Treatment of Penis Cancer

Penile cancer is a malignant neoplasm of the corresponding organ. 95% of cases are squamous cell carcinoma. It can start at any part of the body, but most often affects the foreskin and glans. Rare types of cancer include basalioma, sarcoma, adenocarcinoma, and melanoma. To cure penis cancer, doctors abroad perform surgical interventions to remove the primary tumor and lymph nodes, as well as to conduct radiation therapy, and chemotherapy. In the early stages, the disease can be cured with minimally invasive non-surgical procedures.

Content

1. Surgical treatment
2. Lymph node surgery
3. Local non-surgical treatment
4. Radiation therapy
5. Systemic chemotherapy
6. Why is it worth undergoing treatment abroad?
7. Treatment in Europe with Booking Health

Surgical treatment

Surgery is the main treatment option for penile cancer. The scope of the operation depends on the stage of the disease.

Circumcision is the least traumatic operation for penile cancer. It is performed only at an early stage, in an independent form, or as an addition to radiation therapy. The doctor removes only the foreskin and an area of adjacent skin. If the neoplasm is limited to this area and there is no evidence of tumor spread to the surrounding tissues, then surgery is sufficient to cure most patients.

Simple excision is an analog of an excisional biopsy, which is performed as a diagnostic procedure. The manipulation is used for early-stage penile cancer. The doctor removes a small area of skin along with the tumor. Then the removed tissue is examined in the laboratory. If the resection margin is clear, then the scope of treatment is considered adequate.

Wide excision is a more traumatic but reliable treatment option. The doctor captures more of the tissues surrounding the tumor. It reduces the likelihood of local recurrence but increases the resulting skin defect. Whenever possible, the margins are simply brought together and sutured. If this is not possible, a skin graft is performed.

Mohs surgery is a method of surgical treatment for penile cancer, which ensures the maximum preservation of the patient's tissues. It is an alternative to wide excision. The surgical intervention is less traumatic but complicated and lengthy. The doctor removes the tumor with minimal involvement of the surrounding tissues. The operating material is then examined. After the diagnosis, the doctor cuts off the skin flaps in the direction where the cancer cells are found. After each stage, a repeated histological examination of the removed tissues is carried out. It continues until all resection margins are clear. As a result, the doctor can remove penile cancer, while at the same time preserving more of the patient's penis tissue. This operation provides the same oncological results as a wide excision of the tumor, but with less trauma, better functional and aesthetic results. The surgery is performed only for early-stage tumors if there is no spread to the deeper layers of the skin.

Glansectomy is a surgical procedure to completely remove the glans penis. It is this area that is the most common localization of penile cancer. After removing the neoplasm, doctors perform a reconstructive stage of the operation to restore the glans penis with skin grafts. After surgical treatment, sexual function is preserved, although the sensitivity of the glans penis is decreased.

Penectomy can be partial or total. The surgery involves partial or total removal of the penis. This operation is performed when the tumor has spread to deeper tissues. Since most tumors develop in the area of the glans penis, partial penectomy can usually be performed. The doctor steps back a few centimeters from the edge of the tumor. After the operation, the length of the penis is significantly reduced. 

Doctors strive to save the organ, if possible, without compromising the oncological outcome of the treatment. After surgery, the person remains able to urinate while standing.

In the case of total penectomy for penile cancer, the entire organ is removed, including the part that is located inside the pelvis. The doctor will form a hole in the perineum for the urination – between the scrotum and the anus. The man will still be able to control urination, but he will have to urinate sitting up.

Orchiectomy is a surgical intervention used for advanced penile cancer. The doctor removes the patient's testicles to avoid tumor recurrence. After this surgery, irreversible infertility develops, and testosterone production decreases. Only a small amount is produced by the adrenal glands. Therefore, after this operation, the man receives lifelong replacement therapy with drugs containing male sex hormones. Modern medicines are easy to use and safe for health: they can be administered once every few weeks or even once every few months.

