Penile TumourUro-Oncology Unit
Penile tumour is a rare tumour in developed countries, affecting 1/100,000 men in Europe and the USA (in some regions of Spain this incidence is higher). However, in some underdeveloped countries it becomes the most frequently diagnosed tumour in men, as is the case in Uganda.
Epidermoid tumour on the penis (or squamous cell carcinoma) accounts for 95% of cases, but other types of tumours have been described as melanomas, lymphomas, mesenchymal tumours, or metastases from other tumours. It is essential to identify certain precursor lesions of penile cancer: intraepithelial lesions, Bowen’s disease, Paget’s disease, giant condyloma, among others.
The human papillomavirus (HPV) is present in one third of the cases, and is considered one of the main risk factors. The virus is involved in carcinogenesis and interferes with oncogenes and tumour suppressor genes, favouring the development of tumours. The HPV subtypes most commonly associated with penile tumours are HPV 16 and 18.
Other risk factors related to penile tumours are advanced age, phimosis, chronic inflammation (Balanitis xerotica obliterans), condyloma acuminatum (HPV), treatment with psoralen or UVA phototherapy, smoking, living in socio-economically deprived areas, and sexual promiscuity. It is thought that childhood circumcision can decrease the incidence of penile cancer, but this remains a controversial issue nowadays.
- Urologists highly specialised in penile cancer.
- Penis lesions biopsy.
- Penile Doppler ultrasonography.
- Radiodiagnostic service: CT, NMR, and PET.
- Sentinel node.
In the diagnosis of penile cancer, a physical exam is essential. The penis and groin should be examined to identify lesions (number, appearance, location) and discard possible involvement of the corpora cavernosa as well as inguinal lymphadenopathy. In case of doubts about the involvement of corpora cavernosa, a penile Doppler ultrasonography or NMR can be done. Once the lesion has been identified, the anatomopathological diagnosis must be achieved by means of a biopsy or total exeresis, and must state the presence or absence of HPV. The study is complemented by CT, PET or sentinel node identification in selected cases.