Best Penile Cancer Treatment in Delhi, India

Penile cancer is a rare form of cancer that develops in the tissues of the penis. It typically starts in the skin cells on or around the penis and can spread to other parts of the organ or nearby lymph nodes if left untreated. The exact cause of penile cancer is often unknown, but certain risk factors, such as human papillomavirus (HPV) infection, smoking, poor hygiene, and chronic inflammation, may increase the likelihood of developing the disease.

Penile cancer can show itself through changes in the penis' skin, like a discoloured or thickened area, a lump, or a sore that just won't heal. The discolouration can be red, white, or grey, and the skin may take on a scaly or wart-like appearance. Lumps may feel firm or tender and can be painless at first. Sores associated with penile cancer may bleed or ooze pus.

Penile cancer can manifest in various types, each with its own characteristics and implications for treatment. The primary types of penile cancer include:

• Squamous cell carcinoma: This is the most common type of penile cancer, accounting for the majority of cases. It originates in the thin, flat cells lining the surface of the penis. Squamous cell carcinoma can develop anywhere on the penis but often begins on the glans (head) or foreskin.
• Verrucous carcinoma: This is a rare subtype of squamous cell carcinoma characterised by slow-growing, wart-like growths on the penis. Verrucous carcinoma tends to have a less aggressive course compared to other types of penile cancer.
• Basal cell carcinoma: Although rare, basal cell carcinoma can occur on the penis.It develops from the basal cells in the deeper layers of the skin and is typically less aggressive than squamous cell carcinoma.
• Melanoma: Melanoma is a type of skin cancer that can arise on the penis, often presenting as dark-coloured or irregularly shaped lesions.Penile melanoma is relatively uncommon but tends to be more aggressive than other types of penile cancer.
• Adenocarcinoma: This rare type of penile cancer originates in the glandular cells of the penis, typically arising in the sweat glands or the urethra. Adenocarcinoma may require different treatment approaches compared to squamous cell carcinoma.

Penile cancer can develop due to a combination of genetic, environmental, and lifestyle factors. While the exact cause of penile cancer remains unclear, several risk factors have been identified that may increase the likelihood of developing the disease:

• Human papillomavirus (HPV) infection: Certain strains of HPV, particularly HPV types 16 and 18, have been linked to an increased risk of penile cancer. HPV is a common sexually transmitted infection, and individuals with a history of HPV infection may have a higher risk of developing penile cancer.
• Poor hygiene: Poor hygiene practices, such as inadequate cleaning of the penis, can increase the risk of developing penile cancer. Smegma, a substance that can accumulate under the foreskin, may contain carcinogens and contribute to the development of cancerous lesions.
• Smoking: Tobacco use, particularly smoking cigarettes, has been associated with an increased risk of penile cancer. The carcinogens present in tobacco smoke can damage the DNA in penile cells, potentially leading to the development of cancer.
• Age: Penile cancer is more common in older men, with the risk increasing with age. The majority of cases occur in men over the age of 50, although the disease can affect men of any age.
• Phimosis: Phimosis is a condition in which the foreskin of the penis cannot be fully retracted, leading to inflammation and irritation. Chronic inflammation associated with phimosis may increase the risk of penile cancer.
• History of genital warts: Individuals who have a history of genital warts, which are caused by certain strains of HPV, may have an increased risk of developing penile cancer.
• Uncircumcised status: Uncircumcised men may have a slightly higher risk of penile cancer compared to those who are circumcised. However, the protective effect of circumcision appears to be more significant in populations with high rates of HIV infection.

Having one or more risk factors does not guarantee the development of penile cancer, and many individuals with risk factors never develop the disease. Conversely, some cases of penile cancer occur in individuals with no identifiable risk factors.

Penile cancer may present with various symptoms, which can vary depending on the stage and location of the cancer. Some common signs and symptoms of penile cancer include:

• Changes in skin colour or texture: This may include areas of the penis that appear reddish, bluish, or white. The skin may also become thicker, develop ulcers, or show other abnormalities.
• Lumps or growths: Individuals may notice the development of lumps, bumps, or growths on the penis. These growths may be painless or tender to the touch.
• Sores or ulcers: Penile cancer can cause the formation of sores or ulcers on the penis that do not heal or that bleed easily. These sores may be accompanied by pain, itching, or discharge.
• Changes in foreskin: For uncircumcised men, penile cancer may lead to changes in the foreskin, such as tightening or difficulty retracting it. This may be accompanied by pain or discomfort.
• Swelling: Swelling or enlargement of the penis, particularly in the affected area, may occur with penile cancer.
• Bleeding: Bleeding from the penis, especially without any apparent cause, can be a symptom of penile cancer. This may occur during urination, intercourse, or spontaneously.
• Pain or discomfort: Some individuals with penile cancer may experience pain, discomfort, or tenderness in the penis or in the surrounding area.

