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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 ==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.
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):===Infection with human papilloma virus===
* Stage I - Cancer has only affected The link between the presence of [[glans penis|glanshuman papillovirus]] (HPV) and/or foreskin.* Stage II - Cancer has spread to genital cancer was established in the [[penis|shaft]] of the penis1980s.* Stage III - Mobile (operable) inguinal lymph nodes<ref>zur Hausen H.* Stage IV - Fixed (inoperable) inguinal lymph nodes or distant metastasisGenital papillomavirus infections. * Recurrent ''Prog Med Virol'' 1985;32:15- Cancer that has returned after treatment21. Prognosis can range considerably for patients</ref><ref>Kaufman RH, depending where on Adam E: Herpes simplex virus and human papilloma virus in the scale they have been stageddevelopment of cervical carcinoma. Generally speaking, the earlier the cancer is diagnosed, the better the prognosis. The overall 5''Clin Obstet Gynecol'' 1986; 3: 678-year survival rate for all stages of penile cancer is about 50 percent. == Treatment == There are several treatment options for penile cancer692</ref><ref>McCance DJ, depending on stagingKalache A. They include surgery, radiation therapyAshdown K, chemotherapy, 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 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 possiblepenis from Brazil].* Laser surgery ''Int J Cancer'' 1986:37:55- laser light is used to burn or cut away cancerous cells59</ref><ref>Villa LL, Lopes A.* [[Circumcision]] - cancerous foreskin is removedHuman papillomavirus DNA sequences in penile carcinomas in Brazil.* Amputation ''Int J Cancer'' 1986;37([[penectomy]]6) :853- a partial or total removal of the penis, and possibly the associated lymph nodes5. Radiation therapy is usually used adjuvantly with surgery to reduce the risk of recurrence</ref><ref>McCance DJ. With earlier stages of penile Human papillomaviruses and cancer. ''Biochem Biophys Acta'' 1986;823:195-206</ref><ref>Barrasso R, a combination of topical chemotherapy and less invasive surgery may be usedDe Brux J, Croissant O, et al. More advanced stages High prevalence of papillomavirus-associated penile cancer usually require a combination intraepithelial neoplasia in sexual partners of surgery, radiation 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 chemotherapy.In addition to all the above, treatment of 18 as the underlying disease like Brucellosis, is important to limit disease recurrence. == Risk factors == The exact cause of penile cancer is unknown. The myth that [[smegma]] was a carcinogenicand cervical cancers in 1990, and thus that [[circumcision]] would render a man immune to penile cancer, was invented in 1932 they could be spread by a defender of ritual circumcision named [[Abraham L. Wolbarst]], who also believed that circumcision prevented epilepsy, paralysis, and [[masturbation]]sexual contact.<ref>Wolbarst APoland RL. [http://www.cirp. Circumcision and Penile Cancerorg/library/general/poland/ The question of routine neonatal circumcision]. ''The LancetN Eng J Med'', vol. 1 no. 5655 (January 16, 1932)1990; 322: pp. 1501312-1535.</ref> No laboratory or clinical research had been done on the subject At least one study suggests that circumcised men are 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 1963higher risk for HPV infection,<ref>DCook LS, Koutsky LA, Holmes KK.G. Reddy; I.K. BaruahClinical presentation of genital warts among circumcised and uncircumcised heterosexual men attending an urban STD clinic. "Carcinogenic Action of Human Smegma," ''Archives of PathologyGenitourin Med'', vol. 75, no. 4 (April 1963)1993;69: pp. 414262-420.4</ref> circumcision advocates continue to stubbornly repeat itmaking being circumcised a risk factor.
The link between the presence ===Use 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.tobacco===
Relocate text; add sub-headings.
}}</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
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
|accessdate=2020-02-10
}}</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 ==