Penile Cancer

Cancer of the penis is very rare, there are around 700 cases in the UK each year and 36,000 globally. It is most often diagnosed in men over the age of 60 years however much younger can also be affected. It is is usually a slow growing cancer and if caught early before further spread the chances of survival are high and around 70% of men diagnosed with penile cancer will survive the disease. Unfortunately most men tend to ignore potential penile cancer symptoms for some time which leads to a subsequent delay in diagnosis.

 

Penile Anatomy

Penile Anatomy

Causes and Prevention

The causes and the way penile cancer develops is not fully understood, however there are some factors which seem to increase the risk of developing the disease.

Human Papilloma Virus (HPV)

There are over 200 different types of HPV virus. Common types cause warts and verucas and are spread by skin to skin contact.

Around 40 types of HPV are transmitted via sexual intercourse and there are several types of HPV virus which are considered high risk viruses (including types 16 and 18 most commonly). These can infect the anus, penis, throat and cervix and are linked with the development of some cancers in these areas. The body’s immune system is usually able to kill the virus, however sometimes in rare instances the virus can persist for many years without causing any symptoms and then develop into cancer or a pre-cancerous conditions. Practicing safe sex using a condom can help reduce the risk of HPV as well as Sexually Transmitted Infections (STIs) in general.

The risk of developing these types of HPV related cancers is greater in men who have sex with other men or who have weakened immune systems (such as those with HIV).

Around 50% of men diagnosed with the most common type of penile cancer show evidence of infection with one of these HPV types.

HPV Vaccination

Girls are routinely offered an HPV vaccine at school to reduce the risk of cervical cancer. As of 2019, in the UK 12 and 13 year old boys are also being offered the vaccine. It also available for men who have sex with other men. For more information on HPV vaccination please click here

The presence of the foreskin

Penile cancer is virtually unknown in men who have been circumcised as a child, however circumcision in later life does not reduce the risk of penile cancer. The risk of uncircumcised men developing penile cancer is greater in the presence of phimosis (below).

Phimosis

This is the inability to pull back or retract the foreskin fully. It can occur as a result of skin irritation or inflammation but can effect some men from birth. It will reduce the ability of a man to clean the penis thoroughly or notice any abnormal changes. Sometimes it may lead to a build-up of substances under the foreskin that could later contribute to the development of penile cancer. Research suggests that men with phimosis are around 10 times more at risk of developing penile cancer.

Smoking

Some studies have suggested that smoking may increase the chance of developing penile cancer. This may be because harmful chemicals found in cigarettes are excreted in the urine which may then interact with secretions that can build up under the foreskin of an uncircumcised man, especially in the prescence of phimosis, resulting in abnormal cell changes in the penis.

Psoralen-UV-A Photochemotherapy (PUVA)

A treatment called Psoralen-UV-A Photochemotherapy (PUVA) which is used to treat some forms of the skin disease psoriasis, as well as some types of cancer has been linked to the development of penile cancer.

 

Possible Symptoms

Symptoms of penile cancer may include the following listed below. However there are also several non-cancerous conditions that can affect the penis and initially cause similar appearances.

  • A growth or ulcer on the penis, especially on the glans or foreskin.
  • Changes in the colour of the penis.
  • Skin thickening on the penis.
  • Persistent discharge with foul odour beneath the foreskin.
  • Blood coming from the tip of the penis or under the foreskin.
  • Unexplained pain in the shaft or tip of the penis.
  • Irregular or growing bluish-brown flat lesions or marks beneath the foreskin or on the body of the penis.
  • Reddish, velvety rash beneath the foreskin.
  • Small, crusty bumps beneath the foreskin.
  • Irregular swelling at the end of the penis.

Cancer can develop anywhere in the penis but the most common places are under the foreskin and on the head (glans).

If a man with any of these symptoms which do not show an improvement after an intial course of treatment, or if there is any doubt as to a diagnosis, they should be referred to a hospital specialist called a urologist for further assessment on an urgent basis. In the majority of cases other non-cancerous conditions of the penis (such as those listed below) will be the cause of the symptoms.

 

Non-Cancerous Conditions

Balanitis

This is a term used to describe inflammation of the penis and is more common in uncircumcised men. The glans may become swollen, red and painful and uncircumcised men may find it difficult to retract the foreskin. It can be caused by the yeast infection candida (which causes vaginal thrush in women and can be passed between partners) and other infection including those which are sexually transmitted (STIs). Other causes can be vigorous penile activity causing too much friction (for instance sexual intercourse) or chemical irritants from toiletries.Balanitis can be treated by using an anti-yeast cream and tablets if it is due to candida or sometimes steroidal cream to reduce inflammation in in other causes of irritation. In some cases antibiotics may be needed to treat STIs.

Condyloma (Genital warts)

These may appear in the form of cauliflower shaped, pinkish growths around the penis. They may or may not cause itching, soreness or irritation and are a direct result of becoming infected with a strain of the Human Papilloma Virus (HPV) during sexual intercourse. This strain of HPV does not directly cause penile cancer although it may increase the risk of developing the disease. Condylomas can be treated using special creams and ointments. They can also be frozen or burned off using additional medical procedures if necessary. Unfortunately none of the treatments is a definitive cure and warts may reoccur in the future. Practicing safe sex with a condom will reduce the risk of this type of infection.

Cysts

Cysts can occur anywhere on the body including the shaft of the penis and may appear as small lumps. They are formed of substances that are not cancerous and  are usually painless. If they are causing symptoms they can be surgically removed.

Lichen Planus

This may appear as a mauve, itchy rash which more commonly occurs on the wrists or shins. It will usually resolve without any treatment.
For more information on Lichen Planus form NHS Choices please click here

Pearly Penile Papules

Around 10-20% of men may notice these small pearl like bumps which usually affect the crown of the penis. They are not infectious and do not require any treatment.

Peyronies disease

This is a rare non-cancerous condition that can cause the shaft of the penis to curve due to hardened tissue forming. This may cause the penis to bend on erection and make sexual intercourse painful. It can be treated with surgical and non-surgical procedures.

Lichen sclerosus et atrophicus (Balanitis Xerotica Obliterans; BXO)

This is the formation of white lesions which can lead to phimosis in uncircumcised men. It is found in a small percentage of men with penile cancer but has not been definitively linked as a causative factor in its development.

Sexually Transmitted Infections (STIs)

For comprehensive information from NHS Choices detailing STIs please click here

 

View our Pocket Rocket penile cancer awareness Z-card here

 

Penile Cancer Z-card

Order here

 

 

 

References available on request.

Last updated February 2022. Next review November 2022.

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