Penile cancer: Difference between revisions
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}}</ref> Penile cancer is extremely rare, and it tends to develop in men over the age of sixty. | }}</ref> Penile cancer is extremely rare, and it tends to develop in men over the age of sixty. | ||
== | == Risk factors == | ||
The major risk factors for penile cancer are advanced age (greater than age 60), use of tobacco, and infection with human papilloma virus. | |||
== | ===Circumcision myth=== | ||
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. | |||
===Infection with human papilloma virus=== | |||
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. [http://www.cirp.org/library/disease/cancer/mccance/ 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. | |||
===Use of tobacco=== | |||
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> | 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 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 | [[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 | ||
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}}</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]].) | }}</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 | Bissada ''et al''. (1986) report cancer forms on the [[circumcision scar]].<ref name="bissada1986">{{REFjournal | ||
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}}</ref> Circumcision may now be considered a risk factor for penile cancer. | }}</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 | |||
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== 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 == | == Circumcision as prevention == | ||