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Symptoms include rednessThe major risk factors for penile cancer are advanced age (greater than age 60), irritationuse of tobacco, a sore or a lump on the penisand infection with human papilloma virus.<ref>{{REFweb | quote= | url=http://www.medicinenet.com/penis_cancer/page2.htm | title=Penis Cancer | last= | first= | publisher= | work= | date= | accessdate=2008-06-24}}</ref>
== Staging == Like many malignanciesThe myth that [[smegma]] was a carcinogenic, and thus that [[circumcision]] would render a man immune to penile cancer can spread to other parts of the body. It is usually a primary malignancy, the initial place from which a cancer spreads was invented in the body. Much less often it is 1932 by a secondary malignancy, one in which the cancer has spread to the penis from elsewhere. Doctors use the extent defender of ritual circumcision named [[metastasisAbraham L. Wolbarst]] to estimate what stage the disease is in, to aid in treatment decisions who also believed that circumcision prevented epilepsy, paralysis, and prognosis. The stages are assessed as follows (Jackson's staging): * Stage I - Cancer has only affected the [[glans penis|glansmasturbation]] .<ref>Wolbarst A. Circumcision and/or foreskinPenile Cancer.* Stage II - Cancer has spread to the [[penis|shaft]] of the penis''The Lancet'', vol.* Stage III - Mobile (operable) inguinal lymph nodes1 no.* Stage IV - Fixed 5655 (inoperableJanuary 16, 1932) inguinal lymph nodes or distant metastasis: pp. * Recurrent 150- Cancer that has returned after treatment153. Prognosis can range considerably for patients</ref> No laboratory or clinical research had been done on the subject at the time, depending where on however Wolbarst's myth found its way into early medical textbooks regardless. Although the scale they have been stagedsmegma hypothesis was completely disproven by an exhaustive study by Reddy in 1963,<ref>D.G. Reddy; I.K. Baruah. Generally speaking"Carcinogenic Action of Human Smegma," ''Archives of Pathology'', the earlier the cancer is diagnosedvol. 75, the better the prognosisno. 4 (April 1963): pp. The overall 5414-year survival rate for all stages of penile cancer is about 50 percent420.</ref> circumcision advocates continue to stubbornly repeat it.
There are several treatment options for penile The link between the presence of [[human papillovirus]] (HPV) and genital cancerwas established in the 1980s.<ref>zur Hausen H. Genital papillomavirus infections. ''Prog Med Virol'' 1985;32:15-21.</ref><ref>Kaufman RH, depending on stagingAdam E: Herpes simplex virus and human papilloma virus in the development of cervical carcinoma. They include surgery''Clin Obstet Gynecol'' 1986; 3: 678-692</ref><ref>McCance DJ, radiation therapyKalache A., chemotherapyAshdown K, and biological therapyet al. [http://www.cirp. The most common treatment is one of five org/library/disease/cancer/mccance/ Human papillomavirus types 16 and 18 in carcinomas of surgerythe penis from Brazil]. ''Int J Cancer'' 1986: * Wide local excision 37:55- The tumor 59</ref><ref>Villa LL, Lopes A. Human papillomavirus DNA sequences in penile carcinomas in Brazil. ''Int J Cancer'' 1986;37(6):853-5.</ref><ref>McCance DJ. Human papillomaviruses and some surrounding healthy tissue are removedcancer. ''Biochem Biophys Acta'' 1986;823:195-206</ref><ref>Barrasso R, De Brux J, Croissant O, et al.* Microsurgery High prevalence of papillomavirus- Surgery performed associated penile intraepithelial neoplasia in sexual partners of women with a microscope is used to remove cervical intraepithelial neoplasia. ''N Engl J Med'' 1987 Oct 8;317(15):916-23.</ref> Poland identified human papilloma virus (HPV) types 16 and 18 as the tumor cause of penile and cervical cancers in 1990, and as little healthy tissue as possiblethat they could be spread by sexual contact.* Laser surgery - laser light is used to burn or cut away cancerous cells<ref>Poland RL.* [[Circumcision]http://www.cirp.org/library/general/poland/ The question of routine neonatal circumcision] . ''N Eng J Med'' 1990; 322:1312- cancerous foreskin is removed5.* Amputation ([[penectomy]]) </ref> At least one study suggests that circumcised men are at higher risk for HPV infection,<ref>Cook LS, Koutsky LA, Holmes KK. Clinical presentation of genital warts among circumcised and uncircumcised heterosexual men attending an urban STD clinic. ''Genitourin Med'' 1993;69:262- 4</ref> making being circumcised a partial or total removal of the penis, and possibly the associated lymph nodesrisk factor.
