Penile Cancer - Symptoms and Diagnosis

Symptoms of penile cancer

The main symptoms of penile cancer are the appearance of a tumor on the skin of the penis, initially small in size and often in the form of a gradually increasing compaction. The tumor may be papillary or have the appearance of a flat, dense formation. As it grows, the tumor may ulcerate, causing bloody discharge and bleeding, even profuse. When the ulcer becomes infected, the discharge acquires a sharp, foul odor. The spread of the tumor into the cavernous bodies is initially prevented by Buck's fascia and the protein membranes, the growth of which leads to vascular invasion and dissemination of the tumor process.

With phimosis, the tumor may remain unnoticed for quite a long time, and the patient's main complaint will be related to discharge from the prepuce, possibly of a purulent nature. Then, a thickening is found in the area of the foreskin, sometimes a tumor that extends beyond the area of narrowing of the foreskin.

The general condition of the patient does not suffer for a long time, but as the tumor grows and especially when metastases appear, the following symptoms of penile cancer occur: a deterioration in the general condition of the patient is possible, manifested in the form of general weakness, loss of appetite and weight loss, increased fatigue, pain in the tumor area. Less often, patients complain of enlarged inguinal lymph nodes, pain in the groin area, burning during urination, hematuria.

Diagnosis of penile cancer

Diagnosis of penile cancer should be comprehensive and include physical, instrumental and laboratory examination methods. The main task is to establish the diagnosis and stage of the tumor process.

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Clinical diagnosis of penile cancer

During a clinical examination of the patient, it is necessary to assess the size, location of the tumor, and the degree of infiltration of the surrounding tissues. In this case, palpation of the base of the penis and scrotum, and inguinal lymph nodes is performed. Rectal examination allows assessing the condition of the perineum and pelvic organs.

During examination, a tumor is found on the skin of the penis, which, depending on the stage and type of growth, may look different.

In case of cancer in situ, the tumor is most often represented by an area of hyperemia located on the inner layer of the foreskin or on the head of the penis, sometimes with a weeping surface.

• At stages Ta-1, the tumor is in the form of a villous exo- or endophytic neoplasm that does not extend to the spongy body of the head and cavernous bodies.
• At stage T2, the tumor infiltrates the head and possibly the corpora cavernosa.
• At stage T3, the tumor is of significant size, usually with decay and infiltration of the spongy and cavernous bodies, with transition to the urethra and/or prostate.
• At stage T4, the tumor spreads to the skin, soft tissues of the pubis, and urethra.

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Laboratory diagnostics of penile cancer

The next stage of the examination should be taking a scraping from the surface of the tumor for cytological examination of the material. At the same time, a puncture of enlarged or dense regional lymph nodes is performed. In cases where the tumor is endophytic in nature and the results of the cytological examination of the scraping do not allow an accurate diagnosis, an open biopsy is indicated to confirm it, clarify the morphological structure of the tumor and its prevalence.

Instrumental diagnostics of penile cancer

Ultrasound is used to determine the size and depth of invasion of the primary tumor, as well as to assess the condition of the inguinal and iliac lymph nodes. MRI is usually used when ultrasound is uninformative. MRI allows for a clear image of the structures of the penis, making it possible to determine the degree of tumor invasion with greater accuracy. Computed tomography is uninformative when assessing primary lesions, but is quite effective in detecting enlarged inguinal and pelvic lymph nodes.