Penile cancer - Definition

Penile cancer is a malignant growth found on the skin or in the tissues of the penis, usually originating in the glans and/or foreskin. It is a rare form of cancer with an annual incidence of 1 in 100,000 in developed countries.[1] (http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_penile_cancer_35.asp?sitearea=)

Risk Factors

The American Cancer Society (http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_penile_cancer_35.asp?sitearea=) provides the following as risk factors for penile cancer. They are: Human Papillomavirus Infection, Smoking, Smegma, Phimosis, Treatment of Psoriasis, Age and AIDS. Lack of circumcision is included among the enumerated risk factors, however, it is lised as a controversial topic that should not distract the public from the known and proven risk factors.

Risk

The overall 5-year survival rate for all stages of penile cancer is about 50%. Specifically in the United States the lifetime risk of an uncircumcised man for developing invasive penile cancer (IPC) is one in 600 [2] (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7377156&dopt=Abstract), which is in excess of 3 times higher than for males neonatally circumcised.[3] (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11144896&dopt=Abstract)[4] (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8380060&dopt=Abstract)[5] (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8260177&dopt=Abstract)

The evidence indicates that childhood circumcision reduces the incidence of penile cancer. [6] (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11196386&dopt=Abstract)[7] (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11144896&dopt=Abstract)[8] (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7377156&dopt=Abstract)[9] (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11405332&dopt=Abstract)[10] (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10643514&dopt=Abstract)[11] (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10699138&dopt=Abstract)

The American Cancer Society noted in a 1998 statement:

"... penile cancer risk is low in some uncircumcised populations, and circumcision is strongly associated with other socioethnic practices that are associated with lessened risk. The consensus among studies that have taken these other factors into account is that circumcision alone is not the major factor preventing cancer of the penis. It is important that the issue of circumcision not distract the public's attention from avoiding known penile cancer risk factors -- having unprotected sexual relations with multiple partners (increasing the likelihood of human papillomavirus infection) and cigarette smoking."[12] (http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_penile_cancer_35.asp?sitearea=)

It has been claimed that circumcision decreases the risk of HPV infection in males and thereby the risk of developing penile cancer.[13] (http://content.nejm.org/cgi/pmidlookup?view=short&pmid=11948269)[14] (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15388997)[15] (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12238658)

Wallerstein found that the risk of penile cancer in Finland, Norway, and Denmark (all noncircumcising countries) is about the same (1 in 100,000) as in the U.S.

The American Medical Association and the Royal Australasian College of Physicians say the use of infant circumcision to prevent penile cancer alone in adulthood is not justified. [16] (http://www.ama-assn.org/ama/pub/article/2036-2511.html) [17] (http://www.racp.edu.au/hpu/paed/circumcision/print.htm)

Staging

Like many malignancies, penile cancer can spread to other parts of the body. It is usually a primary malignancy, the initial place from which a cancer spreads in the body. Much less often is it a secondary malignancy, where cancer has spread to the organ from other antatomy. Doctors use the extent of metastasis to complete a process called staging. Patients will be assigned a "stage" to aid in treatment decisions and prognosis. Stage I

• Cancer has only affected the glans and/or foreskin.

Stage II

• Cancer has spread to the shaft of the penis.

Stage III

• Cancer has affected the penis and surrounding lymph nodes.

Stage IV

• Cancer has moved beyond the groin area to other parts of the body.

Recurrent

• Cancer that has returned after treatment.

Prognosis can range considerably for patients, depending where on the scale they have been staged. Generally speaking, the earlier the cancer is diagnosed, the better the prognosis. The overall 5-year survival rate for all stages of penile cancer is about 50%.

Treatment

There are several treatment options for penile cancer, depending on staging. They include surgery, radiation therapy, chemotherapy, and biological therapy. The most common treatment is one of four types of surgery: Wide Local Excision

• The tumor and some surrounding healthy tissue are removed.

Microsurgery

• Surgery performed with a microscope is used to remove the tumor and as little healthy tissue as possible.

Laser Surgery

• Laser light is used to burn or excise cancerous cells.

Circumcision

• Cancerous foreskin is removed from the penis.

Amputation

• The most common and effective treatment of penile cancer is penectomy. A penectomy can range from partial to total removal of the penis. The surgeon may also decide to remove associated lymph nodes.

Radiation therapy is usually used adjuvantly with surgery to reduce the risk of recurrence. With earlier stages of penile cancer, a combination of topical chemotherapy and less invasive surgery may be used. More advanced stages of penile cancer usually require a combination of surgery, radiation and chemotherapy.

Images of Invasive Penile Cancer

[18] (http://www.dermis.net/bilder/CD52/img0084.jpg)[19] (http://www.dermis.net/bilder/CD55/img0066.jpg)[20] (http://www.dermis.net/bilder/CD16/img0038.jpg)[21] (http://www.dermis.net/bilder/CD14/img0092.jpg)[22] (http://www.dermis.net/bilder/CD16/img0037.jpg)

References

• E.J. Schoen, M. Oehrli, C.J. Colby and G. Machin. The Highly Protective Effect of Newborn Circumcision Against Invasive Penile Cancer. Pediatrics 2000;105(3):e36 From the Departments of Genetics, Pediatrics, and Pathology, Kaiser Permanente Medical Center; and Division of Research, Kaiser Permanente Medical Care Program, Oakland, California.<i> Full Text (http://216.180.250.186/~circsec/library/schoen2/index.html) (<i>The lead author of this paper is a noted and outspoken circumcision activist. The article was published in a journal noted for its pro-circumcision stance.)
• C. Maden, K.J. Sherman, A.M. Beckmann, T.G. Hislop, C.Z. Teh, R.L. Ashley and Daling JR. History of Circumcision, Medical Conditions, and Sexual Activity and Risk of Penile Cancer. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Wash.<i> [23] (http://216.180.250.186/~circsec/library/maden/index.html)
• M Kochen, S McCurdy. Circumcision and the Risk of Cancer of the Penis. A Life-Table Analysis. <i>From the Program in Epidemiology, School of Public Health, University of California, Berkeley.<i> [24] (http://216.180.250.186/~circsec/library/kochen/index.html)
• Boczko S, Freed S. Penile carcinoma in circumcised males. <i>N Y State J Med 1979;79(12):1903-4. Full text (http://www.cirp.org/library/disease/cancer/boczko/)
• Cold CR, Storms MR, Van Howe RS. Carcinoma in situ of the penis in a 76-year-old circumcised man. J Fam Pract 1997;44:407-10. Full text (http://www.cirp.org/library/disease/cancer/vanhowe/)