Radiation therapy is usually used adjuvantly with surgery to reduce the risk of recurrence. With earlier stages ===Use 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.In addition to all the above, treatment of the underlying disease like Brucellosis, is important to limit disease recurrence. tobacco== Risk factors == The exact cause of penile cancer is unknown. The myth that [[smegma]] was a carcinogenic, and thus that [[circumcision]] would render a man immune to penile cancer, was invented in 1932 by a defender of ritual circumcision named [[Abraham L. Wolbarst]], who also believed that circumcision prevented epilepsy, paralysis, and [[masturbation]].<ref>Wolbarst A. Circumcision and Penile Cancer. ''The Lancet'', vol. 1 no. 5655 (January 16, 1932): pp. 150-153.</ref> No laboratory or clinical research had been done on the subject at the time, however Wolbarst's myth found its way into early medical textbooks regardless. Although the smegma hypothesis was completely disproven by an exhaustive study by Reddy in 1963,<ref>D.G. Reddy; I.K. Baruah. "Carcinogenic Action of Human Smegma," ''Archives of Pathology'', vol. 75, no. 4 (April 1963): pp. 414-420.</ref> circumcision advocates continue to stubbornly repeat it. The link between the presence of [[human papillovirus]] (HPV) and genital cancer was established in the 1980s.<ref>zur Hausen H. Genital papillomavirus infections. ''Prog Med Virol'' 1985;32:15-21.</ref><ref>Kaufman RH, Adam E: Herpes simplex virus and human papilloma virus in the development of cervical carcinoma. ''Clin Obstet Gynecol'' 1986; 3: 678-692</ref><ref>McCance DJ, Kalache A., Ashdown K, et al. Human papillomavirus types 16 and 18 in carcinomas of the penis from Brazil. ''Int J Cancer'' 1986:37:55-59</ref><ref>Villa LL, Lopes A. Human papillomavirus DNA sequences in penile carcinomas in Brazil. ''Int J Cancer'' 1986;37(6):853-5.</ref><ref>McCance DJ. Human papillomaviruses and cancer. ''Biochem Biophys Acta'' 1986;823:195-206</ref><ref>Barrasso R, De Brux J, Croissant O, et al. High prevalence of papillomavirus-associated penile intraepithelial neoplasia in sexual partners of women with cervical intraepithelial neoplasia. ''N Engl J Med'' 1987 Oct 8;317(15):916-23.</ref> Poland identified human papilloma virus (HPV) types 16 and 18 as the cause of penile and cervical cancers in 1990, and that they could be spread by sexual contact.<ref>Poland RL. [http://www.cirp.org/library/general/poland/ The question of routine neonatal circumcision]. ''N Eng J Med'' 1990; 322:1312-5.</ref> At least one study suggests that circumcised men are at higher risk for HPV infection,<ref>Cook LS, Koutsky LA, Holmes KK. Clinical presentation of genital warts among circumcised and uncircumcised heterosexual men attending an urban STD clinic. ''Genitourin Med'' 1993;69:262-4</ref> making being circumcised a risk factor.
Edit heading.
}}</ref> Penile cancer is extremely rare, and it tends to develop in men over the age of sixty.
== Symptoms Risk factors ==
== Pathology =Circumcision myth===* A. Precancerous Dermatologic Lesions* B. Carcinoma in Situ (Bowen Disease, Erythroplasia of Queyrat)* C. Invasive Carcinoma of the Penis
== Treatment =Infection with human papilloma virus===
Hellberg ''et al''. (1986) identified tobacco use as another risk factor for cancer of the penis.<ref>Hellberg D, Valentin J, Eklund T, Staffan Nilsson. [http://www.cirp.org/library/disease/cancer/hellberg1/ Penile cancer: is there an epidemiological role for smoking and sexual behavior?] ''Brit Med J'' 1987;295(6609):1306-8</ref> The use of tobacco has since been a well established risk factor in cancer of the penis.<ref>Harish K, Ravi R. [http://www.cirp.org/library/disease/cancer/harish/ The role of tobacco in penile carcinoma]. ''Brit J Urol'' 1995;75(3):375-377.</ref><ref>Rogus BJ. Squamous cell carcinoma in a young circumcised man. ''J Urol'' 1987;138(4):861-2.</ref><ref>Maden C ''et al''. History of Circumcision, Medical Conditions, and Sexual Activity and Risk of Penile Cancer. ''Journal of the National Cancer Institute'', vol. 85, no. 1., January 6, 1993, pp. 19-24.</ref>
Other risks include poor hygiene, and an increased number of sexual partners (30 partners or more).<ref>•Brinton LA, Reeves WC, Brenes MM, ''et al''. The male factor in the etiology of cervical cancer among sexually monogamous women. ''Int J Cancer'' 1989;44(2):199-203.</ref>
===Other risks===
[[Phimosis]] has been implicated as a risk factor in sexually active males, because a non-retractile foreskin may result in poor hygiene, and because men with phimosis are at higher risk for lichen sclerosus (also known as [[balanitis xerotica obliterans]]), which may also be a risk factor.<ref name="titlebmj.com Rapid Responses for Rickwood ''et al''., 321 (7264) 792-793">{{REFweb
| quote=
| accessdate=2007-12-13
}}</ref> Adult males with a non-retractable foreskin who are sexually active may want to have the phimotic condition corrected. (For conservative treatment options, see [[phimosis]].)
