Surgery is the main line of treatment for penile cancer along with radiotherapy and chemotherapy. Penis preservation and reconstruction is possible in recent times due to latest operative techniques.

Surgery

The treatment of small-sized cancers located on the surface and not yet metastasized is done by removal of solely the malignant area and small extent of the adjoining area. The removal of the cancer is carried out with the assistance of conventional surgery employing laser or cryotherapy (an iced probe is used for freeze-killing the cancerous cells).

In case only the foreskin has been affected, then circumcision could be done as part of the treatment.

All of the above mentioned treatments are generally on an outpatient basis and could be administered under the influence of local or general anaesthesia on the basis of individual situations.

Wide local excision
In case the cancer has metastasized to a larger area then wide local excision is performed wherein the cancer along with a small section of bordering adjacent normal tissue is removed. The bordering adjacent tissue is vital as it lowers the chances of cancer recurring in the future.
The operative procedure is done under the influence of general anaesthesia and requires a brief hospital stay.

Preservation and Reconstructive Surgery
In case of larger sized cancers present on the penis head, the globular part or the glans would be removed. Under such circumstances, the previous normal appearance could be restored by grafting a part of the skin taken from any other part of the body.

Hospitalisation of nearly 5 days would be necessary and regular wound dressing would be needed for nearly two weeks.

Penectomy
In case the cancer spread is large and has covered a major part of the penis, then partial amputation (partly removing) or total (complete removal of the penis). The operation most apt for the patient would depend on the location of the tumour. In case the tumour is located close to the penile base, then total amputation is the sole choice. This form of operation is presently done less often, as doctors generally are able to preserve the penis.

Reconstructive surgery
In case there are no symptoms of the cancer having metastasized, then penis reconstruction subsequent to amputation could be performed.

This is another kind of operation wherein the procedure performed involves removal of a small part of the skin and the muscle from the arm and utilising it for reconstructing a new penis. At times reconnection of few of the nerves could be done by the surgeons for facilitating sensation and the requisite blood flow for allowing the reconstructed penis to be have an erection.

There could additionally be the removal of a diminutive number of lymph nodes from the groin region for checking whether the cancer has metastasized. In case there is perceivable enlargement of the nodes in the groin area, then generally the course of treatment would involve the removal of all the glands in the groin.

Radiotherapy
Radiotherapy is the treatment of the cancer employing high-power rays for obliterating cancer cells while preserving as much of normal cells as possible.

Radiotherapy is infrequently employed as an alternative to surgery when the person is not fit enough to undergo surgery or does not desire to undergo surgery.

Radiotherapy could be employed for the treatment of lymph nodes that have been affected in the groin part for reducing the risk of the cancer metastasizing.

Radiotherapy could also be employed for treatment of symptoms like pain in case the cancer has reached other areas of the body such as the bones.

External radiotherapy
It is generally administered as a sequence of brief treatments given on a daily basis wherein high power x-rays are focussed onto the location of the cancer with the assistance of a machine. The treatment is generally offered on weekdays and each session lasting for about fifteen minutes. The number of treatments that would be given are dependent on the kind and size of the cancer, however the complete course for treating early stages of the cancer normally lasts for about 6 weeks.

Prior to the radiotherapy session, the radiographer would accurately position the patient on to a seating place. The patient would be alone in the room during the course of the session and can communicate with the radiographer who could view and speak to the patient from another room.

Radiotherapy is a painless procedure; however one is required to stay totally motionless for few minutes during the treatment session.

Radioactive Implants
Radioactive implants also called brachytherapy could be given during radiotherapy. Under the influence of general anaesthesia, tiny radioactive wires are meticulously placed on the inflicted spots of the penis. The wires remain in their position for nearly five days and are then taken out. This form of treatment is generally employed for treatment of smaller sized cancers located on the glans. When the implants are positioned on the penis, the person would be required to remain in a secluded room in the hospital to avert needless radiation exposure to others.

Side effects
At times there could be side effects that could arise due to radiotherapy treatment. By the time the person reaches the concluding phases of the treatment, the skin on the penis could turn tender and could break down. Long-standing radiotherapy could cause the normal tissues to thicken and stiffen (fibrosis). In few men, it could lead to the tube carrying urine via the penis (the urethra) to narrow thus causing immense discomfort during passage of urine. In case there has been urethral narrowing, then it could be treated by a surgery for stretching or dilating the area. This is performed by inserting a fine tube into the urethra and done under the influence of general anaesthesia.

Chemotherapy
It employs the use of cancer-combatant or cytotoxic drugs for annihilating cancerous cells. It could be administered with a single drug or many drugs given together. Chemotherapy is at times given for the treatment of very small-sized, early stages of cancers that are restricted to the foreskin and the glans (end of the penis).

Chemotherapy could be administered in tablet form or via injection, intravenously in case of highly advanced stages of the cancer. It could be given alongside surgery or radiotherapy or both.

