Penile cancer
Penile cancer: Excerpt from Professional Guide to Diseases (Eighth Edition)
The most common form of penile cancer, epidermoid squamous cell cancer, is usually found in the glans but may also occur on the corona glandis and, rarely, in the preputial cavity. This malignancy produces ulcerative or papillary (wartlike, nodular) lesions, which may become quite large before spreading beyond the penis; such lesions may destroy the glans prepuce and invade the corpora.
The prognosis varies according to staging at time of diagnosis. If begun early enough, radiation therapy increases the 5-year survival rate to over 60%; surgery only, to over 55%. Unfortunately, many men delay treatment of penile cancer because they fear disfigurement and loss of sexual function.
Causes and incidence
The exact cause of penile cancer is unknown; however, it's generally associated with poor personal hygiene and with phimosis in uncircumcised men. This may account for the low incidence among Jews, Muslims, and people of other cultures that practice circumcision at birth or shortly thereafter. (Incidence isn't decreased in cultures that practice circumcision at a later date.) Early circumcision seems to prevent penile cancer by allowing for better personal hygiene and minimizing inflammatory (and commonly premalignant) lesions of the glans and prepuce. Such lesions include:
❑leukoplakia — inflammation, with thickened patches that may fissure
❑balanitis — inflammation of the penis associated with phimosis
❑erythroplasia of Queyrat — squamous cell cancer in situ; velvety, erythematous lesion that becomes scaly and ulcerative
❑penile horn — scaly, horn-shaped growth.
Penile cancer rarely affects circumcised men in modern cultures; when it does occur, it's usually in men who are older than age 50.
Signs and symptoms
In a circumcised man, early signs of penile cancer include a small circumscribed lesion, a pimple, or a sore on the penis. In an uncircumcised man, however, such early symptoms may go unnoticed, so penile cancer first becomes apparent when it causes late-stage signs or symptoms, such as pain, hemorrhage, dysuria, purulent discharge, and obstruction of the urinary meatus. Rarely is metastasis the first sign of penile cancer.
Diagnosis
Diagnosis of penile cancer requires a tissue biopsy.
CONFIRMING DIAGNOSIS Preoperative baseline studies include complete blood count, urinalysis, an electrocardiogram, and a chest X-ray. Enlarged inguinal lymph nodes due to infection (caused by primary lesion) make detection of nodal metastasis by preoperative computed tomography scan difficult.
Treatment
Depending on the stage of progression, treatment includes surgical resection of the primary tumor and, possibly, chemotherapy and radiation. Local tumors of the prepuce only require circumcision. Invasive tumors, however, require partial penectomy if there's at least a 2-cm, tumor-free margin; tumors of the base of the penile shaft require total penectomy and inguinal node dissection (procedure is less common in the United States than in other countries where incidence is higher). Radiation therapy may improve treatment effectiveness after resection of localized lesions without metastasis; it may also reduce the size of lymph nodes before nodal resection. It's not adequate primary treatment for groin metastasis, however. Topical 5-fluorouracil is used for precancerous lesions. A combination of bleomycin, methotrexate, and vincristine with or without cisplatin is used for metastasis.
Special considerations
Penile cancer calls for good patient teaching, psychological support, and comprehensive postoperative care. The patient with penile cancer fears disfigurement, pain, and loss of sexual function.
Before penile surgery:
❑Spend time with the patient, and encourage him to talk about his fears.
❑Supplement and reinforce what the physician has told the patient about the surgery and other treatment measures, and explain expected postoperative procedures, such as dressing changes and catheterization. Show him diagrams of the surgical procedure and pictures of the results of similar surgery to help him adapt to an altered body image.
❑If the patient needs urinary diversion, refer him to the enterostomal therapist.
Although postpenectomy care varies with the procedure used and the physician's protocol, certain procedures are always applicable:
❑Constantly monitor the patient's vital signs and record his intake and output accurately.
❑Provide comprehensive skin care to prevent skin breakdown from urinary diversion or suprapubic catheterization. Keep the skin dry and free from urine. If the patient has a suprapubic catheter, make sure the catheter is patent at all times.
❑Administer analgesics as ordered. Elevate the penile stump with a small towel or pillow to minimize edema.
❑Check the surgical site often for signs of infection, such as foul odor or excessive drainage on dressing.
❑If the patient has had inguinal node dissection, watch for and immediately report signs of lymphedema, such as decreased circulation or disproportionate swelling of a leg.
❑After partial penectomy, reassure the patient that the penile stump should be sufficient for urination and sexual function. Refer him for psychological or sexual counseling if necessary.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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