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Penile Cancer
By Amy Otis
, RN

Cancer of the penis is extremely rare in the United States affecting only about one percent of men each year. Penile cancer does tend to be slow growing. When it is diagnosed early it is highly curable. Generally it is more common in countries where circumcision at birth is not as common as in the United States and Europe. This type of cancer is rare in Jewish and Muslim men who are circumcised routinely shortly after birth.

The risks for penile cancer include:

Age: Most cases are seen in men between ages 45 and 75, although nearly a third of cases occur in men under age 50. In other countries it accounts for 10% to 20% of male cancers in this same demographic.

The Human Papillomavirus (HPV): This sexually transmitted disease has more than 40 to 60 subtypes. HPV-16 and HPV-18 are most frequently linked to penile cancer. This is the same virus that causes genital warts and cervical cancer in women.

There currently is a vaccine called Gardasil® which protects against HPV, although only against four of these. Their numbers are: HPV-6, HPV-11, HPV-16 and HPV-18.

It is vital to get young people vaccinated against this virus in this writer's opinion. There are roughly six million new cases of HPV in the United States every year. About 75% of these occur in the 15 to 24 year-old population. If you think you have genital warts, see your health care provider right away to prevent transmission and to prevent their growth. (They can get quite large).

Lack of circumcision at birth: Studies have shown that penile cancer rates are higher in populations where circumcision is done later in life or not at all as mentioned earlier. There is an association between penile cancer and poor genital hygiene and phimosis.

Phimosis: Phimosis refers to a tightening of the penile foreskin that prevents its retraction over the glans. This situation can lead to the buildup of bodily oils and bacteria. Retraction and proper cleansing should occur routinely if phimosis is present.

Symptoms

A tumor most frequently occurs on the glans (tip) and on the inner lip of the foreskin if intact. It may begin as a small lump or ulcer on the penis, as a nodule, or a dry and scaly area. An early tumor is usually painless.

The greatest hindrance to early diagnosis is delay in seeking medical attention. Most men are hesitant to discuss any penile changes with their health care provider. It's hard for the majority of men to discuss abnormal findings regarding their genitals. This is why information is power and why this article is being written.

Penile cancer symptoms may include:

  • A wart-like growth, lump or lesion (often genital warts)
  • A lump that is freely moveable.
  • An open sore that won't heal.
  • Discharge under the foreskin that does not resolve with daily cleansing.
  • Penis pain or bleeding that occurs when the disease is advanced.

Prevention

Condoms are the number one way to prevent contracting HPV. Even without penetration during foreplay HPV can be transmitted. Check yourself often and get regular screenings by a health care professional if you have multiple sexual partners.

Men who are not circumcised should be taught at a young age how to clean properly under their foreskin. Men with intact foreskins need to examine the area underneath it regularly. Keeping this area clean is a key to lowering the risk of penile cancer for men who have retained foreskins.

Abstinence is a method of prevention, as well as limiting the number of sexual partners.

It has been hypothesized that smegma may serve as a carcinogenic agent; although studies have shown conflicted results it is certainly worth mentioning.

Treatment

Treatment options vary according to the stage, size, location, and invasiveness of the tumor. Surgery remains the most common form of treatment. Before undergoing any surgical procedure always get a second opinion.

For very small superficial primary lesions, this cancer may be treated with laser light therapy, laser therapy that destroys the tumor, radiation therapy, and in some cases, a cream containing a chemotherapy drug. These treatments offer the best chance of sparing the glans penis and sexual function. Chemotherapy is often used in conjunction with surgery when surgery is indicated.

Surgery to remove all or part of the penis is called penectomy and is not commonly done unless it is extremely necessary.

Partial penectomy is the more frequently used form of therapy. The tumor is removed along with a margin of normal tissue. Sparing as much of the glans and shaft as possible is a surgeon's primary concern in order to retain urinary and sexual function.

Total penectomy involves removal of the entire penis and is reserved for large tumors. The surgeon reroutes the urethra behind the testicles and a hole (urethrostomy) is created to allow urination.

Penile reconstructive surgery involves using skin from the buttocks or forearm to create a new penis. This option is a possible in some cases. It's something you need to discuss with your surgeon since every case is different.

It is crucial to find penile tumors early and seek immediate medical attention for any abnormalities on the penis. Find a well-known urologist that you feel comfortable talking to. This type of cancer can be highly psychologically devastating. Remember as stated earlier: the greatest hindrance to early diagnosis is delay in seeking medical attention.

For more on Peyronie's disease see that article. For more Erecticle Dysfunction, go there.. For more on Penis Problems, see that article.

Amy Otis is a registered nurse, a writer and an educator. Amy's the founder of several health-related web sites, a sexual health site called Sex Ed 101 and BeingWoman.net - Stop by, you might just learn something.

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