Penile Cancer – Treatment Overview

Penile cancer treatment is dependent on several factors like the location and extent of the cancer, grading, whether or not metastasis has occurred and the person’s general health condition.

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.

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