What is it?
O penis cancer (penile cancer) is a neoplasm that usually begins in the glans or foreskin, has slow and progressive growth, and may invade the deep tissues of the penile shaft like the tunica albuginea of the corpus cavernosum or spongy.
Thus, more undifferentiated tumors, composed of more aggressive cells, grow faster. It usually starts as a itchy wound.
Any vegetative lesion (with noticeable growth to the naked eye), hardened, ulcer-vegitant, or wound with growth that does not heal may represent a suspected penile cancer and should be investigated. The lesion may proliferate causing vegetative deformation and disfiguring the glans and penis. The primary lesions are located on the glans, foreskin and penile shaft in 60%, 23% and 9% of cases, respectively.
The main sign is an erythematous wound (reddish lesion of the skin caused by capillary vasodilation) on the penis that does not heal, with slow and progressive growth. There are cases in which the lesion is covered by the foreskin (in patients with phimosis). Thus, these lesions are usually infected. Purulent secretion flows through the preputial meatus. Cancer may be suspected when, on palpation, a hardened lesion is felt under the foreskin.
As the main lymphatic metastasis pathway, the site to be examined should be the inguinal-crural region. Any hardened lymph node should be considered cancer until proven otherwise. But there are also cases where the lymph nodes are not considered suspect in the palpation examination. Up to 20% of patients without clinical suspicion of palpation-positive lymph nodes will be compromised on microscopic examination. Rare cases are diagnosed initially with distant metastatic disease.
A phimosis occurs when the foreskin is not discovered for glans exposure. These patients have increased 22 risk for penile cancer. Thus, because they present smegma, accumulation of exfoliated epithelial cells under the foreskin and stagnant urine are irritative for the preputial mucosa.
O penis cancer is more incident in virus carriers HPV (16, 18, 31 and 33 serotypes present 5-10 times greater risk), and HIV (8 times greater). In addition, in smokers, patients of low socioeconomic level, with chronic balletic diseases (sclerosing xerotic balanitis - inflammation in the skin that lines the glans). Moreover, in patients with a history of sexual relations with animals (zoophilia). Patients with a past of sexual promiscuity and poor genital hygiene are the most affected.
Diagnosis of penile cancer
Seek medical advice if a penis the early diagnosis of penile cancer facilitates its removal with little or no damage to the penis. The diagnosis is made by biopsy of the lesion, and a postectomy (removing excess skin from the penis). Therefore, this surgery can be important and definite for the treatment of the primary lesion and local staging of the disease.
The histological type is defined by anatomopathological examination. The locoregional penis cancer can be performed by computed tomography. However, it is possible to detect it by infusion into the radiotracer lesion to investigate lymph node involvement.
The treatment is performed by removal of the lesion with broad margins if the lesion is preputial and partial amputation of the penis when the lesion is invasive. Some early primary lesions may be laser treated (CO2 or Nd-YAG) or glandectomy.
Thus, more extensive injuries may require Total amputation of the penis or even emasculation (total removal of the penis and testicles). THE lymphadenectomy (removal of lymph nodes that drain the cells of the penis cancer to the vile region) is prevalent in patients with invasive tumors. Therefore, lymph node involvement requires complementation by bilateral inguinal lymphadenectomy. In addition, if pelvic suspicion is suspected, iliac-obturator lymphadenectomy (surgical removal of one or more lymph node groups).
Advanced cases can be treated initially by neoadjuvant chemotherapy.
Prevention of penile cancer
Prevention of penis cancer it goes through basic hygienic measures such as cleansing of the foreskin and glans during bathing. Patients with phimosis should undergo postectomy, and the protective effect is maximized when surgery is performed in the neonatal period.
Sexual promiscuity and sexually transmitted diseases, especially those of viral origin, should be avoided because they may participate in the etiology of the disease. Use condom. Do not practice bestiality. Do not smoke. Get vaccinated against the virus HPV.
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