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Penile & Testicular cancer

Penile Cancer is a disease in which malignant (cancer) cells form in the tissues of the penis.

 

The penis is a rod-shaped male reproductive organ that passes sperm and urine from the body. It contains two types of erectile tissue (spongy tissue with blood vessels that fill with blood to make an erection):

1         Corpora cavernosa: The two columns of erectile tissue that form most of the penis.

2         Corpus spongiosum: The single column of erectile tissue that forms a small portion of the penis. The corpus spongiosum surrounds the urethra (the tube through which urine and sperm pass from the body).

 

The erectile tissue is wrapped in connective tissue and covered with skin. The glans (head of the penis) is covered with loose skin called the foreskin.

Human papillomavirus infection may increase the risk of developing penile cancer.

Anything that increases your chance of getting a disease is called a risk factor.

Circumcision may help prevent infection with the human papillomavirus (HPV). A circumcision is an operation in which the doctor removes part or all of the foreskin from the penis. Many boys are circumcised shortly after birth. Men who were not circumcised at birth may have a higher risk of developing penile cancer.

Other risk factors for penile cancer include the following:

·         Being age 60 or older.

·         Having phimosis (a condition in which the foreskin of the penis cannot be pulled back over the glans).

·         Having poor personal hygiene.

·         Having many sexual partners.

·         Using tobacco products.

Penile Cancer

 

The penis contains several types of tissue, including skin, nerves, smooth muscle, and blood vessels. Running through the inside of the penis is a thin tube called the urethra. Urine and semen come out through the urethra. The head of the penis is called the glans. At birth, the glans is covered by a piece of skin called the foreskin, or prepuce. The foreskin is often removed in infant boys in an operation called circumcision.

Inside the penis are 3 chambers that contain a soft, spongy network of blood vessels. Two of these cylinder-shaped chambers, known as the corpora cavernosa, lie on either side of the upper part of the penis. The third lies below them and is known as the corpus spongiosum. This chamber widens at its end to form the glans. The corpus spongiosum surrounds the urethra, a tube that carries urine from the bladder through the penis. The opening at the end of the urethra is called the meatus.

When a man gets an erection, nerves signal to his body to store blood in the vessels inside the corpora cavernosa and corpus spongiosum. As the blood fills the chamber, the spongy tissue expands, causing the penis to elongate and stiffen. After ejaculation, the blood flows back into the body, and it becomes soft again.

Semen consists of fluid produced by 2 small sacs near the bladder and prostate (the seminal vesicles) and by the prostate gland. It contains sperm cells that were made in the testicles. This fluid is produced and stored in the seminal vesicles. During ejaculation, semen from the seminal vesicles passes into the urethra and out the tip of the penis.

Cancers of the Penis

Each of the tissues in the penis contains several types of cells. Different types of penile cancer (cancer of the penis) can develop in each kind of cell. The differences are important because they determine the seriousness of the cancer and the type of treatment needed.

Epidermoid carcinoma: Penile cancer develops in the skin of the penis. About 95% of penile cancers develop from flat skin cells called squamous cells. Penile tumors tend to grow slowly. If they are found at an early stage, these tumors can usually be cured. Squamous cell penile cancers can develop anywhere on the penis but most develop on the foreskin (in men who have not been circumcised) or on the glans.

Verrucous carcinoma is an uncommon form of squamous cell cancer that can occur on the male or female genitals, skin, mouth, larynx, and anus. Verrucous carcinoma of the genitals is sometimes also called a Buschke-Lowenstein tumor. It looks a lot like a benign (noncancerous) genital wart (see the section "Benign and Precancerous Conditions" for more information). These low-grade cancers can spread deeply into surrounding tissue, but they rarely spread to other parts of the body.

Adenocarcinoma, a very rare type of penile cancer, can develop from sweat glands in the skin of the penis. Paget disease of the penis is a condition in which adenocarcinoma cells are found in the penile skin. The cancer cells at first spread within the skin, but they may eventually invade underneath the skin and spread to lymph nodes. Paget disease can affect skin anywhere in the body but most often affects skin of the perianal area (tissues of or around the anus), vulva, and the breasts. (This condition should not be confused with Paget disease of the bone, an entirely different disease also named after Dr. James Paget.)

The earliest stage of squamous cell cancer of the penis (or any other organ) is called squamous cell carcinoma in situ (CIS). Penile CIS is contained entirely within the skin of the penis and has not yet spread to deeper tissues of the penis. Depending on the exact location of a CIS of the penis, doctors may give additional names to the disease. CIS of the glans is sometimes called erythroplasia of Queyrat. The same condition when found on the shaft of the penis (or skin of other parts of the body) is called Bowen disease.

