The primary male organ consists of two testes (singular testis), located in an external sac called scrotum. Within the testes there are numerous small tubes that twist and coil to form the seminiferous tubules, which produce sperm, the male sex cell. The testes also secrete testosterone, which develops and maintains secondary sex characteristics. Lying over the superior surface of each testis is a single, tightly coiled tube called the epididymis. This structure stores sperm after it leaves the seminiferous tubules. The epididymis is the first duct through which sperm passes after its production in the testes. The upward duct is the epididymis which forms the vas deferens (seminal duct or ductus deferens). This is a narrow tube that passes the inguinal canal into the abdominal cavity. The vas deferens extends over the top and down the posterior (back) surface of the bladder, where it joins the seminal vesicle. The union of the vas deferens with the duct from the seminal vesicle forms the ejaculatory duct.
The penis is the male organ of copulation. It is cylindrical and composed of erectile tissue that encloses the urethra (the tube which is connected to the bladder). The urethra expels both semen and urine from the body. The enlarged tip of the penis, the glans penis, contains the urethral orifice (meatus). A movable hood of skin called prepuce or foreskin, called the glans penis.
Although penile cancer is rare, it is estimated that in 2014 about 1,640 new cases will be diagnosed and about 30 % of patients will die. Penile cancer increases with age and 4 out of 5 cases are men over the age of 55. Early diagnoses of penile cancer often go undetected because of the patients’ embarrassment to bring questions to the physician, denial, loss of sexual function, and fear is often a factor which often stops many men from seeking medical screening.
The first symptoms appear on the head or foreskin consisting of a hard bump or a firm mass of tissue. Other symptoms consist of Itching, burning, raised or flat wart-like (verrucae) lesion, inflamed sore, discharge, bleeding, redness, irritation, or swollen lymph nodes in the groin.
The HPV (human papilloma virus) is a DNA (Deoxyribonucleic Acid) virus from the papillomavirus family. It has been found in one half of all infected penile cancers. This type of virus will cause a type of growth called papilloma are genital warts (condyloma acuminatum). The high risk types that are linked with penile cancer include HPV 16 (the predominate genotype for approximately 63 % of all cases), HPV 18, and HPV 31. These virus’ produce no visible signs of pre-cancerous conditions until the cancer has already developed. One study had found that one half of men 18 and older have had a genital HPV infection. The infection is spread from one person to another by any type of skin contact but sexual relations are the predominate cause.
Testing for penile cancer should be done by a medical Urologist. A detailed history and physical (H&P) examination will be performed. If cancer is suspected, a biopsy from the penis will be performed. Another procedure is called a cystoscopy (a small camera inserted into the penis opening which is sent all the way to the bladder) to check for any suspicious tissue. The Urologist may want to do an imaging test called an MRI (magnetic resonance imaging) to view the area on a computer screen to insure tumors haven’t invaded the deeper tissue of the penis. The physician may order an ultra sound procedure, using high-energy sound waves which bounce off external organs creating echoes, which then, form a picture on a screen called a sonogram in aid of diagnoses.
The stages of penile cancer are
STAGE 0 – Carcinoma in situ, (an early form of cancer).
STAGE l – Cancer that is only affecting subepithelial connective tissue.
STAGE ll – Lymph nodes or has invaded the corpora or urethra.
STAGE lllA – Deep invasion into the penis and metastasis (spread) to one lymph node.
STAGE lllb – Deep invasion into the penis and metastasis into multiple inguinal lymph nodes.
STAGE lV – Caner has invaded into structures adjacent to the penis, metastasized into pelvic nodes and prostate.
If caner is diagnosed your physician may offer various treatments. One option is to remove the affected area, by using local anesthesia to remove the entire cancerous area, leaving a border of healthy skin. Then a specimen is sent to the lab to make sure all the caner is removed. Another type of surgery is Moh’s Surgery. This procedure is a detailed surgery where small layers of skin are individually removed and viewed under a microscope until no cancer cells are present. The last option would be a surgical procedure called a Penectomy, where partial or total amputation (removal) of the penis is performed.
If the penis is a total excision, a man may consider a penile implant. There are several prosthesis options for the penis. One type of implant is an incision (cut) is made in the underside of the penis. Then the tissue on both sides of the urethra is expanded to allow placement of the implants, which are placed on both sides the urethra. Then the skin is closed with sutures (stitches) that will be absorbed by the body. Another option that can be inflated at will is called the Inflatable Prosthesis. This is when incisions are made in the underside of the penis, the side of the scrotum, and on the abdomen several inches above the base of the penis. The penile tissue is stretched to allow placement of the prosthesis. The fluid reservoir for the prosthesis is implanted under the skin above the bladder at the base of the pelvis. The prosthesis can be inflated by applying pressure on the reservoir. The skin is sutures that will be absorbed by the body.
To prevent penile cancer a man should get a HPV virus vaccine such as Gardasil and use condoms during sexual relations, and limit intercourse to one trusted partner. Be sure to perform good genial hygiene by thoroughly washing the penis, scrotum and foreskin daily with soap and water. Secretions that build up under intact foreskin causes a condition called Smegma (A thick smelly substance that has been linked Penile Cancer). Studies show that circumcised (removal of the foreskin) men has lower risk of Penile Cancer than those who are not circumcised. Uncircumcised men can develop the condition called Phimosis (where the foreskin becomes tight and difficult to retract) and that hinders consistant bodily hygiene. Don’t smoke. Researchers believe that inhalants are absorbed into the bloodstream and damage genes in the cells of the penis. Smoking increases the risk of HPV virus due to a weakened immune system. Normal cells regulate themselves by making a substance called Tumor Suppressor Gene (TSG) products which keep cells from growing too fast which will produce cancer. Two proteins (E6 and E7) made by the high-risk HPV, blocks the function of TSG in cells which may make them susceptible to become cancerous.
Prognosis for Penile Cancer varies from person to person depending on the stages and individual health. Early intervention to detect the cancer is a premium to prevent spreading. For a positive prognosis visit your doctor regularly and feel free to ask your physician any question that will benefit your health.