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| {{DiseaseDisorder infobox |
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| Name = Carcinoma of the penis |
| | '''For patient information, click [[Carcinoma of the penis (patient information)|here]]''' |
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| ICD10 = {{ICD10|C|60||c|60}} |
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| ICD9 = {{ICD9|187}} |
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| {{Search infobox}}
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| '''Editor-in-Chief:''' Joel Gelman, M.D. [mailto:jgelman@uci.edu], Director of the Center for Reconstructive Urology and Associate Clinical Professor in the Department of Urology at the University of California, Irvine
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| {{Editor Help}} | | '''Editor(s)-in-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com]; {{AE}} {{Swathi}} |
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| '''Penile cancer''' is a [[cancer|malignant]] growth found on the skin or in the tissues of the [[penis]], usually originating in the glans and/or foreskin. It is a rare form of [[cancer]] with an incidence of 1 in 100,000 per year in developed countries.[http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_penile_cancer_35.asp?sitearea=]
| | {{SK}} Penile cancer, squamous cell cancer - penis, cancer of the penis, penile carcinoma, neoplasm of penis, malignant tumor of penis, cancer of penis, malignant penile tumor, malignant penile tumour, malignant tumour of penis, carcinoma of penis |
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| ==Risk factors== | | ==[[Carcinoma of the penis overview|Overview]]== |
| The [[American Cancer Society]] [http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_penile_cancer_35.asp?sitearea= provides] the following as risk factors for penile cancer: [[human papillomavirus]] (HPV) infection, [[tobacco smoking|smoking]], [[smegma]], [[phimosis]], treatment of [[psoriasis]], age, and [[AIDS]]. The other etiologic factor most commonly associated with penile carcinoma is poor hygiene. There is some evidence that lichen sclerosus (also known as [[balanitis xerotica obliterans]]) may also be a risk factor.[http://bmj.bmjjournals.com/cgi/eletters/321/7264/792#110919]
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| ==Risk== | | ==[[Carcinoma of the penis historical perspective|Historical Perspective]]== |
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| The lifetime risk of a man developing invasive penile cancer (IPC) in the United States is 1 in 600 if he is uncircumcised [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7377156&dopt=Abstract], and more than 3 times lower if he was circumcised neonatally.[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11144896&dopt=Abstract][http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8380060&dopt=Abstract][http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8260177&dopt=Abstract]
| | ==[[Carcinoma of the penis classification|Classification]]== |
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| This and other evidence suggests that childhood [[circumcision]] reduces the incidence of penile cancer.[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11196386&dopt=Abstract][http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11144896&dopt=Abstract][http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7377156&dopt=Abstract][http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11405332&dopt=Abstract][http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10643514&dopt=Abstract][http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10699138&dopt=Abstract] Studies have found that circumcision decreases the risk of HPV infection in males and thereby the risk of developing penile cancer.[http://content.nejm.org/cgi/pmidlookup?view=short&pmid=11948269][http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15388997][http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12238658]
| | ==[[Carcinoma of the penis pathophysiology|Pathophysiology]]== |
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| But Wallerstein found that the risk of penile cancer in Finland, Norway, and Denmark (all noncircumcising countries) is about the same (1 in 100,000 per year) as in the US. The [[American Medical Association]] and the [[Royal Australasian College of Physicians]] say the use of infant circumcision in hope of preventing penile cancer in adulthood is not justified.[http://www.ama-assn.org/ama/pub/category/13585.html][http://www.racp.edu.au/hpu/paed/circumcision/print.htm] The [[American Cancer Society]] stated in 1998:
| | ==[[Carcinoma of the penis causes|Causes]]== |
| : "... penile cancer risk is low in some uncircumcised populations, and circumcision is strongly associated with other socioethnic practices that are associated with lessened risk. The consensus among studies that have taken these other factors into account is that circumcision alone is not the major factor preventing cancer of the penis. It is important that the issue of circumcision not distract the public's attention from avoiding known penile cancer risk factors -- having unprotected sexual relations with multiple partners (increasing the likelihood of human papillomavirus infection) and cigarette smoking."[http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_penile_cancer_35.asp?sitearea=]
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| == Symptoms == | | ==[[Carcinoma of the penis differential diagnosis|Differentiating Carcinoma of the Penis from other Diseases]]== |
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| A draining [[sore]] on the foreskin or glans of the penis may be a sign of penile cancer. Anyone with these symptoms should consult a doctor immediately.
