Penile cancer

Penile cancer is a malignant tumor that develops from the tissues of the penis that has the ability to metastasize (spread throughout the body). Metastatic cancer of the penis can lead to death of the patient.

Penile cancer is fairly rare cancer. Its prevalence in European countries is on average from 0.1 to 1 per 100 000 males, ranging from 2 to 4 cancer of the urogenital system in men. Most often the disease occurs in men older than 60 years, however, there were cases under the age of 40 years and even in children. About 30 cases of cancer of the penis, unfortunately, are detected in patients in an advanced stage when the tumor is outside of the penis. Approximately 10 patients with pre-installed locally advanced form of the disease, in consequence of metastases. Although not revealed a clear correlation between stage of disease and tumor size and prognosis, these indicators are very important in determining the potential presence of metastases in lymph nodes. So, at the 1st stage of the disease the percentage of metastases ranges from 19 to 29, while the 2nd stage from 46 to 65, when the 3rd stage from 82 to 85.

Predisposing factors for the development of penile cancer include:

Noted the relationship between the development of penile cancer with lifestyle men, insufficient personal hygiene.

Penile cancer can be located on the glans penis, the foreskin, the glans and the skin of the foreskin at the same time, on the coronal sulcus of the penis and on the shaft of the penis. Initially, the disease most often manifests as modified small area of skin, with a consequent increase in size and the seal of this site. Also penile cancer can manifest in the form of ulcers, erosions, or growths in the form of "cauliflower" on the skin or head of the penis. Other manifestations of the disease are the appearance of pain in the area of change, the increase in inguinal lymph nodes accompanied by pain, the impurities in the blood in urine, pain during urination.

In the presence of diseases such as phimosis symptoms may appear much later due to the inability of the patient to observe changes the skin and glans penis. Signs of penile cancer while phimosis, in addition to the above, can be purulent, foul-smelling discharge from the prepuce.

There are three main clinical forms of penile cancer: ulcerative, nodular, and papillary.

• Ulcers form occurs in most cases and is characterized by rapid infiltrative, destructive growth. Sooner appear metastases in regional lymph nodes and infiltration of the corpus cavernosum.
• Knotty (infiltrative) form is less common, typical growth both in depth and on the surface. Unlike ulcerative form during her slower.
• Papillary carcinoma is more common knotty and is characterized by a more benign course. Cases of course of this form without treatment over 10 years. Metastasis later.

Known another kind of cancer of the penis - swollen form, the most rare. It is characterized by rapid growth, early and enhanced metastasis not only in regional lymph nodes and in distant organs.

On the histological structure in the majority of cases (95) occurs in squamous cell carcinoma.

To endophytic cancer with a tendency to active infiltrative growth and rapid metastasis are edematous, nodular and ulcerative forms. To exophytic - papillary carcinoma.

Clinically ulcerative form characterized by the appearance of ulcers on the glans penis or prepuce. Initially, the ulcer is small, superficial, crusted. As more it deepens and expands to the sides. The bottom of the ulcer edge and dense, uneven, bleeding. The ulcer is usually painless.

Papillary carcinoma affects the glans penis and the inner foreskin. Tumor-like protrusion has a villous surface, resembling cauliflower. The surface of the tumor may ulcerate.

Knotty shape for a long time manifested painless education, which is slowly increasing in all directions.

Edematous form initially has the form of small sores, or node, which soon joins pronounced swelling (lymphedema, cancer limpangog).

The first symptoms of cancer of the penis is a small erosion or papilloma on the glans or inner foreskin, which is subjectively less of a concern to patients. Over time these formations increase, which can cause pain or bleeding during erection. When phimosis observed suppurative sanious putrid odor discharge, itching.

Classification of malignant tumors of the penis by the TNM system:

• Ti - tumor diameter less than 2 cm, limited, without signs of infiltration-
• T2 - the tumor size of 2 to 5 cm, with minor infiltration-
• T3 - tumor larger than 5 cm or tumor with a smaller diameter, but with invasion of the cavernous bodies-
• T

Metastases in lymph nodes are evaluated by localization and smesimosti:

• Ni - enlarged movable inguinal nodes on one side
• N2 - enlarged movable inguinal nodes on both sides-
• N3 is increased from both sides not movable inguinal lymph nodes.

The first thing you need to do man, unsuspecting host to penile cancer - to seek a personal consultation with a urologist, on which the examination will be evaluated by the size, location, color, contours and boundaries of education, mobility/the unity of education with tissues, the relationship of the tumor and/or lymph nodes are enlarged with other structures, produced differential diagnosis with other diseases showing similar pattern.

One of the main methods of diagnosis of cancer of the penis is cytological examination and biopsy of the amended section or enlarged inguinal lymph nodes with subsequent histological examination, which allows to determine the stage of disease noticed wherever you go and to determine the indications for follow-up treatment.

