Penile Cancers

What are Penile cancers 
Penile cancers are cancers that result from the mutation and uncoordinated growth of cells of the penis. There are different types of cancers of the penis, such as:

1. Squamous cell carcinoma (epidermoid): This cancer is the most common type of penile cancer and forms in the top part of the skin layer.
2. Melanoma: This type begins in melanocytes. It is considered a very aggressive type of cancer.
3. Adenocarcinoma: This type forms in the glandular cells
4. Basal cell carcinoma: This cancer begins in the basal layer of the skin and grows slowly.
5. Urothelial carcinoma: This cancer forms in the urothelium which lines the urinary system.

Incidence and prevalence of penile cancers in Nigeria
Penile cancer is rare globally, with about 32,000 new cases annually (ASIR: 0.80 per 100,000 males). In Nigeria, the incidence is even lower, with  ≤12 cases per year (ASIR: <0.01 per 100,000 males), among the lowest globally. HPV causes about 50% of cases, meaning ≤6 cases in Nigeria may be HPV-related. The low incidence in Nigeria is largely due to widespread male circumcision, which reduces risk.

Similar to its incidence, the prevalence of penile cancers is also low. An 18-year study at Aminu Kano Teaching Hospital identified only six cases from 1998 to 2015, with patients averaging 59.7 years, all being well-differentiated squamous cell carcinomas. A 2011 study at Lagos University Teaching Hospital over 20 years reported seven cases (1.9% of male genital tract malignancies), with most patients in their 5th decade of life. A recent study from June 2022 at the Federal Teaching Hospital in Gombe found three additional cases in the past decade. 

What penile cancer looks like

Penile cancers can usually present as painless, red areas, with wart-like sores that don't heal easily. Other signs include;

1. Painless lump
2. Bluish-brown growths
3. Foul-smelling discharge
4. Rash
5. Change in skin colour
6. Swelling and irritation (balanitis)

Survival rates
In Nigeria, penile cancer survival rates can vary, but a 5-year survival rate of around 65% is reported, though this can be higher in countries with better access to treatment. Factors that affect the survival from penile cancers are;

1. Stage of cancer
2. Access to Treatment
3. Involvement of lymphatics
4. Options of treatment
5. Causes and Risk Factors
   As with other cancers, penile cancers occur when the cells of a penis grow in an uncoordinated manner. Some of the factors that may increase risks include;
   Age:  males that are 50 years and above are more prone to penile cancers.
6. Uncircumcision: it has been established that most penile cancers occur in uncircumcised individuals.
7. Tobacco smoking: cigarettes and other forms of tobacco lowers the body's immunity, and harms cells which can cause cancer.
8. Human papillomavirus (HPV): HPV is reported to be related to about half of all penile cancers.
9. Human immunodeficiency virus (HIV): Although we have not fully understood why, penile cancers occur mostly in males with HIV.
10. Phimosis: causes penile foreskin to become so tight and unretractable.
11. PUVA: Stands for Psoralen and Ultraviolet A photochemotherapy, which is used to treat psoriasis, can also be a risk factor for cancers.

How to detect the condition
Your physician will conduct a physical examination and inquire about your medical history. Certain tests that may be performed include biopsy where a small tissue sample taken from a skin lesion on the affected area is analyzed in the laboratory to look for cancer cells. Imaging procedures such as X-rays, CT scans, ultrasounds, and magnetic resonance imaging (MRI) are also used to assess the spread of cancer.

When to see a doctor
Prevention is always better, easier and cheaper than cure; it is recommended that you see your doctor regularly for check-ups. Visit your doctor as soon as you observe any unusual lump in your private part. Explain your symptoms to the doctor and seek their advice. It is always easier to treat medical conditions, especially cancers when they are detected early.

Prevention of penile cancers
It's difficult to state appropriate measures for preventing penile cancers, but the following points reduce the risks of having penile cancers;

1. Early circumcision
2. Penile hygiene
3. Avoiding tobacco
4. Restricting sexual partners to avoid HPV and HIV infections.

Penile cancers occur when there is an uncoordinated growth of cells and tissues around the penile area. These cancers are very rare, however they can be fatal when they occur. Cases are mostly seen in patients more than 50 years of age, uncircumcised or those living with HIV. While treatment and survival rates are minimal, it is important to prevent its occurrence. Penile cancers can be prevented through penile hygiene, avoiding tobacco smoking and early circumcision among others.