Diagnosing penile cancer typically involves a combination of a medical history review, physical examination, and various diagnostic tests. Here's an overview of the diagnostic process:

Medical history and physical examination

During the medical history review, the healthcare provider will enquire about symptoms experienced, risk factors (such as smoking, HPV infection, or poor hygiene), and any relevant medical conditions. A comprehensive physical examination of the penis and groyne area will be conducted to look for any abnormalities, such as lumps, lesions, changes in skin colour or texture, or enlargement of lymph nodes.

Biopsy

A biopsy is the definitive diagnostic test for penile cancer. It involves the removal of a small sample of tissue from the suspicious area of the penis, typically under local anaesthesia.

The tissue sample is sent to a pathology laboratory, where it is examined under a microscope by a pathologist to determine if cancer cells are present and, if so, the type and extent of the cancer.

Imaging test

Imaging tests such as ultrasound, MRI, or CT scan may be recommended to assess the size and extent of the cancer and determine if it has spread to nearby lymph nodes or other organs. These studies provide detailed images of the structures inside the body, helping healthcare providers plan appropriate treatment strategies.

Lymph node evaluation

Examination of the lymph nodes in the groyne area is crucial, as penile cancer often spreads to these nodes first. The healthcare provider may palpate the groyne area during the physical examination to check for enlarged or abnormal lymph nodes. Additional tests, such as ultrasound or CT scan of the groyne, may be performed to further evaluate the lymph nodes. In some cases, a biopsy of the lymph nodes may be recommended to confirm the presence of cancer cells.

HPV testing

HPV testing may be performed on tissue samples obtained during biopsy to determine if specific strains of the virus (such as HPV types 16 and 18) are present. HPV infection is a known risk factor for penile cancer, and identifying HPV DNA in tissue samples can provide valuable information for treatment planning.

Other tests

Depending on the individual case, additional tests or procedures may be recommended to assess the extent of the cancer and plan appropriate treatment. These may include blood tests to assess overall health, cystoscopy to examine the inside of the urethra and bladder or other specialised imaging studies.

Penile cancer staging is a system used to describe the extent and spread of the cancer within the body. The most commonly used staging system for penile cancer is the TNM system, which classifies the cancer based on the size of the tumour (T), whether the cancer has spread to nearby lymph nodes (N), and whether it has metastasised to distant organs (M). The stages of penile cancer include:

Stage 0 (Carcinoma in situ)

In this stage, cancer cells are found only in the top layers of the skin of the penis. They have not invaded deeper tissues or spread to nearby lymph nodes or distant organs. Carcinoma in situ is considered the earliest stage of penile cancer.

Stage I

At Stage I, the cancer is confined to the penis and has not spread to nearby lymph nodes or other organs. The tumour is usually small and localised, often limited to the surface layers of the skin or involving only a small area of deeper tissue.

Stage II

In Stage II, the cancer has penetrated deeper layers of tissue within the penis but has not yet spread to nearby lymph nodes or distant organs. The tumour may be larger than in Stage I, extending further into the penile tissue, but it remains confined within the penis.

Stage III

Stage III indicates that the cancer has spread to nearby lymph nodes in the groyne area (known as inguinal lymph nodes) but has not yet metastasised to distant organs. The size of the tumour may vary, and the presence of lymph node involvement suggests a more advanced stage of the disease.

Stage IV

Stage IV is the most advanced stage of penile cancer and is further divided into two subcategories:

Stage IVA: At this stage, the cancer has spread to nearby lymph nodes in the groyne area (inguinal lymph nodes) and may have invaded nearby structures such as the urethra or pelvic bone. The tumour may also be larger and more invasive.

Stage IVB: In Stage IVB, the cancer has metastasised to distant organs such as the lungs, liver, or bones, indicating advanced disease. Metastatic spread to distant sites significantly worsens the prognosis and complicates treatment options.

Treatment for penile cancer depends on various factors, including the stage of the cancer, its location, and the individual's overall health and preferences. The primary treatment options for penile cancer may include:

Surgery

Surgery is often the main treatment for penile cancer, particularly in early-stage disease. The type of surgical procedure recommended depends on the size and location of the tumour.

