Symptoms of penile cancer
The testicles
The testicles are two small, oval-shaped organs located below the penis, enclosed in a skin pouch called the scrotum.
Image of the testicles (cruk)
Starting from puberty, the testicles begin producing sperm. Inside the testicle, small tubes come together to form the epididymis, a single tube that becomes wider as it exits the testicle. This wider tube is known as the spermatic cord.
The spermatic cord leads to a short passage called the ejaculatory duct, which opens into the urethra, the tube that carries urine and semen out of the body through the penis.
Testosterone:
The testicles produce the hormone testosterone, which is responsible for developing male characteristics such as:
- A deeper voice
- Facial hair growth
- Increased muscle mass
- The ability to achieve an erection
- Male sexual drive (libido)
Where does testicular cancer start:
The testicles consist of various cell types, and the kind of cancer you have depends on the specific cell where it begins.
Most testicular cancers arise from germ cells, which are responsible for producing sperm. Doctors classify germ cell cancers into two main types:
- Seminoma
- Non-seminoma
Testicular cancer and the lymph nodes:
Lymph nodes are a part of the lymphatic system that spans the entire body. They, along with lymph vessels, contain a yellow fluid known as lymph. This fluid circulates through the lymphatic system, collecting waste products and draining into veins for waste removal.
Cancer can spread to lymph nodes, causing them to enlarge. In testicular cancer, it’s common for the disease to spread to lymph nodes located at the back of the abdomen, known as retroperitoneal lymph nodes.
These retroperitoneal lymph nodes are situated behind the intestines and in front of the spine. They lie next to the main blood vessels in the abdomen, the aorta, and the inferior vena cava.
Image of the lymph nodes with testicles
Who gets it:
Younger men are more likely to get testicular cancer.
Trans women can also develop testicular cancer if they haven’t had an operation to remove their testicles (orchidectomy).
Men in their early 30s are the most likely to get it. It then becomes less common as men get older.
Symptoms of penile cancer can include:
– A growth or sore on the penis
– Bleeding or a foul-smelling discharge
– A rash on the penis
– Difficulty retracting the foreskin
– Changes in the color of the penis or foreskin
The symptoms mentioned here are more commonly caused by other medical conditions. However, if you experience any of them, it’s important to see your doctor
A growth or sore on your penis
A growth or sore on your penis that doesn’t heal within 4 weeks can be a sign of penile cancer. It might look like a wart, ulcer, or blister and may not be painful. It’s important to notice any changes and consult your doctor about them.
Bleeding from your penis
Bleeding from your penis, including from under the foreskin, can be a sign of penile cancer.
A foul-smelling discharge
A foul-smelling discharge can be caused by an infection, irritation, or inadequate hygiene. It is less commonly due to penile cancer. If you don’t wash your penis daily, smegma, a cheese-like substance, can build up. This is different from a persistent discharge. If you notice anything unusual, it’s important to consult your doctor.
A rash on your penis
You might notice a rash on your penis. It’s important to know what’s normal for you and report any changes to your doctor.
Difficulty in drawing back your foreskin (phimosis)
You might find it harder to pull back your foreskin.
A change in the colour of your penis or foreskin
You might notice changes in the colour of your penis or foreskin. It’s important to recognize what’s normal for you and report any changes to your doctor.
Other rarer symptoms
These symptoms might indicate a more advanced stage of cancer:
– A lump in the groin
– Feeling tired
– Abdominal (tummy) pain
– Pain in the bones
– Unexplained weight loss
If you experience any of these symptoms, it’s important to consult your doctor.
When to see your doctor
You should see your doctor if you notice:
– A growth or sore on the penis that doesn’t heal within four weeks
– Symptoms that are unusual for you
– Symptoms that don’t go away
These symptoms don’t necessarily mean you have penile cancer—they could be due to other medical conditions, like sexually transmitted diseases.
It’s common to feel embarrassed or scared by these symptoms, but it’s crucial not to delay seeing your doctor. Getting checked early ensures that if it is cancer, it can be diagnosed and treated as soon as possible.
The Lymph nodes
Lymph nodes, also known as lymph glands, are small, bean-shaped structures that are part of the lymphatic system. They are found throughout the body, including in the pelvis. If penile cancer spreads, it often moves first to the lymph nodes near the penis, particularly in the groin area.
Where penile cancer starts
Penile cancer can begin in various parts of the penis but most often starts under the foreskin in men who are not circumcised or on the head of the penis (glans). The specific type of penile cancer is determined by the type of cell where it originates.
Risks and causes of Penile cancer:
The exact cause of most penile cancers is unknown, but certain factors may increase the risk of developing the disease.
Human Papilloma virus (HPV)
HPV (Human Papillomavirus) is a common infection that spreads through close skin-to-skin contact, typically during sexual activity, including oral sex. Most sexually active people will encounter HPV at some point, but in most cases, the virus causes no harm and clears up on its own.
There are many types of HPV, with some causing genital warts and others leading to changes that may develop into cancer. HPV is responsible for about 60% of penile cancer cases, with types 16 and 18 being the most common in these cases.
Research, such as a Danish study, suggests that men who have never used condoms are at more than double the risk of developing penile cancer compared to those who have used them. This is likely because condoms help reduce the risk of HPV infection. Additionally, circumcision may lower the risk of HPV infection on the penis.
Age
Penile cancer is more likely to occur in men aged 50 or older, and it is relatively rare in men under the age of 40.
Having a weakened immune system
A weakened immune system can increase the risk of developing penile cancer. Conditions like HIV or AIDS, and certain medications taken after an organ transplant, may reduce the immune system’s ability to fight infections and diseases, including cancer.
Phimosis in uncircumcised men
Circumcision is a minor surgical procedure to remove part or all of the foreskin from the penis. Uncircumcised men may experience difficulty retracting their foreskin, a condition known as phimosis. Men with phimosis have a higher risk of developing penile cancer, although the exact reason is not fully understood.
Phimosis may contribute to this increased risk due to factors such as smegma—a cheese-like substance of dead skin cells that can accumulate under the foreskin and cause irritation and inflammation if not cleaned regularly.
Circumcision in infancy often reduces the risk of penile cancer, while circumcision in adolescence provides some protection. However, circumcision in adulthood does not seem to significantly impact the risk of developing penile cancer.
Psoriasis treatment
Psoriasis is a long-term skin condition that isn’t contagious. It’s sometimes treated with a combination of a drug called psoralen and light therapy, known as PUVA. While PUVA is effective for treating psoriasis, it can also be used in cancer treatment. However, men who have undergone PUVA therapy may have an increased risk of developing penile cancer.
Other possible causes
Stories about potential causes of penile cancer often appear in the media, but the evidence supporting these ideas can vary. Some factors you might have heard about may not be included here due to a lack of clear evidence or because the research is not definitive.
Daignosis
If you have any symptoms, your first step is usually to visit your GP. They will discuss your symptoms with you and conduct an examination. Based on their findings,
Treatment options
A team of healthcare professionals (multidisciplinary team) will determine your treatment plan. Most people undergo surgery to remove the affected