Penile cancer is an uncommon tumor, with an incident of 1/100,000 in developed countries.
There are many associated risk factors, such as phimosis, chronic penile inflammation, HPV, smoking, among others. The only protective factor is neonatal circumcision.
HPV is associated with 1/3 of invasive penile cancer. Squamous cell carcinoma is the most common histological subtype.
80% of penile cancer is curable if diagnosed early. However, there is significant delay in seeking health care, with some patients coming with more than 1 year’s delay.
Physical examination of the penile lesion and groin for inguinal lymph node disease is vital for diagnostic evaluation and future patient management.
Penile ultrasound and MRI are valid options to stage corporal invasion and CT or PET/CT to stage lymph node involvement when indicated.
Local treatment is the treatment to the primary lesion and its recurrence does not significantly influence long-term survival. Therefore, if possible, penile preservation treatments should be offered. There are many options to achieve better cosmetic and functional outcomes, depending on the degree of invasiveness.
The number and the extent of lymph node involvement is the main prognostic factor, and thus correct staging and treatment is mandatory. When nodes are not palpable, staging surgery might be needed. When nodes are palpable, radical inguinal lymphadenectomy is indicated. It is associated with relevant morbidity; however, the fear of complications should not delay a potentially life-saving surgery.
Penile cancer treatment has a significant negative impact on quality of life and sexual function. Penile sparing treatment seems to have better results than more invasive options.
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