Partial or total penectomy: In cases where the cancer is confined to a specific area of the penis, partial penectomy (removal of part of the penis) may be performed. In more advanced cases, total penectomy (complete removal of the penis) may be necessary.

Lymph node dissection: If cancer has spread to nearby lymph nodes, a surgical procedure called lymph node dissection may be performed to remove the affected lymph nodes. This helps prevent further spread of the cancer.

Radiation therapy

Radiation therapy uses high-energy beams to kill cancer cells and shrink tumours. It may be used as the primary treatment for smaller tumours, as an adjunct to surgery, or to treat areas where surgery is not possible.

External beam radiation therapy is commonly used for penile cancer, but brachytherapy (internal radiation therapy) may also be considered in some cases.

Chemotherapy

Chemotherapy involves the use of drugs to kill cancer cells or slow their growth. It may be used in combination with surgery and/or radiation therapy for advanced or metastatic penile cancer.

Systemic chemotherapy, which circulates throughout the body via the bloodstream, is the most common approach for treating penile cancer.

Mohs surgery

Mohs surgery is a specialised technique for removing skin cancers, including some early-stage penile cancers. It involves removing thin layers of tissue and examining them under a microscope until no cancer cells are detected.

Immunotherapy

Immunotherapy is a newer treatment approach that uses drugs to stimulate the body's immune system to fight cancer. While not yet standard for penile cancer, clinical trials are investigating the potential effectiveness of immunotherapy in certain cases.

Clinical trials

Participation in clinical trials may offer access to experimental treatments or new approaches to treating penile cancer. These trials help researchers evaluate the safety and effectiveness of innovative therapies.

Penile cancer and its treatment can lead to various complications, which may affect physical, emotional, and sexual well-being. Some common complications associated with penile cancer include:

• Urinary problems: Surgery for penile cancer, particularly partial or total penectomy, can impact urinary function. Some individuals may experience urinary incontinence (involuntary leakage of urine) or difficulty urinating after surgery. In some cases, additional surgical procedures or interventions may be necessary to manage urinary problems.
• Sexual dysfunction: Penile cancer and its treatment can affect sexual function and intimacy. Partial or total penectomy may result in erectile dysfunction, difficulty achieving or maintaining erections, or changes in sensation. These changes can have a significant impact on sexual relationships and overall quality of life.
• Body image issues: Surgery for penile cancer can alter the appearance of the penis, leading to changes in body image and self-esteem. Some individuals may experience feelings of embarrassment, shame, or anxiety about their appearance and may struggle with acceptance and adjustment after surgery.
• Lymphedema: Lymphedema is a condition characterised by swelling in the arms or legs due to the accumulation of lymphatic fluid. Lymphedema can occur as a complication of lymph node dissection surgery for penile cancer, particularly if lymph nodes in the groin area are removed. Management of lymphedema may involve compression garments, massage therapy, and other conservative measures.
• Psychological impact: A diagnosis of penile cancer and its treatment can have a profound psychological impact on individuals and their loved ones. Feelings of fear, anxiety, depression, and uncertainty are common and may persist even after successful treatment. Psychosocial support, counselling, and participation in support groups can help individuals cope with the emotional challenges of penile cancer.
• Recurrence and metastasis: Despite aggressive treatment, penile cancer can recur (come back) after treatment or spread to other parts of the body (metastasize). Regular follow-up appointments with healthcare providers are essential to monitor for signs of recurrence or metastasis and to adjust treatment as needed.
• Complications of treatment: Surgery, radiation therapy, chemotherapy, and other treatments for penile cancer can also lead to specific complications, such as wound infections, bleeding, pain, fatigue, and side effects from medications. These complications may require additional medical intervention and supportive care.

While there is no guaranteed way to prevent penile cancer, certain lifestyle choices and behaviours may reduce the risk. Here are some strategies for penile cancer prevention:

