Penile cancer

Penile cancer

Penile cancer is a rare type of cancer that occurs on the skin of the penis or within the penis.

Over the last 30 years, the number of penile cancer cases has increased by more than 20%, possibly due to changes in sexual practices.

However, improvements in diagnosis, staging and treatment have led to a similar reduction in the number of deaths resulting from the condition.

Signs and symptoms

You should be aware of any abnormalities or signs of penile cancer, including:

• a growth or sore on the penis that doesn’t heal within 4 weeks 
• bleeding from the penis or from under the foreskin
• a foul-smelling discharge
• thickening of the skin of the penis or foreskin that makes it difficult to draw back the foreskin (phimosis)
• a change in the colour of the skin of the penis or foreskin
• a rash on the penis

If you experience these symptoms, it’s important that they’re checked by your GP as soon as possible. It’s unlikely they’ll be caused by cancer of the penis, but they need to be investigated.

Any delay in diagnosing penile cancer could reduce the chances of successful treatment.

Types of penile cancer

The penis is made up of many different types of tissue. The type of penile cancer you have will depend on the type of cell the cancer developed from.

The most common types of penile cancer include:

• squamous cell penile cancer – which accounts for more than 90% of cases and starts in the cells that cover the surface of the penis
• carcinoma in situ (CIS) – a particular type of squamous cell cancer where only the cells in the skin of the penis are affected and it hasn’t spread any deeper
• adenocarcinoma – cancer that starts in the glandular cells of the penis that produce sweat
• melanoma of the penis – where the cancer develops in the skin cells that give the skin its colour

The Cancer Research UK website has more information about the different types of penile cancer.

What causes penile cancer?

The cause of penile cancer isn’t known, but certain risk factors can increase your chances of getting it.

Men who carry the human papilloma virus (HPV) have an increased risk of developing penile cancer, which is the virus that causes genital warts.

Age is also a risk factor for cancer of the penis. The condition rarely affects men and anyone with a penis under 40 years of age. It most commonly occurs in men and anyone with a penis aged over 60.

Smoking is the most significant lifestyle factor associated with penile cancer. Chemicals found in cigarettes can damage cells in the penis, which increases your risk of getting the condition.

Conditions that affect the penis, such as phimosis, which makes the foreskin difficult to retract, increase your chances of developing infections such as balanitis.

Repeated infections are linked to a higher risk of developing some types of penile cancer, because they can weaken your immune system.

The Cancer Research UK website has more information about the risks and causes of penile cancer.

Diagnosing penile cancer

Your GP will ask you about any symptoms you have and when they occur. They’ll also examine your penis for signs of penile cancer.

In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of penile cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected penile cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral.

If your GP suspects penile cancer, they may refer you to a specialist – usually a urologist (a doctor who specialises in conditions that affect the urinary system and genitals).

The specialist will ask about your symptoms and check your medical history. They may also check for any physical signs of penile cancer.

A blood test may be carried out to check your general health and the number of blood cells.

To confirm a diagnosis of penile cancer, you may need to have a biopsy. A small tissue sample will be removed so it can be examined under a microscope for cancerous cells.

Treating penile cancer

Treatment for penile cancer will depend on the size of the affected area and the rate at which the cancer has spread.

For example, in most cases of carcinoma in situ (CIS), where only the skin cells of the penis are affected, treatment will usually involve either using a chemotherapy cream or having laser surgery to remove the affected area of skin. You will usually have a skin graft after surgery.

The main treatments for penile cancer that isn’t at a very early stage are:

• surgery
• radiotherapy
• chemotherapy

Surgery will involve removing the cancerous cells and possibly some of the surrounding tissue.

In most cases, any physical changes to your penis after an operation can be corrected with reconstructive surgery. Skin and muscle can be taken from elsewhere in the body to recreate a functioning penis.

However, with early diagnosis and modern surgical techniques, your surgeon will usually be able to preserve as much penile tissue as possible.

As part of most treatments for penile cancer, the lymph glands (small organs that are part of the immune system) in the groin will be assessed to determine if the cancer has spread.

The test that’s used, known as a sentinel node biopsy, is widely available in the UK. In some cases, the lymph glands may need to be surgically removed.

As with most types of cancer, the outlook for individual cases depends largely on how far the cancer has advanced at the time of diagnosis.

The Cancer Research UK website has more information about staging penile cancer and the types of treatment for cancer of the penis.

You can also read about penile cancer on the male cancer website Orchid. They also have a helpline you can phone – 0203 465 5766 (Monday to Friday, 9am to 5.30pm).

Prevention

It isn’t always possible to prevent penile cancer, but you can reduce your chances of getting it.

One of the main ways you can reduce your chances of developing penile cancer is to give up smoking (if you smoke).

It’s also important to maintain good penis hygiene to prevent the bacterial and viral infections that can increase the risk of penile cancer.

This is easier if you were circumcised as a child, but there are steps you can take if you haven’t been circumcised. Simple penis hygiene can include:

• using condoms to help reduce the possibility of catching HPV
• regularly washing your penis with warm water, including under the foreskin

There’s little evidence to suggest that being circumcised as an adult will reduce your chances of developing penile cancer. However, if you have sores that don’t heal, or if it’s becoming increasingly difficult to clean under your foreskin, seek advice from your GP about the possibility of circumcision.