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Penile cancer

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Precancerous conditions of the penis

Precancerous conditions of the penis have the potential to develop into penile cancer.

The most common precancerous conditions of the penis are:

  • penile intraepithelial neoplasia (PeIN)
  • balanitis xerotica obliterans (BXO)
  • Buschke-Lowenstein tumour
  • bowenoid papulosis
  • leukoplakia

Penile intraepithelial neoplasia (PeIN)

Penile intraepithelial neoplasia (PeIN) is the most common precancerous condition of the penis. PeIN is a general term used to describe precancerous conditions of the penis that may develop into invasive squamous cell carcinoma (SCC) if not treated.

PeIN refers to abnormal cell changes, called carcinoma in situcarcinoma in situA very early stage of cancer in which tumour cells have not yet invaded surrounding tissues., that occur on the skin surface of the penis.

  • PeIN on the glans (glans penis or head) or foreskin of the penis is sometimes called erythroplasia of Queyrat.
  • PeIN on the shaft of the penis is sometimes called Bowen’s disease.

Erythroplasia of Queyrat and Bowen’s disease have similar features, behave the same and are associated with similar types of human papillomavirus (HPV)human papillomavirus (HPV)A type of virus that causes abnormal tissue growth (warts) and other changes to cells.. They are typically treated in the same way.

Risk factors

The following risk factors may increase a man’s chance of developing PeIN:

  • human papillomavirus (HPV) infection
  • inability to fully pull back (retract) the foreskin over the glans
    • This condition is called phimosis.
  • poor genital hygiene
  • not being circumcised
    • Although there is some evidence that circumcision reduces the risk of penile cancer, there is not enough evidence to recommend circumcision as a way of preventing cancer of the penis.
    • The Canadian Paediatric Society does not recommend routine circumcision of newborn boys. Decisions about circumcision are highly personal and depend more on religious and cultural reasons than on medical reasons.
  • chronic irritation, inflammation and infection of the penis
  • weakened immune system
  • smoking
  • exposure to ultraviolet (UV) light, including PUVAPUVAA type of therapy that uses both psoralen (P) and ultraviolet A (UVA) radiation. therapy
  • having multiple sexual partners
    • This can increase the chance of becoming infected with HPV.
  • exposure to arsenic
    • This is a risk factor only for Bowen’s disease.

Signs and symptoms

The signs and symptoms of PeIN may include:

  • one or more abnormal growths or sores (ulcers) on the penis, with the following features:
    • a raised or flat area with irregular borders
    • white to red in colour
    • may be crusty
    • may be scaly
    • may bleed
    • may be itchy
  • painful urination
  • discharge from the penis
  • inability to fully pull back (retract) the foreskin over the glans (phimosis)

Diagnosis

If the signs and symptoms of PeIN are present, or if the doctor suspects PeIN, tests will be done to make a diagnosis. Tests may include:

  • medical history and physical examination
  • biopsy

Treatment

Because PeIN is considered carcinoma in situ, it is treated the same as stage 0 penile cancer.

Balanitis xerotica obliterans (BXO)

Balanitis xerotica obliterans (BXO) is an inflammatory condition of skin that affects the foreskin and the glans (glans penis or head) of the penis. It may also be called penile lichen sclerosus.

There are no known risk factors for BXO.

Signs and symptoms

Signs and symptoms of BXO may include:

Diagnosis

If the signs and symptoms of BXO are present, or if the doctor suspects BXO, tests will be done to make a diagnosis. Tests may include:

  • physical examination
  • biopsy of the skin of the penis

Treatment

Treatment options for balanitis xerotica obliterans may include:

  • topical steroid cream
  • topical tacrolimus (Protopic)
    • This drug suppresses the immune system.
  • surgery
    • Surgery may be needed to open the urethra if it is narrowed.
  • circumcision
    • This is a treatment option for men who have not been circumcised.
  • laser surgerylaser surgeryA surgical technique that uses a laser (an intense beam of light) to make bloodless cuts in tissue.