===Circumcision as a risk factor===
Bissada ''et al''. (1986) report cancer forms on the [[circumcision scar]].<ref name="bissada1986">{{REFjournal
}}</ref> Circumcision may now be considered a risk factor for penile cancer.
== Symptoms == Symptoms include redness, irritation, a sore or a lump on the penis.<ref>{{REFweb | quote= | url=http://www.medicinenet.com/penis_cancer/page2.htm | title=Penis Cancer | last= | first= | publisher= | work= | date= | accessdate=2008-06-24}}</ref> == Pathology ==* A. Precancerous Dermatologic Lesions* B. Carcinoma in Situ (Bowen Disease, Erythroplasia of Queyrat)* C. Invasive Carcinoma of the Penis == 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 it is a secondary malignancy, one in which the cancer has spread to the penis from elsewhere. Doctors use the extent of [[metastasis]] to estimate what stage the disease is in, to aid in treatment decisions and prognosis. The stages are assessed as follows (Jackson's staging): * Stage I - Cancer has only affected the [[glans penis|glans]] and/or foreskin.* Stage II - Cancer has spread to the [[penis|shaft]] of the penis.* Stage III - Mobile (operable) inguinal lymph nodes.* Stage IV - Fixed (inoperable) inguinal lymph nodes or distant metastasis. * 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 percent. == 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 five 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 cut away cancerous cells.* [[Circumcision]] - cancerous foreskin is removed.* Amputation ([[penectomy]]) - a partial or total removal of the penis, and possibly the 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.In addition to all the above, treatment of the underlying disease like Brucellosis, is important to limit disease recurrence. == Circumcision as prevention myth==
The myth that circumcision rendered males immune to penile cancer was invented in 1932 by a New York doctor named [[Abraham L. Wolbarst]], M.D.<ref>Wolbarst, AL. Circumcision and penile cancer. ''Lancet'' 1932; 150-3.</ref> Wolbarst wrote an article that was published in ''The Lancet'' in 1932, implicating human male [[smegma]] as carcinogenic.<ref>Wolbarst A. Circumcision and Penile Cancer. The Lancet, vol. 1 no. 5655 (January 16, 1932): pp. 150-153.</ref> His hypothesis had absolutely no basis in valid scientific and epidemiological research.<ref>Fleiss PM, Hodges F. [http://www.cirp.org/library/disease/cancer/fleiss/ Neonatal circumcision does not protect against cancer]. ''BMJ'' 1996;312(7033):779-80.</ref> Wolbarst was directly responsible for proliferation of this myth, and all subsequent repetitons of it can be traced to his opinion article, although Wolbarst himself advocated universal neonatal circumcision principally as a preventive for epilepsy, paralysis, and [[masturbation]].<ref>Fleiss PM, Hodges F. [http://www.cirp.org/library/disease/cancer/fleiss/ Neonatal circumcision does not protect against cancer]. ''BMJ'' 1996;312(7033):779-80.</ref>
== Incidence of penile cancer ==
In North America the rate of penile cancer has been estimated to be 1 in 100,000<ref>Cutler SJ, Young JL Jr. Third national cancer survey: incidence data. Bethesda, Md. US Dept of Health, Education, and Welfare, Public Health Service, 1975</ref>. Maden ''et al''. reported penile cancer among a fifth of elderly patients from rural areas who had been circumcised neonatally and had been born at a time when the rate of neonatal circumcision was about 20% in rural populations.<ref>Maden C, Sherman KJ, Beckman AM, Hislop TG, Teh CZ, Ashley RL, ''et al''. [http://www.cirp.org/library/disease/cancer/maden/ History of circumcision, medical conditions, and sexual activity and risk of penile cancer]. ''JNCI'' 1993;85:19-24</ref> Their study also shows that the rate of penile cancer among men circumcised neonatally has risen in the United States relative to the rise in the rate of neonatal circumcision.
Penile cancer is very rare in Europe and North America, occurring in about one in 100,000 men in the latter. It accounts for 0.2% of cancers and 0.1% of deaths from cancer amongst males in the United States. However, in some parts of Africa and South America it accounts for up to 10% of cancers in men.<ref name="titleACS :: What Are the Key Statistics About Penile Cancer?">{{REFweb
|date=2006-08
|accessdate=
}}</ref> Gardasil has been shown to also be effective in males, and has been approved by the FDA to be marketed as such.<ref name="Bloomberg">Cortez, Michelle Fay and Pettypiece, Shannon. {http://www.bloomberg.com/apps/news?pid=20601202&sid=aajzweDaXZh0&refer=healthcare Merck Cancer Shot Cuts Genital Warts, Lesions in Men]. ''Bloomberg News''. (Bloomberg.com) 13 Nov 2008.]</ref>Two to three doses are necessary.
{{SEEALSO}}
* [[Cervical cancer]]
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* {{REFweb
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|title=Penile cancer, cervical cancer, and circumcision
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* {{REFweb
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|title=Cancer of the Penis
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