Lymph node surgery

Most types of cancer spread metastases to regional lymph nodes as they reach advanced stages, and penile tumors are no exception. It is not always possible to detect metastases using clinical methods. On the one hand, the lymph nodes do not always become swollen with the available metastatic foci, since micrometastases can be only a few millimeters in size. On the other hand, swollen lymph nodes in the case of penile cancer do not always indicate cancer spread. They may be swollen due to infectious complications. Therefore, most patients, except for the very early stages of penis cancer, require inguinal lymphadenectomy; some also require pelvic lymphadenectomy. The examination of the surgical material allows giving an accurate answer to the question of whether there are metastases in the regional lymph nodes. In addition, sentinel lymph node biopsy is performed in developed countries. For some patients, this is an opportunity to avoid lymphadenectomy.

Inguinal lymphadenectomy is a surgical procedure for lymph node removal. It is performed at stage T2 and above in all patients, regardless of whether signs of penile cancer spreading to the lymph nodes have been detected. The purpose of this stage is not only therapeutic but also diagnostic. The specialists should examine the lymph nodes to make sure there are no metastases. Further cancer treatment tactics depend on their presence or absence. In patients with detected metastases, lymphadenectomy reduces the risk of penis cancer recurrence.

Inguinal lymphadenectomy involves the removal of at least 12 lymph nodes. It is major surgery. It is performed through an incision 8-10 cm long. The task of the doctor is to remove the lymph nodes without damaging the large vessels and nerves located in the groin.

Sentinel lymph node biopsy is an innovative diagnostic method that allows many patients to avoid lymphadenectomy. This procedure is performed intraoperatively. It is performed in the early stages of penile cancer.

The sentinel lymph node is the one that receives lymph from the tumor first. If metastases develop somewhere, then first of all here. If there are no metastatic foci in the sentinel lymph nodes, then other nodes are also likely to be clean, so they can not be removed.

The advantage of sentinel lymph node biopsy is that there are only 2-3 such nodes. Accordingly, surgery to remove them is more sparing and less likely to lead to complications. Patients are less likely to suffer from lymphedema.

But to identify the sentinel lymph node, lymphoscintigraphy is required, so the procedure is performed only in specialized centers. Doctors inject a radioactive substance into the tumor and then use a gamma camera to check where it accumulates. These nodes are removed and examined to see if they have metastases. If there are metastases, lymphadenectomy is performed in its standard scope. If there are no metastases, lymphadenectomy is not performed. Most patients with early-stage penile cancer do not have metastases.

Pelvic lymphadenectomy is required in the presence of 2 or more metastases in the inguinal lymph nodes. Pelvic lymph nodes are removed to check for metastases and to reduce the risk of regional tumor recurrence. Pelvic lymphadenectomy is a rather traumatic intervention that is performed through an incision in the lower abdomen. It can be performed simultaneously with the removal of the primary penile tumor or after some time, at the second stage of surgical treatment.

Local non-surgical treatment

At an early stage, the penis tumor can be cured even without surgery. Non-surgical procedures are used mostly for carcinoma in situ. This is the tumor of the superficial layers of the skin. Of all the existing treatment methods, they have the least traumatic effect on the tissues of the penis, and are the safest for health.

Non-surgical treatment options are as follows:  

• brachytherapy – contact irradiation of the tumor;
• laser ablation – it is used for squamous cell carcinoma in situ, the early stage of basalioma, as well as for men who refuse surgical treatment;
• cryoablation – it is used for warty forms of penile cancer and carcinoma in situ on the glans penis;
• local chemotherapy – it is the treatment option only for precancerous conditions or carcinoma in situ; 
• local immunotherapy – application of imiquimod cream, which stimulates the destruction of the tumor by the patient's immunity;
• photodynamic therapy – irradiation with light of a certain wavelength after the application of a photosensitizer that makes cancer cells sensitive to light.

After non-surgical procedures, the risk of penile cancer recurrence is higher than after surgery. Nonetheless, the treatment can be repeated if the tumor recurs. The patient is carefully monitored to detect a relapse in time.

Radiation therapy

Radiation therapy can be used in two versions for penile tumors. These are as follows:

• external beam radiation therapy;
• brachytherapy (contact radiation therapy). 

