Cancer of the penis

In the structure of cancer, penile cancer is only 0.2%. The average age of patients was 62.3 years, with a peak incidence in patients older than 75 years. At the age of 40, the disease is extremely rare, and the children have casuistic cases. The standardized incidence rate in our country in 2000 and 2005 was 0.54 and 0.53 per 100,000 people, respectively. There was no increase in morbidity.

[1], [2], [3], [4], [5]

Epidemiology

The incidence of penile cancer in Europe and the world is 0.1 - 0.9 and 0.45 per 100 000 people, respectively. It should be noted that there are large differences in morbidity depending on the geographic region. So, if in Europe and the USA penile cancer accounts for 0.4 to 0.6% of all malignant neoplasms among men, in some countries in Africa and Latin America the incidence is 10-20%.

Although penile cancer refers to tumors of external localization, 15 to 50% of patients consult a doctor only in the late stages. In almost 30% of patients, the cancer of the penis is detected when the tumor is already outside the organ and 10% of them have distant metastases.

[6], [7], [8], [9],

Causes of the cancer of the penis

Why there is cancer of the penis to the end is not unknown. It is known that chronic irritation of the skin of the preputial sac by the smegma and the products of the bacterial decomposition of the depleted epithelial cells plays a negative role, therefore, the probability of developing penile cancer is lower in men subjected to circumcision than in men with preserved foreskin. This is most evident in phimosis, when the smegma accumulates in significant quantities and chronic inflammation is more pronounced. Thus, in patients with penile cancer, phimosis is found in 44-90% of cases.

Long-term exposure to smegma affects the likelihood of developing penile cancer, as indicated by the varying incidence of the disease, depending on cultural and religious practices in different countries.

For example, among Jewish men who, for religious reasons   , are usually circumcised on the 8th day after birth, cancer of the penis is extremely rare. However, among Muslims who are circumcised at an older age, the cancer of the penis is observed in the bowl. It should be noted that circumcision in adults does not reduce the risk of developing the disease.

[10], [11], [12]

Symptoms of the cancer of the penis

Cancer of the penis has one typical symptom - the appearance on the skin of the penis of the tumor, initially small in size and often in the form of a gradually increasing compaction. The tumor can be papillary or have the appearance of a flat, dense formation. As the growth can occur, ulceration of the tumor, while there are bleeding and bleeding, right up to profuse. When infected with ulcers, the detachable gets a sharp fetid odor. The spread of the tumor into the cavernous bodies is initially impeded by the fascia fascia and the white shells, the germination of which leads to vascular invasion and dissemination of the tumor process.

[13]

Stages

Stage	Tumor prevalence	Lymph node involvement	The presence of metastases
Stage 0	Tis-Ta	N0	M0
Step I	T1	N0	M0
Stage II	T1 T2	N1 N0	M0 M0
Stage III	T1-3	N2 N2 N0-2	M0
Stage IV	T4 T any T any	N any N3 N any	M0-1

[14]

Forms

Below is the clinical classification of penile cancer by the TNM system for 2002.

Criterion T characterizes the degree of prevalence of the primary tumor.

• Tx - insufficient data for the evaluation of the primary tumor.
• T0 - primary tumor is not detected.
• Tis - preinvasive carcinoma (carcinoma in situ).
• Ta - non-invasive warty carcinoma.
• T1 - the tumor extends to the subepithelial connective tissue.
• T2 - the tumor extends to spongy or cavernous bodies.
• TK - the tumor extends to the urethra or prostate.
• T4 - the tumor spreads to neighboring organs.

Criterion N characterizes the degree of involvement of regional lymph nodes in the process.

• Nx - insufficient data to assess the state of regional lymph nodes.
• N0 - there are no signs of regional metastases of lymph nodes.
• N1 - metastases in one superficial inguinal lymph node.
• N2 metastases in several superficial inguinal lymph nodes or metastases on both sides.
• N3 - metastases in the deep inguinal lymph nodes or in the lymph nodes of the pelvis with one or both sides.

Criterion M characterizes the presence of distant metastases.

• Mx - insufficient data to assess the presence of distant metastases.
• M0 - there are no distant metastases.
• Ml - metastasis to distant organs.

The degree of tumor anaplasia is determined by the morphological classification.

• Gx - the degree of anaplasia can not be established.
• G1 - low degree of anaplasia.
• G2 is the average degree of anaplasia.
• G3 - high degree of anaplasia.
• G4 - undifferentiated tumors.

[15], [16], [17]

Treatment of the cancer of the penis

Cancer of the penis is treated differently, the method of treatment is determined by the stage of the disease, while the success of treatment depends on the effectiveness of the effect on the primary tumor and the zones of regional metastasis.

Resection of the penis or total penectomy serve as the "gold standard" of the operative treatment of penile cancer. With  an increase in lymph nodes, determined by the primary treatment of the patient, it is necessary to remove not only the primary tumor, but also the lymph nodes of the zone of regional metastasis.

Lymphadenectomy (Duquin's operation) can be performed simultaneously with surgery for the primary tumor, and after the disappearance of inflammatory changes, and after ineffective chemotherapy or radiation therapy, the indications to which are established based on the stage of the disease. Unfortunately, at present there are no precise recommendations defining the indications for lymphadenectomy, as well as the amount and time of the operative intervention.