Penile cancer

In the structure of oncological diseases, penile cancer accounts for only 0.2%. The average age of patients was 62.3 years, with the peak incidence occurring in patients over 75 years of age. The disease is extremely rare in patients under 40 years of age, and isolated cases have been recorded in children. The standardized incidence rate in our country in 2000 and 2005 was 0.54 and 0.53 per 100,000 people, respectively, i.e. no increase in incidence was noted.

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Epidemiology

The incidence of penile cancer in Europe and the world is 0.1 - 0.9 and 0.45 per 100,000 people, respectively. It should be noted that there are large differences in incidence depending on the geographic region. Thus, if in Europe and the USA penile cancer accounts for 0.4 to 0.6% of all cases of malignant neoplasms among men, then in some countries in Africa and Latin America the incidence reaches 10-20%.

Although penile cancer is an external tumor, 15 to 50% of patients seek medical attention only at late stages. In almost 30% of patients, penile cancer is detected when the tumor has already spread beyond the organ, and 10% of them have distant metastases.

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Causes penile cancer

The reasons for penile cancer are not fully understood. It is known that chronic irritation of the preputial sac skin with smegma and products of bacterial decomposition of exfoliated epithelial cells plays a negative role, therefore circumcised men have a lower probability of developing penile cancer than men with preserved foreskin. This is most evident in phimosis, when smegma accumulates in significant quantities and chronic inflammation is more pronounced. Thus, phimosis is detected in 44-90% of cases of penile cancer patients.

Long-term exposure to smegma affects the likelihood of developing penile cancer, as indicated by the varying incidence of the disease depending on cultural and religious practices in different countries.

For example, penile cancer is extremely rare among Jewish men, who are usually circumcised on the 8th day after birth for religious reasons. However, penile cancer is more common among Muslims, who are circumcised at an older age. It should be noted that circumcision in adults does not reduce the risk of developing the disease.

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Symptoms penile cancer

Penile cancer has one typical symptom - the appearance of a tumor on the skin of the penis, initially small in size and often in the form of a gradually increasing compaction. The tumor may be papillary or have the appearance of a flat dense formation. As it grows, the tumor may ulcerate, with bloody discharge and bleeding, up to profuse. When the ulcer becomes infected, the discharge acquires a sharp foul odor. The spread of the tumor into the cavernous bodies is initially prevented by Buck's fascia and the protein membranes, the growth of which leads to vascular invasion and dissemination of the tumor process.

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Stages

Stage	Prevalence of tumor	Lymph node involvement	Presence of metastases
Stage 0	Tis-Ta	N0	M0
Stage I	T1	N0	M0
Stage II	T1 T2	N1 N0	M0 M0
Stage III	T1-3	N2 N2 N0-2	M0
Stage IV	T4 T any T any	N any N3 N any	M0-1

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Forms

Below is the 2002 clinical classification of penile cancer using the TNM system.

The T criterion characterizes the degree of prevalence of the primary tumor.

• Tx - insufficient data to assess the primary tumor.
• T0 - the primary tumor is not detected.
• Tis - preinvasive carcinoma (carcinoma in situ).
• Ta is noninvasive verrucous carcinoma.
• T1 - the tumor extends into the subepithelial connective tissue.
• T2 - the tumor extends into the corpora spongiosum or corpora cavernosa.
• T3 - the tumor spreads to the urethra or prostate.
• T4 - the tumor spreads to neighboring organs.

The N criterion characterizes the degree of involvement of regional lymph nodes in the process.

• Nx - insufficient data to assess the condition of regional lymph nodes.
• N0 - no signs of metastasis to regional lymph nodes.
• N1 - metastases in one superficial inguinal lymph node.
• N2 metastases in multiple superficial inguinal lymph nodes or metastases on both sides.
• N3 - metastases in the deep inguinal lymph nodes or in the pelvic lymph nodes on one or both sides.

Criterion M characterizes the presence of distant metastases.

• Mx - insufficient data to assess the presence of distant metastases.
• M0 - no distant metastases.
• Ml - metastases to distant organs.

The degree of tumor anaplasia is determined by morphological classification.

• Gx - the degree of anaplasia cannot be determined.
• G1 - low degree of anaplasia.
• G2 - moderate degree of anaplasia.
• G3 - high degree of anaplasia.
• G4 - undifferentiated tumors.

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Treatment penile cancer

Penile cancer is treated in different ways, the treatment method is determined by the stage of the disease, while the success of treatment depends on the effectiveness of the impact on the primary tumor and the area of regional metastasis.

Penile resection or total penectomy is the "gold standard" of surgical treatment for penile cancer. When lymph node enlargement is detected during the patient's initial visit, it is necessary to remove not only the primary tumor, but also the lymph nodes in the area of regional metastasis.

Lymph node dissection (Duquesne operation) can be performed simultaneously with the operation on the primary tumor, or after the disappearance of inflammatory changes, or after ineffective chemotherapy or radiation therapy, the indications for which are determined based on the stage of the disease. Unfortunately, there are currently no precise recommendations defining the indications for lymph node dissection, as well as the scope and time of the surgical intervention.