is important, as poor genital hygiene increases the risk of phimosis and infections.  Retracting the foreskin and cleaning the area of the foreskin and head of the penis with soap, followed by replacing the foreskin afterwards, can help prevent phimosis and the infections that can lead to penile cancer.

 

Men who develop HPV (human papilloma virus) are at a greater risk of developing penile cancer than men who don’t get HPV.  Vaccines against HPV (i.e. Gardasil) are thought to be protective, but it is well understood that men who don’t have a large number of sexual partners are at a very low risk of developing penile cancer.[v]

 

Finally, tobacco use (both smoking and smokeless) has been linked to penile cancer rates.  In fact, one study showed that the rate of cancer is significantly higher in current smokers than men who quit smoking.  Men who never used tobacco had significantly lower rates of cancer.  In fact, men who had penile cancer and smoked were three times more likely to have penile cancer spread to other areas of the body. [vi]

Diagnosis

 

Diagnosis is made by a healthcare provider by inspecting the genitals and lymph nodes in the groin.  If something looks suspicious, a biopsy of the area may be taken to send to a lab and determine if there is cancer.  Imaging such as ultra-sound and CT scans can be used to see if cancer has spread to areas outside of the penis.

 

Treatments

 

Treatments vary depending on the type and stage of cancer.  These may include surgical removal of the lesion, lymph nodes, or simply a circumcision.  In some cases, topical agents or laser therapy can be used to treat the cancer.  Radiation therapy or systemic chemotherapy may be used when cancers have spread to the lymph nodes or other areas of the body.

[i] The information and statistics in this page were based on information gathered from the American Cancer Society website at www. cancer.org/cancer/penile-cancer (last viewed 1/31/19) unless otherwise noted.

[ii] Montes Cardona CE, García-Perdomo HA. Incidence of penile cancer worldwide: systematic review and meta-analysis. Rev Panam Salud Publica. 2017;41:e117. doi: 10.26633/RPSP.2017.117.

[iii] Shabbir M, et. al. Ther Adv Urol. 2013 Jun; 5(3): 161–169.

[iv] https://www.cancer.org/cancer/penile-cancer/detection-diagnosis-staging/signs-symptoms.html (7/19/19)

[v] Montes Cardona CE, García-Perdomo HA. Incidence of penile cancer worldwide: systematic review and meta-analysis. Rev Panam Salud Publica. 2017;41:e117. doi: 10.26633/RPSP.2017.117.

[vi] Montes Cardona CE, García-Perdomo HA. Incidence of penile cancer worldwide: systematic review and meta-analysis. Rev Panam Salud Publica. 2017;41:e117. doi: 10.26633/RPSP.2017.117.