Penile Cancer

Penis is the Latin word for "tail", meaning reproductive rate. It consists of two parts, the body and the head, and the head is covered with the foreskin called "preputium". It consists of a "spongiosal body" containing urinary and semen channels called "urethra" and two spongy tube-like structures rich in blood vessels called "cavernous body". Cavernous bodies; They are wrapped in a sheath made of durable fibers, and inside the sheath there are small chambers called "cavern", which means hollow. These chambers fill with blood upon sexual stimulation and cause the penis to become erect. The spongy body is located in the lower part of the penis. It is not surrounded by a hard sheath and its tip expands to form the head part of the penis called the "glans".

Penile cancer is a very rare type of cancer that affects the skin and other tissues of the penis and more than 95% is squamous cell. It is a type of cancer. While the incidence is 0000.5% in developed countries, this rate increases to 1-2% in underdeveloped countries. It is common in regions where infections caused by viruses called HPV and transmitted through sexual contact are common.

What are the causes?

Any situation that increases the risk of contracting a disease. defined as “risk factor”. Having risk factors does not mean that you will get that disease, but not having risk factors does not mean that you will not get that disease.

Although the exact cause is not known, some risk factors related to penile cancer have been identified.

• Age: Penile cancer is more common over the age of 60.

• Phimosis: It means that the foreskin cannot be retracted due to adhesions or narrowness of the tip. income. In the presence of phimosis, the risk of penile cancer increases 10 times.

• Not being circumcised: The risk of penile cancer increases 3 times in uncircumcised men. Circumcision also reduces the risk of HPV transmission.

• Chronic penile inflammation

• Exposure to UV light: UV applied in some skin diseases such as psoriasis. Light therapy increases the risk by 9 to 10 times.

• Tobacco and tobacco products: Risk 5

• Polygamy: The risk of developing penile cancer is 3 to 5 times higher in men who have a history of multiple sexual partners at the same time or at different times and who have a history of first sexual intercourse at an early age. It is high.

• Poor personal hygiene: It is more common in men who have poor personal hygiene, live in rural areas, have a low socio-economic level and are unmarried.

• HPV infection: It is the most important risk factor for penile cancer. It contains over 100 types of viruses that cause warts. Some types of HPV can infect the reproductive organs and anal area and are passed from person to person through sexual contact. It is detected in 70-100% of penile cancer tissues in the initial stage and in 30-40% of penile cancer tissues in the advanced stage. The risk of HPV transmission is also low in people who have been circumcised.

How does it show?

The first noticeable symptom of penile cancer is bleeding in the penis. It is a wound with discharge.

• Itching and burning sensation on the penis

• Swollen, wart-like wound or mass

• Redness

• Discharge

• Bleeding

• Irritation

• Swelling in the groin area

How is it diagnosed?

The probability of recovery is high with early diagnosis. Since penile cancer is very rare, it is often confused with other diseases and cannot be detected at an early stage.

• Physical examination

• Biopsy

When cancer is suspected during physical examination, the biopsy taken from the wound is sent to the laboratory and examined by the Pathologist. This study is called cancer staging. For this purpose, additional radiological imaging methods may be used. Cancer usually spreads directly to surrounding healthy tissues, through lymphatic vessels and blood vessels.

• Ultrasonography

• Computed Tomography

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• Magnetic Resonance Imaging

• Cystoscopy

As a result of all these researches, the stage of the cancer determines. The stage of the cancer is important in terms of the treatment to be applied.

• Stage 0: Cancerous cells are detected superficially on the penis skin, there is no spread.

• Stage 1: Cancerous cells have reached the connective tissue just under the penis skin. There is no involvement in lymph and blood vessels. Cancer cells look very similar to normal cells when examined under a microscope.

• Stage 2: Cancerous tissue has invaded the lymph and blood vessels. The cavernous body that provides erection or the spongiosa body through which the urethra passes may also be involved. Cancer cells look quite different from normal cells when examined under a microscope.

