Penile cancer

Introduction to penile cancer Penile cancer (carcinomaofpenis) is one of the common malignant tumors of the male reproductive system. It has been widely seen in China in the past, accounting for the first place in male germline tumors. In recent years, the incidence rate has been significantly reduced, mostly in middle-aged people. The average age is 30 years old. Most of the patients with penile cancer have a long prepuce, and the incidence of penile cancer is very inconsistent due to factors such as country, region, ethnicity, religion, and health habits. Generally, the incidence rate in Europe and the United States is low. Asia, Africa, Latin America The incidence rate is high, while the incidence in the Jewish and Muslim countries is very low. basic knowledge The proportion of the disease: 0.0001% - 0.0002% (more prevalent foreskin is more common) Susceptible people: male Mode of infection: non-infectious Complications: urethral stricture, urinary fistula, edema

Causes of penile cancer

Virus infection (30%):

Herpes simplex virus (HSV) type II may be the carcinogen of penile cancer and cervical cancer. The data show that the incidence of cervical cancer in the sexual partner of penile cancer is 3-8 times higher than that of the normal group. Human papillomavirus (herpes) Simplex Virus (HPV) is a double-filament DNA virus that can infect various organ epithelia. Special types of HPV can be associated with male and female anal genital warts and cancer. In penile cancer, HPV16 accounts for 0% to 49%, and HPV18 accounts for 9% to 39%. %, HPV6 and HPV11 are not common, and there are 7 cases of 18 cases of penile cancer in Brazil with HPV18 DNA sequence.

Psoriasis (30%):

Oral photosensitizer 8-methoxypsoralen (oxidized psoralen) and UV irradiation can increase the incidence of penile cancer, skin scar formation after penile trauma or circumcision, and the application of immunosuppressive drugs in renal transplant patients, possibly with penile cancer It happened.

In addition, many precancerous lesions can be exacerbated into penile cancer, such as penile leukoplakia, dry penile head inflammation, penile skin angle, viral skin disease (condyloma acuminata, giant condyloma acuminata), and proliferative erythema (or Kayla proliferative) Erythema), Bowen cell papules are lesions of the penis in situ.

Squamous cell carcinoma (30%):

Penile cancer is mainly metastasized by lymphatic metastasis, which can be transferred to the groin, para-vimoral vessels and lymph nodes around the rectum. Because the bilateral lymph nodes are interlaced, they can also be transferred to the contralateral side. Generally, the urethra is less invaded. When the tumor penetrates the tunica albuginea, the tumor can penetrate the tunica. Hematogenous metastasis occurs when the cavernous body is invaded, but most occur after lymphatic metastasis.

The precise staging of the disease and the choice of treatment methods are directly related to the prognosis. The staging methods are different. The clinically used Murrell and Williams staging, stage I: the tumor is confined to the penis, there is no clear lymph node metastasis; stage II: tumor limitations In the penis, there is a positive lymph node metastasis; stage III: the tumor is confined to the penis, there is an unresectable lymph node metastasis; stage IV: the tumor spread invades the perineum and the body.

Penile cancer prevention

1. Pay attention to personal hygiene and take a bath often.

2. Foreskin is too long for early circumcision.

3. Active prevention and treatment of penile cancer precursors such as phimosis, glans dermatitis, papilloma and giant condyloma acuminata.

4. If the penis is uncomfortable, it should be examined early, diagnosed early, kept clean, hygienic, regularly disinfected, and actively prevent infection.

5. Timely treatment of phimosis and foreskin is too long, pay attention to local cleansing, appropriate treatment for precancerous lesions.

Penile cancer complications Complications urethral stricture urinary edema

Radiation therapy is controversial. There is a claim that penile cancer can only be treated with radiation. Due to a large number of exposures, urethral stricture, urinary fistula, penile necrosis and edema can be caused. The application is limited. Penile cancer infection and necrosis can also reduce the effect of radiotherapy. Penile cancer can be combined with bleomycin and X-ray irradiation, and the effect is good.

Penile cancer symptoms common symptoms urination pain inguinal lymph nodes enlargement diarrhea

1. More common in 40 to 60 years old with phimosis or foreskin is too long.

2. Early cancer becomes thickening of the penis head or foreskin epithelium. Most patients show papules on the head of the penis, ulcers, sputum or cauliflower-like plaques, followed by erosion, hard and irregular edges, consciously stinging or burning pain. There is a purulent odor discharge, when the phimosis or foreskin can not be turned up, it can be carefully touched through the foreskin, there is a lump or nodular sensation, local tenderness, early lesions can be seen after the circumcision.

3. If the early lesions are not properly treated, the condition gradually develops, the sacral nodules enlarge or the ulcers enlarge, deepen, the foreskin is tight, thin, shiny, and the edge of the lumps or ulcers can expose the foreskin, and then the cancer Breaking through the foreskin, there is a cauliflower-like mass or cancerous ulcer with malodorous secretions. The advanced tumor can continue to develop and invade the entire penis and corpus cavernosum, and even infiltrate the scrotum, the contents of the scrotum and the pubic region, and the distal part of the penis. Necrosis, shedding, local pain due to poor blood supply, urinary pain after infiltration of the corpus cavernosum, poor or even urinary retention or urinary fistula.

4. Inguinal lymphadenopathy may be a cancer invasion, but also an inflammatory reaction. When a patient visits, the inguinal lymph nodes are generally enlarged, but most of them are caused by local infection of penile cancer, and only a few are tumor metastasis.

5. There are symptoms of metastasis and systemic weight loss, anemia, loss of appetite and other symptoms when there is a distant metastasis.