Penile Cancer Causes

• The precise reasons for penile cancer occurring is ambiguous. It is less prevalent among men that have had circumcision wherein removal of all or parts of the foreskin have been done subsequent to birth. This could be due the reason that uncircumcised men face difficulty in completely pulling back the foreskin hence leading to improper cleansing of the area beneath it that could harbour HPV or human papilloma virus –the key offender leading to penile warts, additionally raising the risk of developing penile cancer.
• Few of the skin conditions affecting the penis could progress leading to the development of cancer when ignored. In case one notices the appearance of whitish or reddish scaly or clammy patches on the skin’s surface of the penis, it is imperative to seek medical advice to get prompt treatment.
• Cancer of the penis is non-communicable and could not be transmitted to others. It is also not due to a heritable flawed gene and other kin members having it would not raise one’s risk of developing this form of cancer.

Penile Cancer Symptoms

• The preliminary signs of penile cancer are mostly an alteration in skin colour or texture (turning thick).
• The symptoms arising later on involve a growth or sores appearing on the penis, particularly on the glans, also known as the foreskin or the top part of the penis, though at times it could also be noted on the base of the penis.
• There could be discharge or blood loss from the penis. Majority of the penile cancers do not cause pain.
• At times, the cancers emerge as flattish growths which are blue-brown in colour or alike reddish rashes or tiny scaly bumps. Mostly, the cancers are discernible only when the foreskin is drawn back.

Such symptoms could be arising along with conditions that are not related to cancer. Much alike other cancerous forms, the cancer of the penis are easy to treat in case there is early diagnosis. Hence, one needs to promptly visit the doctor in case one is in doubt or some of the symptoms start arising.

Diagnosis & Tests

• The general practitioner would carry out an examination, after which one might be referred to a specialist doctor for professional advice and treatment.
• The specialist would conduct a detailed examination of the entire penis and groin area to palpate for any kind of swellings.
• In order to conduct an accurate diagnosis, the doctor would remove a tissue sample from the sores or anomalous surfaces on the penis by a biopsy procedure. This would be conducted under local or general anaesthesia to make it pain-free. The tissues sample removed would be sent for microscopic analysis.
• In case the biopsy procedure affirms the presence of cancer, the patient would be referred to a specialist centre for undergoing additional tests to verify whether the cancer has metastasized.
• Cancer could reach the bloodstream or affect the lymphatic system. The lymphatic system comprising of a mesh of lymph nodes interlinked by delicate ducts, is part of the body’s safeguard mechanism to combat infection and ailments. There could be enlargement of the groin region in case the cancer has metastasized there.
• The outcome of the tests would assist the specialist in deciding the apt form of treatment for the patient.
• CT or computerised tomography scan
  A CT scan is a specialised form of X-ray wherein a sequence of images are captured and passed into a computer for generating in-depth images of the interiors of the body. The scan results would reveal whether the cancer has metastasized to other areas of the body. It is a pain-free procedure that lasts for ten to thirty minutes.
• Lymph node biopsy
  In case there is enlargement in the lymph nodes present in the groin area, the doctor would pass a needle within the node for removing cell sample by the biopsy procedure. This is done for checking for the presence of any form of enlargement because of the cancer. An enlargement in the lymph nodes could be because of an infection and not due to cancer.

Staging and Grading

The staging is done for describing its size and whether metastasis past the initial location has occurred. The doctors are better able to finalise the optimal course of treatment when they have the knowledge of the specific form and staging.

• Stage 1
  Only the foreskin of the penis has been affected by the cancer.
• Stage 2
  The cancer has metastasized to the base of the penis or to one of the lymph nodes present in the groin region.
• Stage 3
  The cancer has deeply metastasized in the shaft of the penis or to several lymph nodes present in the groin region.
• Stage 4
  The cancer has deeply reached to the lymph nodes present in the pelvis or to other areas of the body.

Few doctors could illustrate the staging of the cancer as:

Early disease

Merely the foreskin or the surface of the tip of the penis (glans) has been affected by the cancer.

Intermediate disease

The cancer has metastasized to beneath the top skin layers reaching the shaft of the penis and occasionally small quantities of cancer cells could be detected in one of the lymph nodes present in the groin (infinitesimal disease).

Advanced disease

The cancer has been diagnosed in one or many lymph nodes that have enlargement in the groin region and at times could metastasize to other areas of the body.

In case, the cancer has relapsed subsequent to the original treatment, then it is called as recurrent cancer.

Grading

Grading provides an idea on the rate of development of the cancer and their microscopic appearance. Low-grade would mean that the cancer cells appear analogous to normal cells; they normally have slow growth and are less prone to multiplying. In high-grade tumours, the cells appear anomalous, have a likelihood of quicker spread and are more prone to increasing.