Understanding Penile Cancer?
Penile cancer is a rare form of cancer in which malignant (cancer) cells form in the tissues of the penis. One of the most common types of penile cancer is squamous cell carcinoma that begins in flat cells present in the top layer of the skin. Penile cancer usually develops on or under the foreskin of the penis. Common signs of penile cancer include sores, skin changes, discharge, and bleeding. Human papillomavirus (HPV) has been found as one of the most common cause of penile cancer in about one-third of penile cancer cases. Circumcision (removal of the foreskin of the penis) helps in preventing HPV and also decreases the risk of penile cancer. Penile cancer can usually be cured if found early.
General Key Points About Penile Cancer
Some key points to remember about penile cancer include the following:
- Penile cancer is a disease characterized by formation of malignant (cancer) cells in the tissues of the penis.
- HPV infection increases the risk of developing penile cancer.
- Common signs of penile cancer include sores, discharge, and bleeding.
- There are several tests that may help in examining the penis and also can be used to detect and diagnose penile cancer.
Treatment Options for Patients With Penile Cancer
There are different types of treatment options available for patients with penile cancer. Some of them include the following:
- Radiation therapy
- Biologic therapy
Surgery for Penile Cancer
Surgery is the most commonly used treatment for all stages of penile cancer. The doctor may remove the cancer using one of the following procedures:
In this procedure, a tumor is cut from the skin in thin layers and the layers continue to be removed until no more cancer cells are seen. This type of surgery removes as little normal tissue as possible and is often used to remove cancer present on the skin. It is also commonly called as Mohs surgery.
In this surgical procedure a laser beam is used as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor.
It is a surgical procedure wherein an instrument is used to freeze and destroy abnormal tissue. It is also called cryotherapy.
It is a surgery to remove either a part or the entire foreskin of the penis.
Wide Local Excision
It is a surgery to remove only the cancer and some normal tissues surrounding it.
Amputation of the penis
In this surgery either a part or the entire penis is removed. If only a part of the penis is removed, it is called partial penectomy and if the entire penis is removed, it is called total penectomy.
Radiation Therapy for Penile Cancer
In this type of cancer treatment, high-energy x-rays or other types of radiations are used to kill cancer cells. Radiation therapy can be of two types – external radiation therapy and internal radiation therapy. Both external and internal radiation therapies are used in the treatment of penile cancer.
Chemotherapy for Penile Cancer
Chemotherapy is a type of cancer treatment wherein drugs are used to stop the growth of cancer cells, either by killing the cells or by stopping their division. Chemotherapy can be either given by mouth or injected into a vein or muscle. Sometimes, chemotherapy is placed directly onto the skin or into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen. The drugs mainly affect cancer cells in those areas (regional chemotherapy).
Biologic Therapy for Penile Cancer
Biologic therapy is a treatment in which the patient's immune system is used to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defense mechanism against cancer. This method of cancer treatment is also called biotherapy or immunotherapy.
Effects of Penile Cancer on Sexual Life
Naturally one of the most difficult issues with surgery is its effect on the appearance of a man’s penis and its function including normal sexual intercourse. In older men this may not be a cause for concern but for sexually active men it creates a number of possible problems.
If a man suffering from penile cancer has had a wide local incision to remove the cancer affected area, the area becomes swollen and tender after the surgery. Once the wound has healed, there occurs some scarring at the site of the operation and the penis may undergo a slight change in the shape. However, it should not affect the erection and men should be able to have sexual intercourse as effectively as before the surgery.
If a man has had a glansectomy and skin graft, then the glans which is the most sensitive part of the penis will be absent. However, the nerves and blood supply which control erections should be left intact so that the men should be able to have sexual intercourse as they did prior to surgery. However, it may take some time for the swelling from the surgery to resolve. It may also take a while for men to accept the change in the appearance of their penis post surgery.
In case of partial penectomy, men should still be able to have penetrative sex. Past research studies have suggested that over 50% of men who have had partial penectomy were still able to have an erection but they have to adjust to the change in the appearance of their penis.
In case of total penectomy, normal sexual intercourse is not possible as the entire penis is removed. Sex after cancer of the penis is not possible due to removal of the whole penis. In such cases, the men may feel less of a man and worry about fulfilling their partner’s sexual needs. In such situations, it is necessary for men to talk to their partners and explore other ways of maintaining a satisfactory sex life such as with the use of adult toys like massagers and vibrators that may bring pleasure to both men and their partners. Besides this, role playing may also help in maintaining a stable sexual life. Although, some men feel a kind of stigma attached to these types of sexual gratification, majority of people all over the world prefer these methods to enhance their sex life after total penectomy.
The effect penile cancer has on one’s sex life and sexuality depends on the type of treatment. Most treatments for penile cancer don’t affect the sexuality of men. Doctors always try to use the treatment that preserves as much of the penis as possible so that sexual intercourse can occur as normally as possible.
The effect of penile cancer on sexuality is different for every person. Some people need help and support for coping with their sex-related issues. They find this support in their healthcare team, partner, friends or fellow survivors. There are also a number of online groups that host discussion boards where you can talk about your sex-related concerns with someone and get your queries solved.
Some people find things more difficult when it comes to discussing about their sexual life. For such people, a mental health provider can help them to cope with the physical and emotional trauma that cancer brings and determine how to move forward and live their life happily. They should look for a therapist with expertise in working with people affected with cancer.
Sexual Problems due to Penile Cancer Treatment
Some of the major sexual problems in men after penile cancer treatment are:
- Lack of interest in sex
- Erectile dysfunction (ED)
- Premature ejaculation
- Passing some urine during an orgasm
- Dry orgasm without discharge of semen
- Painful sex
Treatment Options for Sexual Problems in Penile Cancer
Some treatment options available for sexual issues in penile cancer include:
These drugs help in getting an erection and keep it for long enough to have sex e.g sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra).
These injections also help in getting an erection by increasing the blood flow to the penis e.g Alprostadil (called Caverject, Edex, or Muse), Papaverine etc.
These are devices used for getting an erection and can be placed inside the penis.
Vacuum Device on the Penis
These are small pumps that can be placed over the penis to help in blood flow into it and therefore help in getting an erection.