Penile Cancer Treatment

Overview of Penile Cancer Treatment in India

Penile cancer is one of the more prevalent varieties of male cancers. It can begin on the outside surface (the glans or head of the penis) or inside surface (the shaft of the penis). It is also seen primarily in men over 55 years of age, depending on where they reside geographically. 

In general, the amount, extent, and effectiveness of treatment for penile cancer depend greatly upon when the disease is diagnosed. For example, men diagnosed in the early stages of penile cancer can be expected to live approximately 85% of the time at five years post-diagnosis. This drops dramatically to 11% after developing advanced disease.

What Is Penile Cancer?

Penile cancer arises through abnormal growth of healthy cells in the penis (an elongated tubular reproductive organ used for urination and sexual intercourse). The penis comprises three major areas: the shaft (the area from the base of the penis to its tip), the external (glans) part of the penis and whether someone is circumcised or uncircumcised (foreskin).

While penile cancer can develop anywhere within your penis, the most common areas for penile cancers to develop include the glans and (if you are uncircumcised) the foreskin.

As with many types of cancer,  early diagnosis of penile cancer leads to improved treatment options. If you notice something unusual about your penis, seek medical attention promptly - it is very important for early detection of cancer.

Types of Penile Cancer Treatment:

There are some other forms of penile cancer which are ranked in order of their prevalence:

Squamous cell carcinoma (SCC)
This type of cancer develops on the upper surface of your skin (epithelium). It constitutes 95 percent of penile cancer.

Melanoma
Such a cancer originates in cells that regulate the amount of dark or light skin colour, known as melanocytes. Melanoma is a more vicious type of cancer.

Basal cell carcinoma (BCC)
The cancer starts with the lowest layer of your epithelium. BCC is a penile cancer with a slow growth.

Adenocarcinoma
This is a cancer that begins in your glandular cells (cells that produce body fluids such as mucus, sweat, etc.).

Urothelial carcinoma
It is a cancer that develops in your urothelium (the layer that lines your bladder, kidneys and all other organs in your urinary system).

Sarcoma
This form of cancer occurs in muscle or connective tissue. It is a very rare type of penile cancer.

Penile cancer has a number of stages:

Stage 0: It is a carcinoma in situ (CIS) and verrucous carcinoma, both localised to the upper layers of the skin. Treatment of CIS on the foreskin may be through circumcision, although those on the glans can be treated using laser or cryotherapy. Laser or cryotherapy can be used a lot to treat verrucous carcinoma.

Stage I: These are the tumours that have developed below the skin of the penis but not into deeper layers. Therapy can involve circumcision, glansectomy, amputation of some part of the penis or radiation.

Stage II: It contains tumours that have penetrated deep in the tissues of the penis, but have not extended to the lymph nodes around the penis. To remove the lymph nodes, partial or total penectomy may be required with or without surgery.

Stage III: This is when the cancer has extended to the surrounding lymph nodes in the groin. Sometimes partial penectomy or a complete penectomy can be prescribed to treat it. In others, chemotherapy (chemo) or chemo plus radiation can be employed initially in order to reduce the tumour.

Stage IV: In part of stage IV cancers, the primary tumour has expanded into adjacent tissues such as the prostate, bladder or the abdominal wall. It is treated through surgery, which is mostly a total penectomy followed by chemotherapy to reduce the size of the tumour.

Procedure:

Over the past decades, there's been a dramatic shift in how penile cancer is treated. While early treatment focused exclusively on the treatment of cancerous tissues, newer treatments include both the removal of cancerous tissues and an attempt to conserve as much functioning tissue as possible. The treatment that is provided to men with penile cancer will be dependent upon the stage of the cancer and the overall health of the man with cancer.

Surgical Approaches

Operation has been the most acceptable mode of treatment in penile cancer of all stages. In the case of early-stage cancers, physicians usually use penile-sparing procedures in order to retain as much normal function as possible. The surgery depends on the extent and location of the cancer.

These surgical procedures can be suggested to very small or surface-level cancers:

Mohs microsurgery: The surgeon excises thin layers of cancer-positive skin and looks under the microscope at each layer until no more cancer cells are present, allowing the surgeon to leave as much healthy tissue as possible.

Laser surgery: It involves the use of high-intensity beams of light to cut off cancerous tissues without much bleeding.

Cryosurgery: Kills abnormal tissue with high temperatures of cold.

Circumcision: This is the removal of the foreskin, which in many cases is adequate in the case of cancer that is localised to this region.

Wide local excision: Is the removal of the cancer, as well as a surrounding layer of normal tissue surrounding the cancer.

Penectomy: When the case is advanced, then partial or total penectomy may be required. In a partial penectomy, the surgeon is removing part of the penis, and in a total penectomy, the surgeon is removing the whole penis. Reconstructive surgery may also be possible after a penectomy to construct a new penis, although this is normally done in stages in specialised centres.

Radiation Therapy

Radiation therapy comprises of high energy rays to kill cancer cells and is delivered in two primary ways. External radiation comes from a machine outside the body, while internal radiation uses small amounts of radioactive material placed inside or close to the cancer.

Radiation therapy is used for many reasons in the treatment of penile cancer. As an example, it can be used as a primary treatment for smaller tumours, in addition to being an option when surgery is not a good choice, or furthermore, it can be used as an adjunctive therapy after surgery to help reduce the chance of the cancer coming back.

Chemotherapy

Chemotherapy uses medication to destroy cancer cells and can be given through your skin or into your bloodstream. Topical chemotherapy, applied directly onto the skin, is usually used to treat very early (stage 0) penile cancers. 

Systemic chemotherapy, which is delivered via your bloodstream, is used to treat advanced metastatic cancer that has spread beyond the penis. The most often used chemotherapeutic agents include cisplatin, fluorouracil, paclitaxel, and ifosfamide (often used in combination). An example of a common chemotherapy regimen for patients who have lymph nodes greater than 4 cm in size would be the TIP regimen (paclitaxel, ifosfamide, and cisplatin) when used as neoadjuvant therapy.

Immunotherapy and Emerging Treatments

Immunotherapy is an innovative method of treating penile cancer. The use of topical imiquimod encourages the immune system to attack cancer cells. Additionally, immune checkpoint inhibitors are being used as second-line therapy for advanced or metastatic penile cancers that have particular features, including a high tumour mutational burden.

New treatment options are being developed by clinical research, such as targeted therapies and new methods for immunotherapy. For example, HPV vaccines are being researched for their potential use as a therapeutic agent for HPV-associated penile cancers in addition to being a preventive measure.

Stage-specific Treatment

Treatment depends on how far the cancer’s gotten.

If it’s early—stage 0 or I, doctors usually stick with simple options. Topical treatments or a small surgery often do the trick.

When cancer moves to the middle stages, things get a bit more serious. Surgery gets more involved, and doctors might have to remove some lymph nodes, too.

For advanced cancer, like stage III or IV, there’s no shortcut. You’re looking at a mix of surgery, radiation, and chemotherapy all working together.