Melanomas: About 2% of penile cancers develop from pigment-producing skin cells called melanocytes. Cancers of these cells are called melanoma. These cancers are more dangerous because they grow and spread more rapidly. Melanomas usually develop from sun-exposed areas of skin. Although sun exposure is an important risk factor for melanoma, a few of these cancers can develop on the penis or other areas not likely to become sunburned.

Basal cell penile cancer: Basal cell cancers represent less than 2% of penile cancers. They are slow-growing tumors that rarely spread to other parts of the body.

Sarcomas: The remaining 1% of penile cancers are sarcomas, cancers that develop from the blood vessels, smooth muscle, and other connective tissue cells of the penis.

Benign & Precancerous Conditions

Sometimes abnormal benign (not cancerous) growths develop on the penis. Some of these benign growths may eventually evolve into invasive cancer if they are not treated. These precancerous conditions can resemble warts or irritated patches of skin. Like penile cancer, they usually develop on the glans or on the foreskin, but they can also occur along the shaft of the penis.

Condylomas are wart-like growths that resemble tiny cauliflowers. Some are so small that they are apparent only when the skin is viewed under a magnifying lens. Others may be as large as an inch or more in diameter.

Squamous cell cancer of the penis usually forms slowly over many years, and it is usually preceded by precancerous changes that may last for several years. The medical term for this precancerous condition is penile intraepithelial neoplasia, or dysplasia. "Intraepithelial" means that the precancerous cells are confined to the epithelium (surface layer of the penile skin).

Testicular Cancer

Definition

Testicular cancer occurs in the testicles (testes), which are located inside the scrotum, a loose bag of skin underneath the penis. The testicles produce male sex hormones and sperm for reproduction.

Compared with other types of cancer, testicular cancer is rare. But testicular cancer is the most common cancer in American males between the ages of 15 and 34. The cause of testicular cancer is unknown.

Testicular cancer is highly treatable, even when cancer has spread beyond the testicle.  Depending on the type and stage of testicular cancer, you may receive one of several treatments, or a combination. Regular testicular self-examinations can help identify growths early, when the chance for successful treatment of testicular cancer is highest.

Symptoms

  • Testicular cancer can result in a number of signs and symptoms. These may include:
  • A lump or enlargement in either testicle
  • A feeling of heaviness in the scrotum
  • A dull ache in the abdomen or groin
  • A sudden collection of fluid in the scrotum
  • Pain or discomfort in a testicle or the scrotum
  • Enlargement or tenderness of the breasts
  • Unexplained fatigue or a general feeling of not being well

Cancer usually affects only one testicle.

Causes

Nearly all testicular cancers begin in the germ cells — the cells in the testicles that produce immature sperm. What causes germ cells to become abnormal and develop into cancer isn't known.

Risk Factors

Researchers don't know what causes testicular cancer. Risk factors may include:

  • An undescended testicle (cryptorchidism). The testes form in the abdominal area during fetal development and usually descend into the scrotum before birth. Men who have a testicle that never descended are at greater risk of testicular cancer than are other men are. The risk remains, even if the testicle has been surgically relocated to the scrotum. Still, the majority of men who develop testicular cancer don't have a history of undescended testicles.
  • Abnormal testicle development. Conditions that cause testicles to develop abnormally, such as Klinefelter's syndrome, may increase your risk of testicular cancer.
  • Family history. If other family members have had testicular cancer, you may have an increased risk.
  • Age. Testicular cancer affects teens and younger men, particularly those between ages 15 and 34. However, it can occur at any age.
  • Race. Testicular cancer is more common in white men than in black men. The reason for racial differences in the incidence of testicular cancer is unknown.

Prevention

Testicular self-examination

There's no sure way to prevent testicular cancer. However, regularly self-examination may improve your chances of finding a tumor at its earliest stage. Beginning in your midteenage years, and continuing throughout your life, examine your testicles at least once a month.

A good time to examine your testicles is after a warm bath or shower. The heat from the water relaxes your scrotum, making it easier for you to find anything unusual.

To do this examination, follow these steps:

  • Stand in front of a mirror. Look for any swelling on the skin of the scrotum.
  • Examine each testicle with both hands. Place the index and middle fingers under the testicle while placing your thumbs on the top.
  • Gently roll the testicle between the thumbs and the fingers. Remember that the testicles are usually smooth, oval shaped and somewhat firm. It's normal for one testicle to be slightly larger than the other. Also, the cord leading upward from the top of the testicle (epididymis) is a normal part of the scrotum. By regularly performing this exam, you will become more familiar with your testicles and aware of any changes that might be of concern.
  • If you find a lump, call your doctor as soon as possible. Testicular cancer is highly treatable, especially when identified early.
  • Your doctor should also examine your testicles whenever you have a physical. If you have an undescended testicle, be sure to tell your doctor, who may refer you to a urologist for treatment or a more specialized exam.

Treatmnet

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