| | ==[[Carcinoma of the penis epidemiology and demographics|Epidemiology and Demographics]]== |
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| == Pathology == | | ==[[Carcinoma of the penis risk factors|Risk Factors]]== |
| * A. Precancerous Dermatologic Lesions
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| * B. Carcinoma in Situ (Bowen Disease, Erythroplasia of Queyrat)
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| * C. Invasive Carcinoma of the Penis
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| ==Staging== | | ==[[Carcinoma of the penis screening|Screening]]== |
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| Like many malignancies, penile cancer can spread to other parts of the body. It is usually a primary malignancy, the initial place from which a cancer spreads in the body. Much less often it is a secondary malignancy, one in which the cancer has spread to the penis from elsewhere. Doctors use the extent of [[metastasis]] to estimate what stage the disease is in, to aid in treatment decisions and prognosis. The stages are assessed as follows:
| | ==[[Carcinoma of the penis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| * Stage I - Cancer has only affected the [[penis|glans]] and/or foreskin.
| | ==Diagnosis== |
| * Stage II - Cancer has spread to the [[penis|shaft]] of the penis.
| | [[Carcinoma of the penis staging|Staging]] | [[Carcinoma of the penis history and symptoms|History and Symptoms]] | [[Carcinoma of the penis physical examination|Physical Examination]] | [[Carcinoma of the penis laboratory tests|Labratory Findings]] | [[Carcinoma of the penis X Ray|X Ray]] | [[Carcinoma of the penis CT|CT]] | [[Carcinoma of the penis MRI|MRI]] | [[Carcinoma of the penis ultrasound|Ultrasound]] | [[Carcinoma of the penis other imaging findings|Other Imaging Findings]] | [[Carcinoma of the penis other diagnostic studies|Other Diagnostic Studies]] | [[Carcinoma of the penis biopsy|Biopsy]] |
| * Stage III - Cancer has affected the penis and surrounding [[lymph nodes]].
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| * Stage IV - Cancer has moved beyond the groin area to other parts of the body.
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| * Recurrent - Cancer that has returned after treatment.
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| Prognosis can range considerably for patients, depending where on the scale they have been staged. Generally speaking, the earlier the cancer is diagnosed, the better the prognosis. The overall 5-year survival rate for all stages of penile cancer is about 50%.
| | ==Treatment== |
| | [[Carcinoma of the penis medical therapy#Medical therapy|Medical therapy]] | [[Carcinoma of the penis surgery#Surgery|Surgery]] | [[Carcinoma of the penis primary prevention|Primary Prevention]] | [[Carcinoma of the penis secondary prevention|Secondary Prevention]] | [[carcinoma of the penis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Carcinoma of the penis future or investigational therapies|Future or Investigational Therapies]] |
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| == Treatment == | | ==Case Studies== |
| | [[Carcinoma of the penis case one|Case #1]] |
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| There are several treatment options for penile cancer, depending on staging. They include [[surgery]], [[radiation therapy]], [[chemotherapy]], and [[biological therapy]]. The most common treatment is one of four types of surgery:
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| * [[Wide local excision]] - The tumor and some surrounding healthy tissue are removed
| | [[Category:Disease]] |
| * Microsurgery - Surgery performed with a microscope is used to remove the tumor and as little healthy tissue as possible
| | [[Category:Types of cancer]] |
| * Laser surgery - laser light is used to burn or cut away cancerous cells
| | [[Category:Oncology]] |
| * Circumcision - cancerous foreskin is removed
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| * Amputation ([[penectomy]]) - a partial or total removal of the penis, and possibly the associated [[lymph nodes]]. This is the most common and effective treatment.