• Stage 3A: In addition to the findings in Stage 2, it has spread to only 1 lymph node in the groin area. Cancer cells look very different from normal cells when examined under a microscope.

• Stage 3B: In addition to the findings in Stage 2, it has spread to more than one lymph node in the groin area. Cancer cells look very different from normal cells when examined under a microscope.

• Stage 4: It has spread to the tissues around the penis, deep lymph nodes in the groin area, tissues around the lymph node, and tissues and organs in distant areas.

How is it treated?

There are different treatment options for penis cancer. While some of these treatments are standard treatment practices, some are experimental treatments.

There are three types of standard treatment approaches.

Surgical Treatment

Surgical treatment is used in all stages of penile cancer. It is the most common treatment option that can be preferred.

• Microsurgery: Also known as Mohs microsurgery. It takes its name from Frederic E. Mohs, who first described this method for the treatment of skin cancers. It is a method in which the tumor is removed from the skin layer by layer, performed under a surgical microscope. The removed tissues are examined with a tissue microscope and the skin continues to be removed in layers until tumor cells are no longer seen.

• Circumcision: The foreskin, which is where penile cancer often occurs, is removed.

• Wide regional tissue removal: It is a method in which only the cancerous tissue is removed along with a small layer of normal tissue in its immediate surroundings.

• Removal of the penis: Depending on the area and stage of the cancerous tissue, part or all of the penis can be removed.

• Laser surgery: Laser beams are like a knife. It is a type of bloodless surgery in which only the cancerous tissue is removed.

• Cryotherapy: It is a type of surgery in which the cancerous tissue is destroyed by freezing.

In the surgical approach, lymph nodes in the groin area can also be removed. Even if the cancerous tissue is completely removed by surgery, some patients may need radiotherapy and chemotherapy after the operation. These treatments are applied to reduce the risk of cancer recurrence.

Radiotherapy

It can be applied before surgery for large-sized cancers (>4cm). It can be applied to small-sized cancers (<4cm) using radioactive nuclei placed outside the body or inside the cancer tissue. In small-sized cancers, the application of radioactive material placed into the tissue provides a success rate of 70-90%. The success rate is low for large cancers. Radiation therapy is also preferred in the presence of cancer that recurs after treatment.

Chemotherapy

There are some chemotherapy protocols applied by administering drugs intravenously before and after the operation in large-sized and advanced-stage penile cancer. p>

Experimental Treatment Methods

In the treatment method called "biological treatment", the patient's own defense cells are taken, modified to fight the cancer tissue, and reintroduced to the patient.

Named "Radiosensitizers" The drugs given are drugs that make cancer cells more sensitive to radiation therapy and are given to the patient after radiotherapy. With this application, more cancer cells can be killed.

The lymph node where cancer cells first spread is called the "sentinel lymph node". During the operation called "Sentinel lymph node sampling", special dyes are injected into the cancerous tissue, the first lymph node that the dye reaches is identified and removed, and examined under a microscope while the patient waits on the operating table. If cancer cells are found in this lymph node as a result of the examination, other lymph nodes are also removed. If no cancer cells are found, other lymph nodes are not removed, only the cancerous tissue is removed.

Pe Treatment options according to the stage of NIS cancer (Summary)

Stage 0

• Mohs microsurgery

• Regional chemotherapy

• Regional biological treatment

• Laser surgery

• Cryotherapy

Stage 1

• Removal of part or all of the penis

• Radiotherapy

• Mohs microsurgery

• Laser surgery

Stage 2

• Removal of part or all of the penis

• Radiotherapy

• Sentinel lymph node sampling

• Laser surgery

Stage 3

• Removal of the entire penis

• Radiotherapy

• Sentinel lymph node sampling

• Radiosensitizers

• Chemotherapy before or after surgery

Stage 4

• Wide regional tissue removal and removal of lymph nodes in the groin area

• Radiotherapy

• Chemotherapy before or after surgery

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