Radiotherapy can be used in the following situations: 

• the main method of destroying the very early cancer, usually allowing the disease to be cured;
• locally advanced cancer – radiation therapy is used to irradiate the lymph nodes after surgery instead of removing them; 
• contraindications to surgical intervention – radiation is used to destroy the primary tumor; 
• advanced cancer, large tumor – before surgery, together with chemotherapy, to reduce the size of the neoplasm and lower the stage. 

External beam radiation therapy is more common. Doctors abroad use high-precision methods that are safe for health, delivering radiation exactly to the target, with minimal damage to adjacent organs and tissues.

Brachytherapy is less common. Radioactive seeds are injected into the tumor through needles.

Systemic chemotherapy

In most cases, chemotherapy is used when cancer has spread to regional lymph nodes and distant organs. It is often conducted after surgery to reduce the risk of recurrence. With inoperable advanced tumors, chemotherapy helps to inhibit the growth of the neoplasm, metastases and increases the life expectancy of patients. Less commonly, chemotherapy is used together with radiation therapy before to shrink the tumor.

2 or 3 drugs are usually used simultaneously (TIP regimen). But in debilitated patients who, for health reasons, cannot tolerate polychemotherapy, therapy with one drug is performed.

Why is it worth undergoing treatment abroad?

If you have been diagnosed and found out about penile cancer, then you need treatment. To get the highest level of medical care, you can go abroad, to one of the countries with advanced medicine. Here are some reasons for you to undergo treatment abroad:

• very early stages of cancer are cured with safe for health non-surgical procedures; 
• preference is given to organ-preserving operations;
• preservation of sexual function (possibility of erection, ejaculation);
• preservation of the aesthetics of the penis due to the reconstructive stage of the operation;
• maintaining the possibility of urination while standing with partial penis removal;
• minimal health risks during surgery;
• sentinel lymph node biopsy is performed to avoid inguinal lymph node dissection;
• safe surgical interventions to remove inguinal and pelvic lymph nodes;
• high-precision, safe for health radiation therapy options.

Experienced urologists with high reputability all over the world work abroad. Hospitals have state-of-the-art equipment at their disposal. In cancer treatment, specialists strive to ensure not only a cure for the disease but also minimal damage to the subsequent quality of life of the patient. Foreign hospitals achieve good results even at 3-4 stages of oncological disease.

Treatment in Europe with Booking Health

To undergo penile cancer treatment in one of the European hospitals, you are welcome to use the Booking Health service. On our website, you can find out the cost of treatment and compare prices in different medical centers to book a program at a favorable price. The cost of surgical treatment for penis cancer with the subsequent plastic reconstruction is between 11,900 EUR and 19,200 EUR. Treatment in Europe will be easier and faster for you, and the cost of treatment will be lower.

Please leave your request on the Booking Health service. Our employee will contact you and provide a consultation on treatment in Europe. The Booking Health company will fully organize your trip to one of the developed countries. We will provide the following benefits to you:

• We will select the best European hospital, whose doctors specialize in penile cancer treatment.
• We will solve the language barrier problem, and we will ensure communication with the doctor of the European hospital.
• We will reduce the waiting period for the medical care program. You will receive treatment on the most suitable dates.
• We will reduce the price. The cost of treatment in Europe will be reduced due to the lack of overpricing and additional coefficients for foreign patients.
• We will solve any organizational issues: we will prepare documents, meet you abroad and take you to the hospital, book a hotel, and provide interpreting services.
• We will prepare the program and translate medical documents. You do not have to repeat the previously performed diagnostic procedures.
• We will help you keep in touch with doctors after the completion of treatment in Europe.
• We will organize additional diagnostic examinations and treatment in European hospitals.
• We will buy medicines abroad and forward them to your native country.

Leading experts from around the world will take care of your health. Booking Health staff will help reduce the cost of treatment, organize your trip to the European hospital, and you can fully focus on restoring your health.

Authors: 

The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Dr. Vadim Zhiliuk. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

Sources:

National Cancer Institute

Cancer Research Institute

Healthline