Revised October 2001

General Information / Anatomy / Function / Statistics

• The penis is the external male organ of urination and coitus     
• Cancers of the penis if found and treated in the early stages have a five year survival rate of 85-90%   
  • If cancer has spread to lymph nodes in the groin the five year survival rate is 30% - 40% 
• Any lesion on the penis should be checked by a doctor     
• Rare in Canada     
• Rare in United States - 0.2% of all cancers     
• Premalignant: Erythroplasia of Queyrat - squamous cell carcinoma in situ of penis

Symptoms / Signs

• Sore or ulcer on the tip of the penis that does not heal
• Rarely painful
• Lump in the groin
• Discharge from the penis caused by infection which may irritate and itch
• Bleeding upon erection

Etiology / Carcinogens / Risks

• Primary cancer of penis is rare
• Uncircumcised males, aged 50-70 with poor hygiene of penis are at highest risk
• Slow growing and is curable if discovered early
• Seattle's University of Washington compared 110 men with penile cancer and 355 disease-free men. Risk of cancer was found to be higher among men who were never circumcised, smokers, men with a lifetime history of 30 or more sexual partners, and a history of genital warts
• Contrary to superstition, intercourse with a female with cervical cancer does not cause penile cancer.  Also, there is no persistent etiologic relationship between carcinoma of the penis and the venereal disease of syphilis, granuloma inguinale or chancroid.
• More common in areas of the world where circumcision is not a common practice, for example, Uganda, Ceylon, Thailand, Vietnam, and India

Prevention

• In areas of high incidence, circumcision in the neonatal period is known to be highly effective in preventing the development of penile cancer

• There are no blood tests to screen for cancer of the penis
• Physical exam
• Biopsy under local anesthetic
• Circumcision (removal of foreskin) may be necessary to remove tumour or expose the lesion for biopsy
• Chest X-ray
• CT scan

Staging   

Tis	- in situ, affects only the surface layer
T1	- invades subepithelial connective tissue
T2	- invades corpus spongiosum or cavernosum
T3	- invades urethra or prostate
T4	- invades other adjacent structures

Types

• Most commonly squamous cell carcinoma. Others include melanomas and sarcomas

Treatment

• In-situ disease (Tis) can be treated non-surgically by laser and topical creams such as 5-fluorouracil
• Early disease (Tis, T1) can be treated by local excision alone without sacrificing the penis
• In patients with more extensive disease (T1, T2 and above) requiring a complete or partial penectomy, radiotherapy is a treatment option which can allow for penile preservation.  In such patients, the optimal treatment should be assessed on a case by case basis by the surgeon and radiation oncologist.
• When the groin nodes are clinically involved by cancer, a surgical dissection of the lymph nodes is required.