The University of Chicago Urologic Cancer Program
Urologists at the University of Chicago specialize in the latest surgical techniques to treat penile cancer. In combination with colleagues in Medical Oncology and the Cancer Research Center, we offer a comprehensive and diverse option of therapies.
An Overview of Penile Tumors
Penile cancer is rare in the United States (annual incidence of 1-2 per 100,000 men, which translates into 1400 cases yearly). Squamous cell carcinoma accounts for 95% of penile cancer cases. The highest incidence in the world is in South America, India, and Africa. Penile cancer is most common in uncircumcised and nonwhite populations. Onset is in the fourth and fifth decades of life.
The cause of penile cancer appears to be chronic irritation. Predisposing factors include presence the foreskin (uncircumcised men), phimosis (tight opening of the foreskin), and poor hygiene. Phimosis is present in more than 50% of patients with penile cancer. The closed space under the foreskin allows accumulation of smegma and chronic irritation. The risk of penile cancer can be virtually eliminated by neonatal circumcision. Delayed circumcision offers only slight protection against the subsequent development of penile carcinoma. Penile cancer is associated with exposure to ultraviolet [UV] radiation treatment for psoriasis. There is also evidence of a relationship between penile cancer and HPV types 16, 18, and 33. These are commonly found in women with cervical cancer.
Penile cancer begins as a small lesion and gradually enlarges to involve the entire penis. It may be flat and cause an ulcer. Alternatively, it may extend away from the penis with the appearance of cauliflower or broccoli. Laboratory studies are usually normal in patients with penile cancer. There is a limited role for radiologic imaging. CT and MRI scans can be helpful in patients with high grade or invasive tumors in whom pelvic or retroperitoneal lymphadenopathy is suspected. A delay in seeking medical attention is very common and can result in progression to advanced local disease. The course of penile cancer is relentless and most untreated patients die within 2 years.
Penile cancer metastasizes in a predictable pattern to inguinal lymph nodes followed by drainage into pelvic lymph nodes (and beyond). Metastatic deposits in the regional lymph nodes continue to enlarge if left untreated, causing skin necrosis, infections, and erosion of the femoral vessels. The risk of spread (metastasis) is related to the size of the initial (primary) lesion. Spread is most common to the lymph nodes, especially those in the thigh. The tumor begins as an area of induration (firmness), erythema (redness), warty growth, nodule, or superficial ulceration. Rarely painful, constitutional symptoms (fatigue, fever, etc.) may result from chronic infection in the nodes.
At clinical presentation, determination should be made of the lesion’s size, location, and depth of involvement. The scrotum and perineum must be inspected and inguinal areas palpated. Pathologic staging by deep biopsy remains necessary to plan appropriate management. Accurate staging is imperative for guiding treatment recommendations.
If there are suspicious (enlarged and hard) lymph nodes in the groin, antibiotics are often prescribed. If the lymph node enlargement does not disappear, then surgery may be required to remove the lymph nodes (ilioinguinal lymphadenectomy).
The goal of treatment is complete removal of the primary lesion with adequate margins. The standard of therapy for the primary lesion is partial or total penectomy (total or partial removal of the penis). Partial penectomy has produced the lowest recurrence rate and is the standard against which all other treatment modalities must be compared. Because of the disfigurement and psychological impact of penile amputation, other treatment options have gained increasing acceptance in the treatment of penile cancer, but must be used within their limitations.
Treatment of penile cancer is often individualized to each patient. Surgeons at the University of Chicago are trained in the most up-to-date and technologically-advanced methods of treating kidney cancers. At you appointment, your surgeon will be glad to discuss all of these treatment options with you.
Surgical Treatment Options for Penile Tumors
Surgery is the main treatment for penile cancers.
Radical (Total) Penectomy
Ilioinguinal Lymph Node Dissection