Penile cancer

• Disease Overview (Causes and Symptoms)

  • Definition and pathophysiology: Penile cancer is a malignant tumor arising in the tissues of the penis, and most cases (approximately 90–98%) are squamous cell carcinoma. It mainly occurs on the glans and prepuce, and the lesion tends to metastasize to the inguinal lymph nodes. Chronic inflammation (such as smegma accumulation in the presence of phimosis) and human papillomavirus (HPV) infection are major risk factors. Incidence generally increases after middle age, mainly in people aged 50 and older.
  • Causes: Factors associated with chronic inflammation of the foreskin (smegma and poor hygiene), phimosis, HPV infection (especially high-risk types), sexual history-related factors such as multiple sexual partners, and smoking are associated with the disease.
  • Main symptoms: A painless or mildly painful nodule, mass, or ulcerative lesion; discharge or foul odor from the lesion; urinary symptoms (frequent urination, painful urination, urinary urgency); enlarged or hardened inguinal lymph nodes; and, in advanced cases, lymphedema of the limbs caused by inguinal lymph node metastasis.

• Treatment Methods and Precautions

  • Diagnostic principles: Suspicious lesions are confirmed by biopsy (partial biopsy or excision of the entire lesion). For staging, a physical examination (including palpation of the inguinal lymph nodes), chest X-ray, abdominal/pelvic CT or MRI, and, if necessary, bone scan or PET-CT are performed.
  • Surgical treatment (the core of standard treatment)
    • Early lesions (especially lesions of the foreskin): Simple circumcision or local excision.
    • Lesions of the glans or distal penis: Partial penectomy — generally securing a margin of normal tissue around the lesion (the clinically intended tissue margin).
    • Advanced or extensive lesions: Extensive excision or total penectomy may be necessary.
    • Inguinal lymph node management: Lymph nodes that are clinically palpable (or suspicious) are removed by inguinal lymph node dissection. Even when the lymph nodes are clinically negative, sentinel lymph node biopsy or selective lymph node evaluation may be considered if there is an invasive stage or high-risk pathological finding.
  • Nonsurgical treatment
    • Radiation therapy: Used when local excision or organ-preserving surgery is difficult, or to relieve pain, ulceration, or bleeding (for symptom relief and preservation purposes).
    • Chemotherapy: Used for advanced or metastatic disease either alone, before surgery (often as neoadjuvant therapy to reduce the size of the lesion), or after surgery as adjuvant therapy. Cisplatin-based regimens are commonly used. A multidisciplinary approach is recommended for metastatic or unresectable lesions.
  • Preservation treatment, rehabilitation, and lifestyle management
    • Wound care, infection prevention, and rehabilitation to preserve urinary and sexual function (urethral reconstruction or penile reconstruction may be considered).
    • Prevention and management of lymphedema after lymph node dissection (compression, exercise, skin care, etc.).
  • Precautions and complications
    • Surgical complications: Bleeding, infection, urethral stricture, changes in sexual function (decreased erections or libido), and psychological effects.
    • Lymphedema after lymph node dissection (swelling of the lower limbs) and wound-healing problems.
    • Regular follow-up is necessary because local recurrence and distant metastasis are possible.
    • Systemic side effects of radiation therapy and chemotherapy (fatigue, skin changes, bone marrow suppression, etc.).
  • Prognosis: The stage, particularly whether lymph node metastasis is present, determines the prognosis. Early localized lesions generally have a favorable prognosis after treatment, but the risks of recurrence and death increase when lymph node metastasis is present.

• Checklist Before an Outpatient Visit (Items to Prepare and Example Questions)

  • Items/information to bring:
    • List of medications currently being taken (especially anticoagulants, antiplatelet drugs, immunosuppressants, etc.)
    • Allergy history (medications, anesthetics, etc.)
    • History of previous surgeries and illnesses (especially genitourinary surgery and whether phimosis is present or has been treated)
    • Recent test results (biopsy results, histopathology reports, imaging CDs/reports)
    • Record of when symptoms began and how they have changed (pain, discharge, changes in size, etc.), and photos of the symptoms if possible
    • Information related to sexual activity: Number of sexual partners, whether condoms are used, and whether HPV vaccination has been received
  • Things to check before the outpatient visit:
    • Whether there is currently a fever or any symptoms of infection (important to check for infection before surgery)
    • Tendency to bleed (whether anticoagulants are being taken)
    • Recent weight changes and systemic symptoms (loss of appetite, night sweats, etc.)
  • Examples of information to tell the doctor in advance during the consultation:
    • When the symptoms began and how they have changed
    • Whether there has previously been a lesion or treatment in the same area
    • The current treatment goal (whether preservation is the priority or complete removal is the priority)

• Examples of General Questions to Ask the Doctor

  • "What are the results of the biopsy of my lesion (pathological findings), and what is the stage?"
  • "What treatment options do you recommend, and what effects can be expected (survival rate and recurrence rate)?"
  • "If I undergo surgery, what changes can be expected in sexual function, urination, or sensation?"
  • "What tests are needed before and after surgery, and what will the recovery period and rehabilitation involve?"
  • "What are the main side effects of chemotherapy or radiation therapy, and how are they managed?"

• Examples of Disease-Specific Questions

  • "In my case, is penile preservation (partial excision or local treatment) possible? If so, what extent of excision is expected, and to what degree can function be preserved?"
  • "If the inguinal lymph nodes are palpable, is immediate lymph node dissection necessary, or should antibiotics be given followed by reassessment (or sentinel lymph node testing) first?"

(Note: The diagnostic and treatment plan varies according to each individual's stage, pathological findings, and overall condition. Therefore, make the final decision based on consultation with your treating medical team.)