Urologic Cancers Library - Penile Cancer
About Penile Cancer
Cancer of the penis is relatively common in many parts of the world, but it is rare in the U.S. About 1,500 new cases of penile cancer will be diagnosed in the U.S. this year. When detected early, penile cancer can be cured. Doctors at Columbia University Department of Urology at NewYork-Presbyterian Hospital are expert at treating and diagnosing penile cancer.
Causes and Risk Factors
The exact cause of penile cancer is unknown, but the following risk factors have been linked to the disease:
HPV:
Infection with some forms of human papilloma virus (HPV) during sexual contact.
Sexual Activity:
Unprotected sex with multiple partners, probably because of the increased risk of contracting HPV.
Smoking:
Cigarette smoking is thought to damage the DNA of cells in the penis, especially in men with HPV infection, and to contribute to the development of penile cancer.
Smegma:
Oily secretions and dead skin cells can accumulate under the foreskin, resulting in a substance called smegma. While not proven, it has been suggested that smegma may contain cancer-causing substances.
Circumcision:
It has been suggested that men who are circumcised have a lower risk of developing penile cancer.
Early Detection and Screening
Early symptoms of penile cancer include the appearance of a painless nodule – a warty growth or ulcer on the penis – especially on the glands or foreskin, or a swelling at the end of the penis. At later stages penile cancer can cause ulceration and bleeding. It is important to discuss any of these symptoms with a physician since penile cancer that is detected and treated in the early stages is curable.
Diagnosis
To determine if an abnormality is cancer, doctors need to perform a biopsy (remove a sample of tissue for laboratory testing). If cancer is confirmed doctors will use any of the following tests to determine the extent of the cancer:
CT scan or MRI:
CT scan or MRI may reveal enlarged lymph nodes--an indication that the cancer has spread.
Lymph Nodes:
Surgeons remove lymph nodes in the groin for biopsy to determine if the cancer has spread.
Sentinel Lymph Node Biopsy:
During a sentinel lymph node biopsy surgeons use a radioactive tracer to find the first lymph node that may be cancerous, minimizing the number of nodes removed for analysis and the side effects of the lymph node dissection.
Treatment
When treated in its early stages, penile cancer can be cured in nearly all patients. Surgery is the most common treatment, particularly for small superficial tumors. Surgeons use a technique called Mohs surgery where they progressively remove and examine thin layers of tissue. More invasive cancers may require surgery to remove part or all of the penis, and extensive surgery to remove the lymph nodes near the penis. Penile cancer is one of the few cancers that can be cured by surgery alone, even when it has spread beyond the penis. Columbia Urology surgeons Drs. Benjamin Spencer and Mitchell C. Benson have particular training and interest in the most advanced surgical techniques for lymph node removal in metastatic penile cancer.
Doctors may use radiation therapy as an alternative to surgery to avoid removing part or all of the penis. They may also use radiation therapy to target affected lymph nodes in the groin and pelvic area or following surgery to reduce the risk of a recurrence.
Doctors may treat penile cancer with topical chemotherapy (placed on the skin) or with systemic chemotherapy (drugs given by injection or mouth).
Prevention
To lower their risk of developing penile cancer men should: avoid sexual practices that can result in human papilloma virus (HPV) infection; limit their number of sexual partners; quit smoking.
Men should also practice good genital hygiene by retracting the foreskin (in uncircumcised men) and cleaning the entire penis since some, but not all, studies suggest that poor hygiene in combination with an uncircumcised penis may increase the risk of penile cancer.
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