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Urology (Expert Forum)
Concerned about penile cancer
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D.
Boston - MA
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
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Concerned about penile cancer
by Plunk, Jul 30, 2003 12:00AM
I am a 28 year old circumcised male with no STD's. About 18 months ago I started feeling pain in my penis. Since then I have been to two med centers, my regular doctor, the emergency room, and a urologist about this problem. Every doctor I go to gives me a bunch of tests for STDs and bacterial infections, and when the tests come back negative, they say they don't know what the problem is. About six months ago, the paidn was at its worst. I told the urologist I felt like my penis was going to fall off and he assured me that I had nothing seriously wron with me. He said it is not that uncommon for people to have pain down there without a cause. I decided to stop seing doctors since nobody had a solution for me, but now I notice there is a dark spot on my penis. The spot is the size of a freckle, but slightly darker. It is not on the head of my penis, but the same side that I feel the pain on. There is not lumps or hard spot where the spot is either. Just a dark spot. I never noticed it untile the doctor in the emergency room pointed to it and said "what's that". I told him it was nothing because I thought he was thinking it mioght be some kind of sore and I know it is not a sore. But now I am worried that it may be penile cancer becaude I read that a dark spot/lesion is a symptom. Can anybody give me some additional information on what the spot relating to penile cancer looks like?
Also, I assume after giving me my advise, you will tell me to see a doctor to be exactly sure what the problem is. I am extremely busy until January of 2004 and was hoping to put it off until then. I read that if you have penile cancer and detect it in the early stages, you can get it removed in a manner that does not affect the functioning of it. Exactly what is considerred "early stages"? I would rather not have to worry about going to doctors and getting biopsies, ect. right now, but I also do not want to lose my entire penis just because I waited six extra months. Any info regarding this would be a big help. I have read everything I could on the internet, but every site seems to say the same thing. Thank you for your time.
Also, I assume after giving me my advise, you will tell me to see a doctor to be exactly sure what the problem is. I am extremely busy until January of 2004 and was hoping to put it off until then. I read that if you have penile cancer and detect it in the early stages, you can get it removed in a manner that does not affect the functioning of it. Exactly what is considerred "early stages"? I would rather not have to worry about going to doctors and getting biopsies, ect. right now, but I also do not want to lose my entire penis just because I waited six extra months. Any info regarding this would be a big help. I have read everything I could on the internet, but every site seems to say the same thing. Thank you for your time.
Doctor's Answer
by Kevin Pho, MD, Jul 31, 2003 12:00AM
, Jul 31, 2003 12:00AM
Hello - thanks for asking your question.
As you rightly assume, it would be impossible to say what it is without examining you. However, I can answer your factual questions about penile cancer.
Here is an excerpt from UptoDate, which describes the early presentation of penile cancer:
"In a review of more than 4000 cases of penile cancer, 47 percent presented with a penile mass, lump, or nodule, 35 percent had a sore or ulceration, and 17 percent had an inflammatory type of lesion. At presentation, 43 percent of lesions were less than 2 cm in size and 57 percent were larger. In a second series, the glans was affected in 48 percent of cases, followed by the prepuce (21 percent), both glans and prepuce (9 percent), coronal sulcus (6 percent), and shaft (less than 2 percent); in 14 percent of cases, disease had invaded into the shaft of the penis from more distal sites.
Both a papillary and a flat type of growth pattern have been described for penile carcinomas. The papillary form usually arises from a verrucous exophytic lesion of the glans or preputial skin, which may subsequently enlarge and coalesce to form a fungating mass with necrosis and significant penile destruction. In contrast, flat lesions tend to invade the deeper structures of the penis while extending laterally across the surface of the penis causing relatively minimal surface changes. These lesions typically appear as small, superficial, round ulcers on a slightly elevated base. Both kinds of lesions may harbor secondary infection, and a foul-smelling purulent discharge is often present.
Early in the disease course, itching and burning may be described beneath the foreskin; pain is minimal in view of the occasionally extensive tissue destruction. Constitutional symptoms such as weight loss and fatigue may accompany disease progression. Hemorrhage, urethral fistula formation, and urethral obstruction are late complications that indicate extensive disease; these are rarely presenting signs. In extreme cases, total replacement of the penis by tumor or penile autoamputation may occur." (1)
Prognosis is determined by the stage of the disease at diagnosis. Thus, I cannot comment on this without knowing any biopsy results. In one study, 5-year survival rate was 66 percent without spread to the lymph nodes and 27 percent with spread.
With proper surgical treatment, 5-year survival rate was 80 to 100 percent without spread to the lymph nodes and 32 to 40 percent with spread.
As you correctly assume, I am going to suggest that you see your physician for consideration of a biopsy to put your mind at ease.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Bibliography:
1) Oh, et al. Carcinoma of the penis: Epidemiology, risk factors, and clinical presentation. UptoDate, 2003.
FYI - I will be away from August 1-9th. I will look forward to answering your questions when I return.
As you rightly assume, it would be impossible to say what it is without examining you. However, I can answer your factual questions about penile cancer.
Here is an excerpt from UptoDate, which describes the early presentation of penile cancer:
"In a review of more than 4000 cases of penile cancer, 47 percent presented with a penile mass, lump, or nodule, 35 percent had a sore or ulceration, and 17 percent had an inflammatory type of lesion. At presentation, 43 percent of lesions were less than 2 cm in size and 57 percent were larger. In a second series, the glans was affected in 48 percent of cases, followed by the prepuce (21 percent), both glans and prepuce (9 percent), coronal sulcus (6 percent), and shaft (less than 2 percent); in 14 percent of cases, disease had invaded into the shaft of the penis from more distal sites.
Both a papillary and a flat type of growth pattern have been described for penile carcinomas. The papillary form usually arises from a verrucous exophytic lesion of the glans or preputial skin, which may subsequently enlarge and coalesce to form a fungating mass with necrosis and significant penile destruction. In contrast, flat lesions tend to invade the deeper structures of the penis while extending laterally across the surface of the penis causing relatively minimal surface changes. These lesions typically appear as small, superficial, round ulcers on a slightly elevated base. Both kinds of lesions may harbor secondary infection, and a foul-smelling purulent discharge is often present.
Early in the disease course, itching and burning may be described beneath the foreskin; pain is minimal in view of the occasionally extensive tissue destruction. Constitutional symptoms such as weight loss and fatigue may accompany disease progression. Hemorrhage, urethral fistula formation, and urethral obstruction are late complications that indicate extensive disease; these are rarely presenting signs. In extreme cases, total replacement of the penis by tumor or penile autoamputation may occur." (1)
Prognosis is determined by the stage of the disease at diagnosis. Thus, I cannot comment on this without knowing any biopsy results. In one study, 5-year survival rate was 66 percent without spread to the lymph nodes and 27 percent with spread.
With proper surgical treatment, 5-year survival rate was 80 to 100 percent without spread to the lymph nodes and 32 to 40 percent with spread.
As you correctly assume, I am going to suggest that you see your physician for consideration of a biopsy to put your mind at ease.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Bibliography:
1) Oh, et al. Carcinoma of the penis: Epidemiology, risk factors, and clinical presentation. UptoDate, 2003.
FYI - I will be away from August 1-9th. I will look forward to answering your questions when I return.
