Penile cancer: Causes, symptoms and treatment

Difficulty in passing urine and a mass in the penis are the most common symptoms of penile cancer, which can be treated with surgery or radiation.

But penile cancer (or cancer of the penis) is neither common nor genetically passed on, say experts. Moreover, personal and sexual hygiene can prevent it in most cases.

“Often, penile cancer is presented as a mass in the penis, difficulty in passing urine and blood discharge from the penis,” says Dr Sujith Kumar Mullapaly, consultant medical oncology (urology), Apollo Proton Cancer Centre, Chennai. “It is painless initially and the pain increases with increased infiltration of the penis. There could be enlarged lymph nodes on the sides of the groin region.”

Dr Shreyas Nagaraj, uro-oncologist, Cytecare Cancer Hospitals, Bengaluru, says penile cancer is not passed on to children.

“There is no genetic cause associated with this cancer,” he says. “Occurrence of penile cancer also does not cause any hindrance in the fertility of a man. During the treatment there could be problems relating to erection of the penis — such as painful erections, bleeding and difficulty in sexual intercourse — but this does not affect the fertility or the quality of semen.”

Causes of penile cancer

According to Dr Mullapaly, the following are the causes of penile cancer:

• About one-third of cases are associated with human papillomavirus (HPV) infection.
• People living with HIV are also prone to having penile cancer.
• Any sexually transmitted disease could be a potential cause of this type of cancer.
• Phimosis (a condition where the foreskin cannot be pulled back over the penis head) and lichen planus (inflammation in the skin of the penis) are potential risk factors.
• Lack of sexual hygiene and having multiple sex partners can also lead to infections leading to cancer of the penis.

Symptoms of penile cancer

Dr Nagaraj says notable changes like the following should set off alarm bells:

• Ulcer in the penis that seems to grow, is painless and does not respond to any medication.

• Cauliflower-like mass in the penile region.
• When an individual with the ability to retract the foreskin is unable to do so.
• Bleeding through the penis.
• Increase (of more than 2cm) in the size of the lymph nodes in the groin region.

Diagnosis

“The first diagnosis is reporting to a doctor when an individual finds there is a change according to the symptoms,” says Dr Mullapaly. “Experts conduct a full-body clinical examination. A biopsy is performed where a sample of the tumour mass is subjected to a clinical test to confirm if it is cancerous or non-cancerous.”

“Ultrasound of the groin is performed to observe the lymph nodes. PET (positron emission tomography scan) is performed post-biopsy to determine if cancer has spread to other regions. The treatment is decided based on all these results.”

Treatment

• Surgery: The affected part of the penis is surgically removed. In certain cases, the entire penis needs to be surgically removed.
• Brachytherapy: The radiation is provided to the affected area via a machine. This is performed until stage 3 of penile cancer.
• Chemotherapy: The medication is provided via blood. This is particularly performed in stage 4 of penile cancer.