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Carcinoma of the penis

Last updated: November 1, 2020

Summary

Primary carcinoma of the penis is a rare tumor disease that mainly occurs in older men. It is associated with several risk factors including (untreated) phimosis, infection with human papillomavirus, and smoking. Patients present with a lump or an ulcerative lesion of the penis. Palpation of the groin and physical examination may reveal enlarged inguinal lymph nodes. Excisional biopsy is performed for histopathological confirmation of the tumor while MRI of the penis and CT of the pelvis are part of the tumor staging. The primary treatment is usually surgical and depends on the extent of the local and regional disease; options include local excision and partial or radical penectomy. Regional lymph node dissection may be necessary if the inguinopelvic nodes are involved. Metastatic disease is rare at inital presentation, but chemotherapy may be a palliative option. The overall prognosis is determined by the presence and extent of regional lymph node involvement.

Epidemiology

  • Rare type of malignancy in industrialized countries
  • More common in low-income regions with poor hygienic conditions, esp. in Africa, South America, and Asia
  • Peak incidence: 60 years of age [1]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

Chronic inflammation of the penis

Clinical features

  • Palpable painless lump or ulcerative lesion of the penis [3]
    • The glans and the foreskin are the most common locations.
    • A concurrent phimosis may conceal the lesion
    • Surface of the lesion may be exophytic, flat, or ulcerated
  • Chronic penile rash or subtle burning sensation
  • Voiding and sexual function typically remain unimpaired
  • Swollen inguinal lymph nodes [2][4]

Diagnostics

Differential diagnoses

The differential diagnoses listed here are not exhaustive.

Treatment

Treatment depends on the stage of the disease and the risk of recurrence, but the initial approach is typically surgical. [4][6]

Prognosis

  • Prognosis is determined primarily by the presence and the extent of inguinal lymph node involvement. [7]
  • 5-year overall survival rates for locally-confined tumors and advanced tumors: 85% and < 60%

References

  1. Survival Rates for Penile Cancer. https://www.cancer.org/cancer/penile-cancer/detection-diagnosis-staging/survival-rates.html. Updated: February 9, 2016. Accessed: March 6, 2017.
  2. Pettaway CA. Carcinoma of the penis: Epidemiology, risk factors, and pathology. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/carcinoma-of-the-penis-epidemiology-risk-factors-and-pathology.Last updated: October 5, 2016. Accessed: March 6, 2017.
  3. Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs.
  4. Pettaway CA. Carcinoma of the penis: Clinical presentation, diagnosis, and staging. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/carcinoma-of-the-penis-clinical-presentation-diagnosis-and-staging.Last updated: August 25, 2016. Accessed: February 15, 2017.
  5. Penile and urethral tumors.
  6. Hakenberg OW, Compérat EM, Minhas S, et al. EAU guidelines on penile cancer: 2014 update. Eur Urol. 2014; 67 (1): p.142-150. doi: 10.1016/j.eururo.2014.10.017 . | Open in Read by QxMD
  7. Pettaway CA. Carcinoma of the penis: Surgical and medical treatment. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/carcinoma-of-the-penis-surgical-and-medical-treatment?source=search_result&search=penis%20carcinoma&selectedTitle=1~45.Last updated: April 27, 2015. Accessed: February 15, 2017.