Buschke-Lowenstein tumour

Buschke-Lowenstein tumour is most commonly found on the glans (glans penis or head) of the penis. It has been suggested that Buschke-Lowenstein tumour is a low-grade cancer related to verrucous carcinoma of the penis. It is a slow-growing tumour that may grow as big as 15 cm.

Risk factors

The following risk factors may increase a man’s chance of developing Buschke-Lowenstein tumour:

  • history of human papillomavirus (HPV)human papillomavirus (HPV)A type of virus that causes abnormal tissue growth (warts) and other changes to cells. infection and other sexually transmitted infections
  • long-term exposure to chemicals
  • long-term irritation of the penis
  • poor genital hygiene
  • inability to fully pull back (retract) the foreskin over the glans (phimosis)
  • weakened immune system
  • low socio-economic status
  • drug abuse
  • smoking

Signs and symptoms

The signs and symptoms of Buschke-Lowenstein tumour may include:

  • an abnormal growth or sore (ulcer) on the penis
    • It may look like a genital wart with a cauliflower-like appearance.
  • tumour or abnormal area that has a foul odour
  • enlarged lymph nodes in the groin
    • This is usually related to a secondary infection.

Diagnosis

If the signs and symptoms of Buschke-Lowenstein tumour are present, or if the doctor suspects a Buschke-Lowenstein tumour, tests will be done to make a diagnosis. Tests may include:

  • medical history and physical examination
  • biopsy
  • magnetic resonance imaging (MRI)magnetic resonance imaging (MRI)An imaging technique that uses a magnetic field to produce pictures of areas inside the body. A contrast medium may be injected into the body to make structures and organs show up clearly on the image.
    • MRI may sometimes be helpful in assessing the extent of the tumour.

Treatment

Buschke-Lowenstein tumour is treated the same as carcinoma in situ or stage 0 penile cancer.

Bowenoid papulosis

Bowenoid papulosis has an extremely low chance of developing into cancer. It affects younger men more often than older men.

Risk factors

The following risk factor may increase a man’s chance of developing bowenoid papulosis:

  • HPV infection

Signs and symptoms

The signs and symptoms of bowenoid papulosis may include one or many reddish or flesh-coloured, warty, raised areas that vary in size. These occur on the shaft of the penis or the nearby perineal skin.

Diagnosis

If the signs and symptoms of bowenoid papulosis are present, or if the doctor suspects a bowenoid papulosis, tests will be done to make a diagnosis. Tests may include:

  • medical history and physical examination
  • biopsy

Treatment

Treatment options for bowenoid papulosis may include:

  • surgery
  • laser surgery
  • cryosurgery
  • topical chemotherapy (given as a cream applied to the skin)
    • 5-flurouracil (Adrucil, 5-FU)
    • podophyllin (Pod-Ben-25, Podofin)
    • retinoic acid
  • topical biological therapy
    • imiquimod (Aldara)
    • interferon
  • curettage and electrodessication

Leukoplakia

Leukoplakia has the potential to become squamous cell carcinoma (SCC).

Risk factors

The following risk factors may increase a man’s chance of developing leukoplakia:

  • human papillomavirus (HPV) infection
  • inability to fully pull back (retract) the foreskin over the glans
    • This condition is called phimosis.
  • poor genital hygiene
  • not being circumcised
    • Although there is some evidence that circumcision reduces the risk of penile cancer, there is not enough evidence to recommend circumcision as a way of preventing cancer of the penis.
    • The Canadian Paediatric Society does not recommend routine circumcision of newborn boys. Decisions about circumcision are highly personal and depend more on religious and cultural reasons than on medical reasons.
  • chronic irritation, inflammation and infection of the penis

Signs and symptoms

The signs and symptoms of leukoplakia are an abnormal whitish area or spots that may form on the opening of the urethra.

Diagnosis

If the signs and symptoms of leukoplakia are present, or if the doctor suspects leukoplakia, tests will be done to make a diagnosis. Tests may include:

  • medical history and physical examination
  • biopsy

Treatment

Leukoplakia is usually treated with surgery.

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