• Practise good hygiene: Maintaining good genital hygiene is essential for reducing the risk of penile cancer. Regularly washing the penis with warm water and mild soap can help remove smegma, a substance that can accumulate under the foreskin and may contain carcinogens.
• Avoid tobacco use: Smoking is a known risk factor for penile cancer. Quitting smoking and avoiding exposure to tobacco smoke can help reduce the risk of developing the disease.
• Practise safe sex: Practising safe sex, including using condoms and limiting the number of sexual partners, can help reduce the risk of sexually transmitted infections (STIs) that may increase the risk of penile cancer, such as human papillomavirus (HPV).
• Get vaccinated against HPV: The HPV vaccine can protect against certain strains of HPV that are associated with an increased risk of penile cancer. Vaccination is recommended for boys and girls before they become sexually active.
• Seek prompt medical attention: Pay attention to any changes in the skin or appearance of the penis, such as lumps, sores, or changes in colour.If you notice any unusual symptoms, such as persistent pain, bleeding, or discharge, seek prompt medical evaluation.
• Practice self-examination: Regularly examine the penis for any abnormalities, such as lumps, bumps, or changes in skin texture or colour. Promptly report any concerning findings to a healthcare provider.
• Consider circumcision: Some research suggests that circumcision may reduce the risk of penile cancer, particularly in men with a history of phymosis (tight foreskin) or poor genital hygiene. However, the evidence is not conclusive, and circumcision surgery should be a personal decision made in consultation with a doctor.
• Maintain a healthy lifestyle: Eating a balanced diet, maintaining a healthy weight, and staying physically active can help reduce the risk of various cancers, including penile cancer.

While these strategies may help reduce the risk of penile cancer, it's essential to remember that not all cases of penile cancer can be prevented. Regular medical check-ups and screenings are crucial for early detection and prompt treatment, which can improve outcomes and prognosis for individuals with penile cancer.

1. Can penile cancer affect fertility or reproductive function?

Penile cancer and its treatment may impact fertility and reproductive function in some cases. Depending on the extent of the cancer and the type of treatment received, individuals may experience changes in sexual function, ejaculation, or fertility. It's essential to discuss any concerns about fertility with a healthcare provider before starting treatment.

2. Are there support groups or resources available for individuals with penile cancer?

Yes, there are support groups, online forums, and resources available for individuals affected by penile cancer and their families. These resources can provide information, emotional support, and connections with others who have similar experiences. Healthcare providers or cancer organisations can help connect individuals with these support services.

3. Can penile cancer recur after treatment, and how is recurrence monitored?

Yes, penile cancer can recur (come back) after treatment, particularly if not all cancer cells were eliminated during initial treatment. Regular follow-up appointments with healthcare providers are essential to monitor for signs of recurrence and to adjust treatment as needed. Monitoring may include physical examinations, imaging tests, and blood tests to detect any changes or abnormalities.

4. How does penile cancer affect mental health and emotional well-being?

A diagnosis of penile cancer and its treatment can have a significant impact on mental health and emotional well-being. Many individuals experience feelings of fear, anxiety, depression, or stress related to their diagnosis, treatment, and potential changes in body image or sexual function. It's essential to address these concerns and seek support from healthcare providers, counsellors, or support groups as needed.

5. What are the long-term effects of penile cancer treatment?

The long-term effects of penile cancer treatment can vary depending on the type of treatment received and individual factors. Some individuals may experience lasting changes in urinary function, sexual function, body image, or emotional well-being after treatment. It's important to discuss potential long-term effects with healthcare providers and to address any concerns or issues that arise.

6. Are there lifestyle changes or self-care practices that can help manage the side effects of penile cancer treatment?

Yes, certain lifestyle changes and self-care practices may help manage the side effects of penile cancer treatment. These may include maintaining a healthy diet, staying physically active, practising relaxation techniques, and seeking support from healthcare providers or support groups. It's essential to follow the guidance of healthcare providers and to communicate any concerns or symptoms experienced during treatment.

7. Is penile cancer contagious?

No, penile cancer is not contagious. It cannot be transmitted from one person to another through casual contact or sexual activity. Penile cancer develops as a result of genetic, environmental, and lifestyle factors, such as HPV infection, smoking, and poor hygiene, rather than through direct transmission from another individual.

8. What is the survival rate for penile cancer?

The survival rate for penile cancer varies depending on several factors, including the stage of the cancer at diagnosis, the type of treatment received, and the individual's overall health. Overall, the five-year survival rate for penile cancer is relatively high when detected at an early stage, with approximately 85-95% of individuals surviving five years or more after diagnosis. However, survival rates may be lower for advanced or metastatic penile cancer.

9. Can penile cancer cause urinary problems?

Yes, penile cancer and its treatment can cause urinary issues in some cases. Surgery for penile cancer, such as partial or total penectomy, may impact urinary function, leading to issues such as urinary incontinence (involuntary leakage of urine) or difficulty urinating. Additionally, tumours that block or compress the urethra (the tube that carries urine from the bladder out of the body) can cause urinary symptoms such as frequent urination, urgency, or difficulty emptying the bladder. It's essential for individuals experiencing urinary problems to discuss them with a healthcare provider for appropriate evaluation and management.

Reviewed By Dr. Himanshu Shukla - Senior Consultant - Surgical Oncology on 16 Oct 2024.