Penile tumor, penile cancer/ penile carcinoma/ penile malignancies

The cause (etiology):
At least 25-75% of men with penile cancer phimosis.
In women who suffer sexual partner penile cancer, the rate for cervical cancer increased 3-8 times compared with the normal sexual partner.
Role of viral infections continue to be studied. Both cancer penis (penile cancer) and cervical cancer (cervical cancer) associated with the presence of herpes virus infection and human papilloma virus (HPV).

Human papilloma viruses (HPV) types 16 and 18 have been found in a third man who suffered from penile cancer. Does this virus causes cancer or merely acting as saprophytes, not defined.

Penile intraepithelial neoplasia is considered as a precursor, but only 5-15% of these lesions develop into invasive squamous cell carcinoma.

There is no real evidence that smegma is a carcinogen (cancer causing substances), although this has been widely believed.
Clinical symptoms:

Patient presents with lesions that are difficult recovery, accompanied by "subtle induration" on the skin, a small growth on the skin (a small excrescence), papules, pustules, or warts growing veruka (a Warty growth), or exophytic growth.

Many men do not see a doctor until the cancer to erosion (eroded) and became preputium smells because of infection and necrosis.

Occasionally, penile cancer in accident on histopathology examination during circumcision (circumcision).

Sometimes found in a mass, ulceration, suppuration, or bleeding (hemorrhage) in the groin area (inguinal) due to nodal metastases.

The pain rarely occur even if the damage has occurred the local network (local significant destruction of tissue) that means.
Patients with cancer that has spread widely (advanced metastatic cancer) may complain of weakness (weakness), weight loss (weight loss), fatigue (fatigue), lesions of the penis may be bloody.

The presence of lesions (wounds) in the penis that does not go away (nonhealing) usually make the patient went to the doctor.

Category lesions of the penis:
1. Benign lesions (benign lesions)
For example: Pearly penile papules, hirsute papillomas, and coronal papillae.

2. Lesions are potentially malignant (premalignant)
This was associated with leukoplakia and squamous cell carcinoma. The most common example is balanitis xerotica obliterans.

3. Malignant lesions (malignant neoplasm or malignant carcinoma)
These include variants of squamous cell carcinoma such as: carcinoma in situ (CIS), erythroplasia of Queyrat, and Bowen disease.

Laboratory examinations:
1. There are no specific laboratory tests (specific) or an indication tumors (tumor markers) in penile cancer.

2. Public inspection, including: complete blood count, chemistries with liver function tests (a chemistry panel with liver function tests), and assessment (assessment) the status of the heart, lungs, and kidneys, is very helpful to detect unforeseen problems.

3. Patients with severe disease can anemis, with leukocytosis and hypoalbuminemia.

4. Hypercalcemia was found in some patients during the absence of spreading (Absence of metastases).


Diagnostic procedures:
Diagnostic test is most important is the biopsy.
Medical Therapy:
Intraepitel neoplasms such as Bowen disease or erythroplasia of Queyrat can be treated with topical 5-fluorouracil.

Radiation therapy
Colors:
1. External beam radiation therapy
2. Brachytherapy

Indication of radiation therapy:
1. The young man with cancer in the glans or coronal sulcus with small size (<3 style="font-weight: bold; color: rgb(0, 102, 0);">Chemotherapy
The drugs most commonly used are: cisplatin, bleomycin, methotrexate, and fluorouracil.

Therapy Surgery (Surgical therapy)
Standard therapy for primary cancer is cut in the local (local excision) and partial or total penectomy.

In patients with small tumors confined to the preputium, enough with the circumcision (circumcision).
Amputation of part (partial amputation) suitable if the cancer involves the glans penis and distal penile erection (distal shaft).
In some situations / circumstances, Local wedge resection can be done easily (feasible), is associated with an average recurrence of 50%. If surgical resection with wedge or partial penectomy does not give enough freedom (adequate margin), then the strategy must be considered a total penectomy. If some of the rest of the penis (penile residual) and the urethra is not enough for the patient to urinate standing up, it can be done urethrostomy perineal action.

Another surgical technique is Mohs micrographic surgery (MMS), which can be used (applicable) for patients with noninvasive disease.


Laser Surgery
Laser surgery (laser surgery) is used in patients with benign lesions (benign) and malignant (malignant) in the surface (superficial). This therapy has been applied in cases of "local and limited invasive disease". Four types of laser used in laser surgery, namely: carbon dioxide, Nd: Yag, argon, and potassium-titanyl-phosphate (KTP) lasers.


Complications
Few surgical complications encountered in the primary tumor excision, partial or complete penectomy, such as:
1. infection
2. edema
3. striktura urethra
if the new urethral meatus should be made.

Complications associated with inguinal node dissections:

1. Early Complications (early complications) such as: wound infection (wound infection), seroma, skin flap necrosis, phlebitis, and pulmonary embolism (pulmonary embolus)

2. Complications follow-up (Late complications) such as: lymphedema of scrotum and lower limbs (legs).

Complications of radiation therapy:
Usually seen in tumors larger than 4 cm.
1. urethral strictures (in 50% of patients)
2. urethral fistula
3. penile necrosis
4. edema
5. pain in the penis

Surgery after radiation therapy is required in 20-60% of patients.

Prevention:
Khitan (circumcision) is set as preventive (prophylactic) is effective for penile cancer. Please note, penile cancer is found more often when circumcision / circumcision was postponed until puberty. Circumcision as an adult little or no protection from penile cancer.

Note:
1. This disease rarely occurs in men who have been circumcised (circumcised men), especially if circumcised as a baby.

2. Penile cancer tend to experience an adult male aged approximately 60-80 years. In young adults do not always encountered. One study reported that 22% of patients younger than 40 years, and only 7% under the age of 30 years.

3. If cancer (carcinoma in situ or CIS) occurs in the glans penis, called erythroplasia of Queyrat. But if there is the "follicle-bearing skin of the shaft" is called Bowen disease.

4. The death rate for penile cancer patients reached 22.4%.

5. As many as 15-50% of patients with penile cancer to see a doctor delayed for more than 1 year.

6. Most of penile cancer is "squamous cell carcinomas".

7. Penile tumors can be found anywhere in the penis, but most found in the glans penis (48%) and preputium (21%).

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