Additional methods of examination in cancer of the penis include:

For suspected metastasis (the further spread of the disease in the body) is performed computed tomography (CT) of the pelvic organs, if necessary, CT scan of abdomen radiography of the chest.

Additional laboratory method for the diagnosis of penile cancer is to determine the level of blood calcium.

The choice of method of treatment for penile cancer depends on the stage of the disease, which can be determined after a thorough examination, determine the stage and extent of disease. Currently known methods of treatment of this disease is represented by:

• Conservative methods of treatment:
  • radiation therapy and brachytherapy method is used in the treatment of small primary formations cosmetic purpose and for the purpose of preservation of penile function. The results of this method remain disappointing, appearing as a large number of relapses.
  • laser therapy and radiation therapy with brachytherapy is used to treat locally advanced forms of the disease. In the treatment uses a combination СО2иNd:YAG laser power 40W:W. Results as with radiation therapy, leave much to be desired, with the development of a recurrence of the disease in 7 cases.
  • cryotherapy.
  • local therapy.
  • chemotherapy.
• Operative methods of treatmentthat include the removal of the primary lesion, tumor, removal of the inguinal and pelvic lymph nodes, and more aggressive techniques to remove a portion of bone of the pelvis.
• Combination therapy - the combination of surgical treatment, chemotherapy, and radiation therapy.

What are the side effects of different treatments

With radiation and brachytherapy complications of this method are the development of local complications, urethral strictures, necrosis (necrosis) of the penis. The main complication of laser therapy are postoperative bleeding (7 cases).

Complications of operative treatment may be narrowing of the newly formed urethra, inability or insufficient length and rigidity of the penis during sexual intercourse, decreased sensitivity of the penis after resection.

What is determining Wymore amount of removal of the penis

The main criterion in determining the level of resection of the penis - partial or total resection - is the location of the primary tumor and the length of the penis considering the fact that when you remove a tumor of the penis is excised indented to the area of healthy tissue by 2 centimeters. This is necessary to prevent further recurrence of the disease and is a recognized standard of care. To consider the option of saving the maximum length of the penis for aesthetic purposes is not recommended. In identifying involvement of the bones of the pelvis are partial resection. However, today, there are a number of short observations, showing that the removal of the primary tumor within healthy tissue indented less than 2 centimeters pre-shows similar results to the standard practice, however, this method until the end unstudied.

What is a prognostic factor after the treatment of penile cancer

Important prognostic factor that deserves special attention is the amount involved during the lymph nodes. In several groups, examined and treated patients there was an increase in percent mortality when the patient has more than 2 inguinal lymph nodes metastases. Five-year survival in these patients ranges from 7 up to 50. When you have three or more metastases to inguinal lymph nodes the probability of hitting the pelvic lymph nodes increases C23 do in comparison withprevious group pateretaja survival udanych patients is less than 5.

Is there a possibility of reconstruction of the penis

Yes, there is. Today, plastic surgeons and urologists apply microsurgical techniques of total or partial recovery of the penis with the use of free musculocutaneous flaps the patient, modern synthetic material (Gore-Tex, Gore Medical, USA) with the restoration of the urethra, the sensitivity, the density of the penis sufficient for sexual intercourse. For full sexual rehabilitation prosthetics newly created penis (neophallus) modern inflatable penile implant. Methods are also being used with the use of your own bone and skin grafts with better accepted and less risk of infectious complications.

Will followup after treatment

Yes, you will need. The frequency of the control techniques will depend on the disease stage and the type of the treatment. You need the supervision of a urologist after treatment not less 5 years.

That may be, if you nenablyudaemo the doctor after treatment

Despite nedostatocno a large number of treatment methods, the submitted literature, the recurrence rate (recurrence) of the disease after surgical treatment ranges from 0 do7 cases, when conservative treatment can be up to 50. With proper monitoring and timely detection of the recurrence of the disease can be cured, otherwise a relapse of the disease can lead to death.

Among the Jews of cancer of the penis is practically not observed. Circumcision ensures that almost 100 per cent prevention of this disease, since most tumors of the penis occurs on the glans or inner surface of the foreskin. Experts have put forward the theory that common causes of tumors are chronic inflammation of the foreskin caused by poor hygiene and possibly provoked by viruses (cancer of the penis and cancer of the uterus, can be transmitted sexually). This theory suggests that men, regularno she bathed an foreskin may reduce the risk, but studies of this issue seem to be rather difficult.

With suspected cancer of the penis should, as early as possible, to seek the advice of a urologist. Late health care seeking men cheat nedostatocno delicate location problems, fear, fear, trying to ignore the illness or personal hostility to the problem. With early treatment the patient theassistance and initial stages of the disease, the prognosis is favorable outcome is significantly higher and requires less aggressive treatment methods.