Signs and Symptoms of Penile Cancer
In most cases, the first sign of penile cancer are changes in color, skin thickening, or a build-up of tissue. Later signs are a painless ulcer or growth on the penis, especially on the glans or foreskin but also sometimes developing on the shaft. Most penile cancers do not cause pain, but some can cause ulcers (sores) and bleeding.
Sometimes the cancers appear as a reddish, velvety rash, small crusty bumps,
or flat growths that are bluish-brown. They may not be visible unless the
foreskin is pulled back. A persistent discharge, usually with a foul odor, may
be present beneath the foreskin.
If cancer has progressed to a more advanced stage, the lymph nodes in your
groin may be swollen. Lymph nodes are bean-sized collections of immune system
cells that fight infection. You, your partner, or your doctor may often be able
to feel the swollen nodes in your groin area.
However, swollen lymph nodes in the groin area can be caused by other
conditions, such as infection. A number of benign conditions, such as genital
warts, can produce similar signs. If you have any of these signs or symptoms, go
see your doctor right away. Remember, the sooner you receive a correct
diagnosis, the sooner you can start treatment and the more effective your
treatment will be.
Because penile lesions affect the skin tissue on the surface of the organ, a
visual examination of the penis can usually detect cancers and other
abnormalities. Swelling at the end of the penis, especially when the foreskin is
constricted, is another common sign that penile cancer may be present.
Biopsy procedures
A biopsy is needed to make an accurate diagnosis. In this procedure, a small
piece of the skin tissue is cut out and sent to a laboratory. There, a
pathologist (a doctor specializing in laboratory diagnosis of diseases) looks at
the tissue under a microscope to see whether cancer cells are present.
Excision or Incision: The type of biopsy depends on the nature of the
abnormality. If your doctor detects nodules (swollen lumps) or plaques (raised,
flat areas) that are 1 cm (about 3/8 inch) or less, the entire lesion will be
removed by excision biopsy.
An incision biopsy, in which only a portion of the affected tissue is
removed, will be performed on lesions that are larger or ulcerated (a break in
the skin or it appears to have a sore) or that appear to grow deeply into the
tissue. These biopsies are usually done in a doctor’s office, clinic, or
outpatient (1 day) surgical center with the patient under local anesthesia
(numbing medication). The tissue is then sent to a laboratory, where a
pathologist examines it under a microscope. The results are usually available
within 3 to 4 days.
Fine Needle Aspiration: Fine needle aspiration (FNA) is a type of biopsy
that can be done in a doctor's office or clinic. Anesthesia may not be needed in
some cases, but if it is, local anesthesia may be injected into the skin over
the mass. Your doctor will place a thin needle directly into the mass for about
10 seconds and withdraw cells and a few drops of fluid. These cells can be
viewed under a microscope to determine if cancer is present.
If the mass is deep inside your body and the doctor cannot feel it, imaging
methods such as ultrasound or a CT scan can be used to guide the needle into the
enlarged lymph node. FNA is not used in every case but is one alternative to
lymph node dissection for some patients.
Sentinel Node Biopsy: Sentinel lymph node biopsy is an alternative to
total lymph node dissection that, for several years, has been used successfully
for some patients with breast cancer or malignant melanoma. Some doctors
recommend its use for some men with penile cancer.
In this procedure, a radioactive tracer and a blue dye are injected into the region of the tumor. The lymphatic vessels carry the dye or radioactive
material to a sentinel node, the first lymph node receiving lymph from
the tumor and the one most likely to contain a metastasis if the cancer has
spread. The surgeon finds this node during the operation either visually (by the
blue dye) or with a Geiger counter (radioactive tracer) and removes it. If the
sentinel node contains cancer, more lymph nodes are removed. If the sentinel
node does not have cancer cells, additional lymph node surgery may be avoided.
Using this approach, fewer patients will need to have many lymph nodes
removed. Removing lymph nodes carries a risk of side effects such as lymphedema
(fluid accumulation in tissues) and problems with wound healing.
If your doctor is considering this procedure, it might be useful to determine
how many sentinel node biopsies he/she has done and whether this approach will
be part of a research study. It is also important to note that all doctors do
not yet perform sentinel lymph node biopsy as an alternative to a more
traditional total lymph node removal. Discuss the procedure with your doctor.
Imaging tests
Imaging tests like those listed below are generally not useful in examining
people with early penile cancer. If the doctor thinks the cancer is advanced or
has spread, then one or more of these tests may be ordered.
Computed tomography (CT): The CT scan is an x-ray procedure that produces
detailed cross-sectional images of your body. Instead of taking one picture, as
does a conventional x-ray, a CT scanner takes many pictures of the part of the
body being studied as it rotates around you. A computer then combines these
pictures into an image of a slice of your body. This test can help tell if your
penile cancer has spread into your liver or other organs.
Often after the first set of pictures is taken you may be asked to drink 1 or
2 pints of a radiocontrast agent, or "dye." This helps outline the
intestine so that it certain areas are not mistaken for tumors. You may also
receive an IV (intravenous) line through which the contrast dye is injected.
This helps better outline structures in your body. A second set of pictures is
then taken.
The solution you drink and the injection can cause some flushing. Some people
are allergic and get hives; rarely more serious reactions like trouble breathing
and low blood pressure can occur. Be sure to tell the doctor if you have ever
had a reaction to any contrast material used for x-rays.
CT scans take longer than regular x-rays and you need to lie still on a table
while they are being done. But just like other computerized devices, they are
getting faster and your stay might be pleasantly short. Also, you might feel a
bit confined by the ring you have to lay in when the pictures are being taken.
CT scans can also be used to guide a biopsy needle precisely into a suspected
metastasis. For this procedure, called a CT-guided needle biopsy, the
patient remains on the CT scanning table while a radiologist advances a biopsy
needle toward the location of the mass. CT scans are repeated until the doctors
are confident that the needle is within the mass. A fine needle biopsy sample
(tiny fragment of tissue) or a core needle biopsy sample (a thin cylinder of
tissue about ½-inch long and less than 1/8 inch in diameter) is removed and
examined under a microscope.
Magnetic resonance imaging (MRI): MRI scans are most helpful in looking at the brain and spinal cord. But they have been used in looking at penile tumors. MRI scans are a little more uncomfortable than CT scans. First, they take longer--often up to an hour. Also, you have to be placed inside a tube, which is confining and can upset people with claustrophobia. The machine also makes a thumping noise that you may find disturbing. Some places provide headphones with music to block this out.
Ultrasound: This is a very common test that is often used in pregnant women to look at the fetus. But it can be applied anywhere in the body. This test works by "bouncing" high frequency sound waves off the tumor and reading their pattern. It is sometimes useful for determining how deeply the cancer has penetrated into the penis.
Chest x-ray: This test may be done to determine whether penile cancer has
spread to the lungs.
Revised: 10/22/2004
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