General and more comprehensive text about cancer diseases, their behavior, causes and treatment can be found here.
Penile cancer is relatively rare in developed countries. However, in some parts of the world (Asia, Africa) it occurs more frequently and therefore, it is good to know some information about this disease.
Lack of hygiene is a very important causative factor. Whitish smelly substance known as smegma accumulates under the foreskin and if not removed, it may cause local inflammation and increases the risk of cancer. This theory is further supported by the fact that the penile cancer is very rare among male Jews and Muslims who undergo circumcision as a part of their religious rituals. The circumcision removes the foreskin significantly improving the hygiene. In patients with phimosis (narrowing of the foreskin), the smegma accumulates more easily and it is assumed that these patients have an increased risk of penile cancer as well.
Other possibly risk factors include effects of carcinogens of cigarette smoke and the influence of HPV virus in penile cells. HPV (human papillomavirus) is extremely widespread and transfers, among others, by sexual intercourse. In addition, some viral strains of HPV are undoubtedly responsible for development of cervical cancer in women and various forms of warts (classic warts, genital warts, mollusci, etc.)
The development of penile cancer is often preceded by emergence of a precancerous lesion, which is for some time limited on exact location and does not spread. This precancerous phase is called erythroplasia of Queyrat and it usually looks like a mossy red lesion located on the glans of penis. The classic penile cancer looks like a reddish site or an ulcer on the penis that does not disappear, but on the contrary grows and destroys adjacent tissues. Local metastatic spread affects the lymph nodes in groin that may painlessly enlarge. Advanced stages may form distant metastases in other organs.
Any strange looking lesion of the penis should be examined by a urologist. In the majority of cases, it is just some benign affection but it is better to be safe than sorry. In addition, other treatable non-malignant diseases may form penile lesions (syphilis, genital warts, etc.). When the finding i unclear. The best solution is to take a small sample of the tissue and send it for a histological examination. Affection of local lymph nodes can be diagnosed by palpation or by ultrasound. The total extent of the tumor including distant metastases can be diagnosed by computed tomography.
Appropriate prevention is sufficient hygiene and washing under the foreskin of the penis. When a man suffers from the narrowed foreskin, circumcision is both the solution and prevention of penile cancer. Avoiding smoking is generally advisable to prevent cancer diseases and cardiovascular diseases. Preventive vaccination against HPV virus as a possible cause of penile cancer is not performed.
Small superficial tumors can be sometimes destroyed by a laser, or removed surgically including therapeutic circumcision, when the tumor is located on the foreskin. Larger tumors may be removed by more extensive operations together with a part or even the whole penis. It is also possible to surgically remove the lymphatic nodes of the groin. However, the loss of lymph nodes may disrupt the lymphatic flow out of the lower extremities resulting in their swelling (lymphedema). The surgical treatment can be combined with chemotherapy and irradiation.