Penile cancer

Penile cancer is the growth of malignant cells on the external skin and in the tissues of the penis. Cancer of the penis is a rare disease. It occurs mostoften in men who were not circumcised as infants.

The cause of penile cancer is unknown. There does, however, appear to be a connection between development of the disease and lack of personal hygiene. Failing to regularly and thoroughly cleanse the part of the penis covered by theforeskin increases the risk of developing the disease.

The most common symptom of penile cancer is a tender spot, an open sore, or awart-like lump that originates at the tip of the penis, spreads slowly across the skin, and invades deeper layers of tissue. Pain and bleeding may develop as the cancer continues to grow. A urologist should be consulted about anygrowths on the penis or abnormal discharge from it. If left untreated penile,cancer infiltrates the lymph nodes. Through the lymphatic (infection-fighting) system, it spreads to the groin and other parts of the body.

The diagnosis of penile cancer is most commonly made by a doctor who specializes in the genitourinary tract (a urologist). The doctor examines the patient's penis for lumps or other abnormalities. A biopsy may be ordered to distinguish malignant changes from syphilis and penile warts. If the results confirma diagnosis of cancer, additional tests are done to determine whether the disease has spread to other parts of the body. This process is called staging.

In Stage I of penile cancer, malignant cells are found only on the surface ofthe head (glans) of the penis. In Stage II, the penile cancer has spread tothe surface of the glans, tissues beneath the surface, and the shaft of the penis. In Stage III, malignant cells have spread to lymph nodes in the groin,where they cause swelling. In Stage IV, the disease has spread throughout thepenis and lymph nodes in the groin, or has traveled to other parts of the body.

Amputation of all or part of the penis (total or partial penectomy) is the most common and most effective treatment. If the disease is diagnosed early enough, surgeons are often able to preserve enough of the organ for urination and sexual activity.

Wide local excision is a form of surgery that removes only cancer cells and asmall amount of normal tissue adjacent to them. Microsurgery removes cancerous tissue and the smallest possible amount of normal tissue. During microsurgery, the doctor uses a special instrument that provides a comprehensive viewof the area where cancer cells are located and makes it possible to determinethat all malignant cells have been removed. Laser surgery uses an intense precisely focused beam of light to dissolve or burn away cancer cells.

Radiation therapy may be administered to enhance the effects of surgery or asan alternative to surgery. External radiation is provided by a machine. Internal radiation involves implanting radioactive elements into the part of thebody where malignant cells are located.

Superficial cancers that are limited to a small area can be treated with fluorouracil (Adrucil, Efudex), a medication that is applied as a cream directlyto the skin of the penis.

More advanced disease requires systemic treatments with chemotherapy that isadministered intravenously or taken by mouth. These drugs enter the bloodstream and kill cancer cells that have spread to any part of the body.

Biological therapy is a type of treatment that is sometimes called biologicalresponse modifier (BRM) therapy. It uses natural or artificial substances toboost, focus, or reinforce the body's disease-fighting resources.

Cure rates are high for cancers diagnosed in Stage I or II, but much lower for Stages III an IV, by which time cancer cells have spread to the lymph nodes.

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