PROF ANTONIO RUFFO
Specialist in Urology
Andrology Genital and Urethral Recostructive Surgery
mobile +39 3511718896
Penile Carcinoma
Epidemiology and risk factors
Penile carcinoma is a tumor with low incidence in Europe and the United States but is found to a greater extent in central African countries.
The incidence of penile cancer increases with age; the most affected group is between 60 and 70 years old.
It is rare before the age of 50 and originates at the penile level, preferably at the glans and then inside the preputial surface, the coronal sulcus, and finally along the penile body.
An important risk factor is characterized by the presence of phimosis which causes an accumulation of smegma associated with poor hygienic conditions.
Other conditions predisposing to penile carcinoma include: genital verrucous lesions, cigarette smoking, radiation therapies and a condition of presumably autoimmune origin called balanitis xerotica obliterans.
Increasing importance is assumed by genital papillomavirus infection (HPV 16 and 18), which epidemiological data demonstrate is associated with squamous cell carcinomas.
Pathological anatomy
Squamous cell carcinoma is the most frequent histological type of penile tumor. It can present with superficial characteristics represented by lesions that appear slightly raised or flat, with a whitish and grainy appearance; the superficial form is usually the histopathological variant with the best prognosis quaod vitam.
The other type of squamous cell carcinoma is the "vertical" variant characterized by a vegetating and polypoid-like mass that also deepens into the deep layers.
There are representatives in the literature of different types of penile carcinoma such as basal cell carcinoma, verrucous carcinoma (another variant of squamous cell carcinoma) and Buschke – Lowenstein tumour.
Preneoplastic lesions of squamous cell carcinoma
Squamous cell carcinoma is preceded by some pre-neoplastic lesions, the most important of which is called Queyrat erythroplasia. This manifests itself as a red, shiny, painless patch that develops on the glans. it can also affect the internal layer of the foreskin, with the appearance of crusty elements and erosions as a result of overlapping infectious and macerative events.
Diagnosis
The diagnosis of penile cancer is made through a careful physical examination of the external genitalia, biopsy of the suspected lesion, MRI of the penis and palpation of the inguinal lymph nodes. In symptomatic patients, inguinal ultrasound with possible needle biopsy of the lymph nodes, computed tomography (CT), positron emission tomography (PET) and bone scintigraphy may also be indicated.
Symptoms
Penile carcinoma presents as an exophytic, nodular or warty area of hard consistency, with an erythematous appearance, often ulcerated, especially in the foreskin or glans.
It is common to encounter irritative or obstructive urination disorders due to neoplastic infiltration of the urethra.
Tight phimosis may coexist which confuses the diagnosis during an initial evaluation.
The first sites of any metastases are lymph nodes; in the advanced stages of the disease, however, the spread of tumor cells occurs at a distance, preferentially affecting the liver, bones, lungs and brain.
Therapy
The therapy for penile carcinoma is primarily surgical in the first instance.
There are two main alternatives:
Partial Penectomy
The local disease is potentially curable through partial penectomy. This procedure is performed distally to the suspensory ligament of the penis. It is recommended when a segment of the organ, at least 2 cm between the suspensory ligament and the tumor, is not affected. Partial penectomy allows for the reconstruction of the glans and the urethral meatus. There are innovative techniques that use skin flaps taken from the thigh for the distal reconstruction of the organ. This type of surgery is considered conservative as it preserves the tissues and the aesthetic appearance of the individual while maintaining virility. However, the lower aggressiveness exposes the patient to the risk of lower oncological radicality. The procedure is performed on an outpatient basis (2 – 3 days), under local-regional anesthesia, and urethral catheter drainage for one or two days is advisable.
Total Penectomy
On the other hand, infiltrating and extensively involving the urethra necessitates the procedure of total penectomy.
Please note that medical terminology can be highly specialized, and it's advisable to consult with a medical professional or use specific medical literature for precise and accurate information.
Total Penectomy
The total penectomy involves the removal of both cavernous bodies and the distal spongy body, along with the execution of a perineal urethrostomy with the bulbous urethra. This approach to penile cancer treatment is necessary if satisfactory surgical results cannot be achieved with partial penectomy alone.
The procedure is performed on an outpatient basis, and local-regional anesthesia is commonly used. Drains and the urethral catheter are usually removed after two or three days.
Is there a possibility to restore my penis to 'normal' if I undergo a partial or total penectomy?
Lengthening phalloplasty procedures can be performed to try to recover lost dimensions, as in the case of partial penectomy.
If you undergo a total penectomy, the only alternative is penile reconstruction with a free flap phalloplasty using the radial forearm free flap."
Please note that this translation is a generalization, and specific medical advice should be sought from a qualified healthcare professional based on individual circumstances.
