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Penile Cancer – Briefly in 7 Key Questions

A rare disease with a frequency of 0.3-0.8 cases per 100,000 men. The incidence is highest in Latin America and parts of Africa, and lowest in countries where early circumcision is practiced.

  1. What is the cause of penile cancer?

The cause is associated with sexually transmitted diseases, human papillomavirus infection, chronic inflammation, and possibly smoking. Phimosis occurs in 40–60% of patients with penile cancer. With this disease, smegma accumulates under the foreskin, and urine is delayed. As a result, the glans penis and the inner layer of the foreskin become chronically inflamed. When smegma decomposes, carcinogenic substances are formed.

  1. What are penile tumors?

Most tumors are squamous with varying degrees of differentiation. Rarely seen in melanoma, lymphoma, and sarcoma. Additional prognostic factors are the depth of invasion and damage to the lymphatic and blood vessels. Most often, penile cancer is a squamous (squamous) cell carcinoma. The tumor is located mainly on the surface of the head or foreskin, less often on the body of the penis.

  1. How are they diagnosed?

Early diagnosis of the disease in the absence of complaints in patients. Conduct an examination of the penis and palpation of the inguinal lymph nodes. If a malignant disease is suspected, a histological examination is performed.

To detect distant metastases, an X-ray examination of the lungs and the skeletal system is performed.

A biopsy is taken to detect enlarged inguinal nodes and swelling of the penis. The antibiotic should be taken 4 weeks prior to the biopsy to act on inflammatory enlarged inguinal lymph nodes and to identify metastatic ones. Reactive hyperplasia occurs in 50-70%, and after removal of the primary tumor of the penis, lymphadenomegaly normalizes. Only a histological (cytological) study proves the presence of metastases in the lymph nodes and determines the stage of the disease.

  1. Where do they metastasize?

Penile carcinoma metastasizes predominantly via the lymphatic route, first affecting the inguinal lymph nodes, then the iliac and para-aortic lymph nodes. Hematogenous metastases occur late, predominantly in the bones and lungs.

  1. What is the treatment?

Treatment is carried out depending on the degree of development of carcinoma. The main treatment is surgical. It is expressed by total or partial resection in combination with the removal of lymph nodes. It can be combined with chemotherapy and radiation therapy. Radiation therapy is an acceptable option for patients who refuse surgery. Brachytherapy (a type of radiation therapy) is suitable for tumors less than 4 cm in diameter. Chemotherapy uses methotrexate, bleomycin, cisplatin, paclitaxel, and ifosfamide.

  1. What is the prognosis?

The prognosis is favorable with early diagnosis of the disease and timely treatment.

  1. What is prevention?

Prevention of penile cancer is extremely important and aims to eliminate predisposing factors. It is necessary to maintain very good hygiene, timely surgical treatment of phimosis, treatment of chronic inflammatory diseases of the penis, immediate consultation with a doctor in case of complaints.

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