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| [[Radiation therapy]] is usually used adjuvantly with surgery to reduce the risk of recurrence. With earlier stages of penile cancer, a combination of topical [[chemotherapy]] and less invasive surgery may be used. More advanced stages of penile cancer usually require a combination of surgery, radiation and chemotherapy.
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| == Vaccine ==
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| A quadri-valent vaccine to prevent HPV infection, [[Gardasil]], has been developed, successfully tested and approved for women by the US [[Food and Drug Administration]].[http://www.nature.com/nrd/journal/v5/n8/full/nrd2117.html] Approval for men is expected in 2008. It is licensed and in production, and could substantially reduce the incidence of HPV infection in men, the incidence of genital warts and ano-genital cancers including penile cancer, and mortality.[http://www.cirp.org/library/disease/cancer/lehtinen1/] It is unclear why the drug's manufacturer chose to stagger testing of the vaccine, potentially leaving many men needlessly vulnerable to HPV infection.
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| ==External links==
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| * E.J. Schoen, M. Oehrli, C.J. Colby and G. Machin. The Highly Protective Effect of Newborn Circumcision Against Invasive Penile Cancer. ''Pediatrics'' 2000;105(3):e36 [http://pediatrics.aappublications.org/cgi/content/full/105/3/e36 Full Text]
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| * C. Maden, K.J. Sherman, A.M. Beckmann, T.G. Hislop, C.Z. Teh, R.L. Ashley and Daling JR. History of Circumcision, Medical Conditions, and Sexual Activity and Risk of Penile Cancer. <i>Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Wash.<i> [http://216.180.250.186/~circsec/library/maden/index.html]
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| * [http://www.health.am/cr/tumors-of-the-penis/ Tumors of the Penis] Jackson SM: The treatment of carcinoma of the penis. Br J Surg 1966;53:33.
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| * M Kochen, S McCurdy. Circumcision and the Risk of Cancer of the Penis. A Life-Table Analysis. <i>From the Program in Epidemiology, School of Public Health, University of California, Berkeley.<i> [http://216.180.250.186/~circsec/library/kochen/index.html]
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| * Boczko S, Freed S. Penile carcinoma in circumcised males. ''N Y State J Med'' 1979;79(12):1903-4. [http://www.cirp.org/library/disease/cancer/boczko/ Full text]
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| * Cold CR, Storms MR, Van Howe RS. Carcinoma in situ of the penis in a 76-year-old circumcised man. ''J Fam Pract'' 1997;44:407-10. [http://www.cirp.org/library/disease/cancer/vanhowe/ Full text]
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| * Lehtinen M, Paavonen J. Vaccination against human papillomaviruses shows great promise. Lancet 2004;364:1731-2. [http://www.cirp.org/library/disease/cancer/lehtinen1/ Full text]
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| ==References==
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| * Edward Wallerstein. ''Circumcision: An American Health Fallacy.'' New York: Springer, 1980: pp. 22, 44, 45, 67, 90, 104-14, 148. (ISBN 0-8261-3240-5)
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| * Paul M. Fleiss, M.D., and Frederick Hodges, D. Phil. What Your Doctor May'' Not ''Tell You About Circumcision.'' New York, Warner Books, 2002: pp. 150-4. (ISBN 0-446-67880-5)
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| * Cabanas RM: An approach for the treatment of penile carcinoma. [http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?db=PubMed&cmd=Search&defaultField=Title+Word&term=Cancer%5Bjour%5D+AND+39%5Bvolume%5D+AND+456%5Bpage%5D+AND+1977%5Bpdat%5D+AND+Cabanas+RM%5Bauth%5D Cancer 1977;39:456.]
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| {{Tumors}}
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| {{SIB}}
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| [[Category:Andrology]] | | [[Category:Andrology]] |
| [[Category:Types of cancer]]
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| [[Category:Penis]] | | [[Category:Penis]] |
| [[Category:Oncology]]
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| [[de:Peniskarzinom]]
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| [[es:Carcinoma de pene]]
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| [[hr:Rak penisa]]
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| [[ja:陰茎癌]]
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| [[fi:Penissyöpä]]
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| [[zh:陰莖癌]]
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