Penile cancer examination

1. Imaging examination

(1) Lymphatic angiography: It is helpful for the diagnosis and metastasis. Generally, it is not used as a routine examination. It is selected by the back of the foot, the penis, and the lymphatics of the spermatic vein. If there is metastasis, the lymph nodes may be irregular, the filling defect, the lymphatic vessel deformation, Signs such as pressure blockage.

(2) B-ultrasound: can determine the liver, abdominal cavity with or without metastases.

(3) CT, MRI: check for post-peritoneal and organ metastasis.

2. Other inspections

When the lesion has only induration, it has not been ruptured. If there is foreskin covering, the circumcision should be used to expose the lesion. Local biopsy can confirm the diagnosis. Biopsy is the most important histological diagnosis. Primary cancer A biopsy can confirm the histological type and pathological grade of the cancer. Inguinal lymph node biopsy can confirm the presence or absence of metastasis, which is helpful for the clinical staging and treatment plan.

Diagnosis and diagnosis of penile cancer

diagnosis

Patients over 40 years old have phimosis or prepuce too long. The head of the penis or ulcer has prolonged unhealed, and it is expanding. The edge is raised. Those with bad odor should be highly suspected of penile cancer. Early lesions are often hidden in the foreskin and neglected to delay diagnosis. When the diagnosis is difficult, the biopsy may be performed. The patient's inguinal lymph nodes are swollen. The lymph node enlargement due to tumor metastasis is hard and the skin is often tender due to infection. Sometimes it is difficult to identify or both, so it is necessary. A lymph node biopsy is required.

There are several penile head indurations that must be differentiated from early penile cancer: 1 penile tuberculosis: often multiple, not easy to break, effective against tuberculosis drugs, 2 penile keratosis: induration with scaling up, but not Broken, 3Bowen's disease: actually a type of penile carcinoma in situ, no local infiltration has occurred, and the above lesions can be clearly diagnosed by biopsy.

Differential diagnosis

1. Penile syphilis penis head and foreskin painless ulcers, granulation is purple-red, the edges are high and hard, similar to the early performance of penile cancer, but there is a history of smelting, serum treponema pallidum hemoagglutination TPHA Positive test, dark-field examination of ulcer secretions can be found in Treponema pallidum.

2. Penile tuberculosis lesions are mostly located in the head of the penis, the ligament and the external urethra. It is ulcerated at about 2/3, and the edge is clear. The ulcer is covered with a layer of necrotic tissue, and the bottom is fresh granulation tissue, about 1/3. Beginning for tuberculous nodules, gradually develop into ulcers, and some can form fistulas. If the lesions involve the corpus cavernosum and fibrous scars can bend the penis, secretion smear, culture or animal inoculation, detect tuberculosis or local biopsy For tuberculosis.

3. Penis amebic disease Penile head ulcers, surface bleeding, secretions, can be mistaken for early penile cancer, but ulcer exudate and local biopsy can be found in amoeba and amoeba cysts.

4. The pathogen of soft sputum is D. serrata, infected by unclean sexual intercourse, often occurs in the head of the penis or the perineum, starting with small red papules, which then become abscesses, enlarge, rupture, forming oval or Round ulcers, varying in depth, mild tenderness, severe penile necrosis, inguinal lymph nodes can be swollen, pain, suppuration, ulceration, Duquelei vaccine skin test positive, direct smear secretion or culture can be detected Duques.

5. Kela proliferative erythema has a sharp red-colored round plaque at the penis head and foreskin, and there are also induration or ulcers. It is often mistaken for precancerous lesions of penile cancer, but pathological examination For the poor proliferation of epidermal acanthosis cells, there is lymphocytic infiltration in the dermis.

6. Penile Bowen's disease is a scaly papule or red scaly plaque on the head of the penis. The boundary is clear, or there is a shallow ulcer and penile cancer that are difficult to identify in the early stage. The histopathological examination of the serial section is used, and the scaly is located in the epidermis. Cellular cancer is Bowen's disease, and cancer cells invade the dermis, which is a penile squamous cell carcinoma.

7. Penile keratosis penis keratosis early in the penis head induration, gradually rising and growing desquamation, but not rupture, pathological histological examination showed papillary squamous cell mass, there are many spines, base Membrane hypertrophy.

8. The tumor-like lesions that cause epithelial cell hyperplasia after viral infection in the penile sulcus of the penis condyloma acuminata can form ulcers, which are confused with the early stage of penile cancer, but histopathological examination shows that the epithelium is papillary hyperplasia, the epidermis extends downward, and the spine The cell layer is thickened, with most nuclear fission, but no cell atypical and polymorphic growth, and no invasive growth.

9. Penile papilloma: This disease is a common benign tumor of the penis. It is a small local uplift from the beginning, gradually increasing in papillary shape, with pedicle or pedicle, red or reddish, soft, growing Slow, secondary infections may have malodorous secretions, easy to be mistaken for penile cancer, can be identified by biopsy.

10. Penile angle: It is a chronic proliferative disease with local protrusions in strips, columnar growth, taupe or yellow, clear edges, or dry and hard as horns, or sharp heads, although proliferative tissue changes, but no Cancer cells grow, and the disease can be identified.

11. Penile induration: This disease occurs mostly in the corpus cavernosum, with local fibrous nodules. Although the mass is tough and the boundary is unclear, the hardness is worse than that of the cancerous mass, the growth is slow, and the surface is smooth and has certain activity. There are few ulcers and inguinal lymph nodes, which are not difficult to distinguish from penile cancer.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.