Cancers of the penis are usually types of skin cancers. Skin cancer can occur anywhere on the penis, but it most commonly occurs at the glans penis (the cone-shaped end of the penis), especially its base. Cancers affecting the skin of the penis, uncommon in the United States, are even rarer in men who have been circumcised.
The cause of cancer of the penis may be long-standing irritation, usually under the foreskin. Infection with human papillomavirus and being uncircumcised increase the risk. Squamous cell carcinoma occurs most commonly. Early forms of cancer that are less common include Bowen disease, extramammary Paget disease, and erythroplasia of Queyrat.
Cancer usually first appears as a painless, reddened area, often with sores, but it can also be a hardened area or look like a wart. Cancers, unlike many other growths, do not heal for weeks. Erythroplasia of Queyrat causes a discrete, reddish, velvety or crusted area on the penis, usually on the glans penis or the inner foreskin. Bowen disease appears the same but affects the shaft. Bowenoid papulosis appears as bumps that are usually smaller, on the shaft of the penis. Lymph nodes in the groin may become enlarged because the cancer has spread to them or because they are infected and inflamed.
To diagnose cancer of the penis, doctors remove a tissue sample for examination under a microscope (biopsy). Sometimes computed tomography or magnetic resonance imaging is done to determine whether the cancer has spread into other tissues outside the penis. Enlarged and inflamed lymph nodes may be biopsied.
Strategies to prevent penile cancer include circumcision in early life and vaccination against the most common cancer-causing strains of human papillomavirus in adolescents.
To treat early or small cancers, doctors prescribe a cream containing fluorouracil or imiquimod or remove the cancer and some normal surrounding tissue with a laser or during surgery. For other cancers, doctors surgically remove the cancer, sparing as much of the penis as possible. Usually, men who undergo this type of surgery are able to use the remaining penile tissue for urination and sexual function. If cancer involves larger areas, the penis needs more extensive surgery.
Sometimes penis cancer spreads to the lymph nodes in the groin, and these nodes may need to be removed. Men with multiple, bilateral or bulky inguinal lymph nodes concerning for cancer should be treated with neoadjuvant chemotherapy prior to surgical removal. If unresectable or locally advanced after resection, then radiation may also be a consideration.
In most men, cancers are small and have not spread. These men survive for many years after treatment. Most men with cancer that has spread beyond the groin lymph nodes die within 5 years.
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