Carcinoma of the penis overview
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Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Swathi Venkatesan, M.B.B.S.[2]
Overview
Carcinoma of the penis is a malignant growth found on the skin or in the tissues of the penis. Carcinoma of the penis may be classified according to cell types into several subtypes: squamous cell carcinoma, adenocarcinoma, melanoma, basal cell carcinoma, lymphoma, and sarcoma. The incidence of carcinoma of the penis is approximately 1 per 100,000 men in the United States. On gross pathology, scaly patches or nodules, erythematous, and ulceration are characteristic findings of carcinoma of the penis. Common risk factors in the development of carcinoma of the penis are human papillomavirus, phimosis, poor genital hygiene, not being circumcised, weakened immune system, smoking, and treatment for psoriasis. And it is caused by an infection with human papillomavirus. The most common symptoms of carcinoma of the penis include non-healing lesion, change in the colour of the penis, redness or irritation of the penis, lump or thickening of the skin on the penis, phimosis, foul-smelling discharge or bleeding from the penis or from underneath the foreskin, itching or burning under the foreskin, swelling of the penis, lump in the groin, and dysuria. Biopsy is helpful in the diagnosis of carcinoma of the penis. The predominant therapy for carcinoma of the penis is surgical resection. Adjunctive chemotherapy, radiation therapy, and biological therapy may be required. Prognosis is generally good, and the 5-year survival rate of patients with carcinoma of the penis is approximately 67%.
Classification
Carcinoma of the penis may be classified according to cell types into several subtypes:
Pathophysiology
On gross pathology, characteristic findings of carcinoma of the penis include:
- Glans and the foreskin are the most common locations
- Scaly patches
- Nodules
- Palpable painless lump
- Erythematous
- Ulceration
- Concurrent phimosis may conceal the lesion
- Surface of the lesion may be exophytic, flat, or ulcerated
- Chronic penile rash or subtle burning sensation
- Swollen inguinal lymph nodes
Grossly noted growth patterns may have prognostic implications:
- Superficial spreading: tumors are limited to lamina propria or superficial corpus spongiosum.
- Usually extend horizontally through multiple anatomical compartments
- Vertical growth: tumors invade deep anatomical levels, surface is non-verruciform and frequently ulcerated
- Verruciform: tumors are exophytic and papillomatous with a cauliflower-like aspect.
- May be limited to surface (verrucous) or invade deep anatomical levels (cuniculatum)
- Mixed patterns: observed in 10 - 15% of all cases
On microscopic histopathological analysis, characteristic findings of carcinoma of the penis include:
- keratinization
- intercellular bridges
- Most histologic subtypes resemble those in vulva, anus or buccal mucosa
- 48 - 65% are squamous cell carcinoma
- Verruciform tumors are verrucous, warty, papillary or cuniculatum carcinomas
- Basaloid and sarcomatoid carcinomas usually have a vertical growth pattern
Grading:
- Grade 1: well differentiated cells, almost undistinguishable from normal squamous cells except for the presence of minimal basal / parabasal cell atypia
- Grade 2: all tumors not fitting into criteria for grade 1 or 3
- Grade 3: any anaplastic cells
Epidemiology and Demographics
The incidence of carcinoma of the penis is approximately 1 per 100,000 males in the United States. The majority of cases are reported in less developed areas. The incidence of carcinoma of the penis increases with age; the diagnostic median age usually is 40 - 70 years, median age 58 years.
- Rare if circumcision is done at birth
- More common if late circumcision (after age 10)
- More prevalent in populations with lower education and higher poverty
- More common in Hispanic and African American men
- Familial cases have occasionally been reported
Risk Factors
Common risk factors in the development of carcinoma of the penis include
- Human papillomavirus
- Phimosis
- Poor genital hygiene
- Uncircumcised males
- Weakened immune system
- Smoking
- PUVA treatment for psoriasis.
Screening
According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for carcinoma of the penis.
Causes
Carcinoma of the penis is caused by an infection with human papillomavirus.
Differential Diagnosis
Carcinoma of the penis must be differentiated from:
- Condyloma acuminata
- Penile intraepithelial neoplasia (PeIN)
- Balanitis xerotica obliterans
- Buschke-Lowenstein tumour
- Bowenoid papulosis
- Leukoplakia.
Prognosis
Prognosis of carcinoma of the penis is generally good, and the 5-year survival rate is approximately 67%. The prognosis varies with the stage of tumor; stages 0–II have the most favorable prognosis.
Staging
Carcinoma of the penis may be classified into several subtypes based on TNM system and UICC staging system.
History and Symptoms
The most common symptoms of carcinoma of the penis include
- Non-healing lesion
- Change in the colour of the penis
- Redness
- Irritation of the penis
- Lump
- Thickening of the skin on the penis
- Phimosis
- Foul-smelling discharge
- Bleeding from the penis or from underneath the foreskin.
Physical Examination
Common physical examination findings of carcinoma of the penis include
- Weight loss
- Pallor
- Inguinallymphadenopathy
- Non-healing ulcer on the penis
- Mass on the penis
- Phimosis
- Skin induration on the penis
- Change in the colour of the penis
- Erythema of the penis
- Foul-smelling discharge
- Bleeding from the penis or from underneath the foreskin
- Swelling of the penis
Laboratory Tests
Some patients with carcinoma of the penis may have elevated concentration of serum calcium, which is usually suggestive of bone metastases.
X Ray
There are no X-ray findings associated with carcinoma of the penis. X-ray may be performed to detect metastases of penile cancer to lungs and bones.
CT
CT scan may be performed to detect metastases of carcinoma of the penis to surrounding lymph nodes, liver, lungs, and other organs.
MRI
MRI may be performed to detect metastases of carcinoma of the penis to brain, spinal cord, and nearby organs and tissues.
Ultrasound
Ultrasound may be helpful in the diagnosis of the extent of carcinoma of the penis.
Other Imaging Findings
There are no other imaging findings associated with carcinoma of the penis.
Other Diagnostic Studies
There are no other diagnostic study findings associated with carcinoma of the penis.
Biopsy
Biopsy is helpful in the diagnosis of carcinoma of the penis.
Medical Therapy
The predominant therapy for carcinoma of the penis is surgical resection. Adjunctive chemotherapy, radiation therapy, and biological therapy may be required.
Surgery
Surgery is the mainstay of treatment for carcinoma of the penis.
Primary Prevention
Effective measures for the primary prevention of carcinoma of the penis include circumcision, good personal hygiene, and safer sexual practices. Gardasil vaccine is recommended for men to prevent HPV infection.
Secondary Prevention
There are no secondary preventive measures available for carcinoma of the penis.