Penile Cancer Treatment Information

PENILE CANCER TREATMENT INFORMATION

Description of the Normal Penis:

The penis is the flexible, expandable male organ; its foreskin is sometimes removed ("circumcision") for religious or perceived hygienic reasons. This penis is comprised of a "shaft" of variable length (average of 5 inches) which arises from the "pubis" -- the area where the pubic bones join in front. The penis has a "head" atop of the shaft, the largest diameter of the penis is where the head starts and is called the "corona" (meaning crown). The "urethra" is the hollow tube at the center of the penis, it extends from the neck of the bladder to the opening at the tip of the penis ("urethral meatus"). The urethra is divided into 3 portions, the "prostatic" , "membranous" and "spongy" urethra. Only the spongy urethra, which is the part within the penis, is considered part of that organ. The urethra carries urine from the bladder and sperm from the testicles to exit the "urethral meatus" opening at the penile tip. Neither the "testicles" within the "scrotal sac" , nor the "prostate gland" which enlivens sperm, is considered part of the penis proper-- although the both feed into it to discharge their fluids through it.

If one slices the penis like a sausage, the urethra is the small central tube within the organ. The urethra opens up near the tip of the penis, inside the head, into an area called the "fossa navicularis" (meaning "boat-like" opening). Since the urethra is normally so narrow (only about 4 millimeters in diameter) it is subject to "stricture" from infection, inflammation, injury, scarring, cancer or its treatments-- which will interfere with the egress of urine and sperm if unrelieved. The spongy urethra within the penis proper is surrounded by a "loose connective tissue" called the "corpus spongiosum" (meaning "spongy body"). This tissue becomes more prominent at the head of the penis, in fact lying directly below the skin there. The corpus spongiosum is flexible and helps protect the delicate urethra. The shaft of the penis is home to a set of paired, expandable tubes, called the "corpus cavernosum" (meaning cave-like body). These are the tubes which fill with blood to expand the penis during erection. They lie along the shaft of the penis, from where it orginates (the "crus" of the penis) at the point where the pubic bones join ("symphysis pubis") and extend to the head of the penis. Both the length of the penis and the shaft diameter increase during erection. The penis is connected to the pubic bones by the "suspensory ligament of the penis" which allows it to dangle. It blends into a fibrous coating, called "fascia" , which surrounds the shaft of the penis under the skin and thereby encloses urether, corpus spongiosum, and 2 corpus cavernosum. The top surface of the penis, as viewed when erect, is called the "dorsum". The loose tissue on the underside of the head is the "prepuce" , from which the foreskin may be removed by circumcision.

The corpus cavernosum and corpus spongiosum fill with blood during erection, the source of that blood are branches from the "dorsal artery of the penis" which arises from the "internal pudic" artery, which itself is a brach of the "anterior iliac" artery, which branches off of the large "desceding aorta". There are also smaller arteries from the internal pudic carrying blood to the "bulb" of the penis (which is the very first portion in front of the pubic bones), and an artery to the "corpus cavernosum". The blood drains from the penis primarily by the "dorsal vein of the penis" and into similarly named venous branches as above, and is ultimately returned to heart by the large "inferior vena cava". The main blood vessels of the penis lie directly beneath the skin and fascia membrane coating, together called "integument". The draining veins of the penis can act as conduits for spread of "local" infections or cancer, and carry local diseases to anywhere in the body to become "systemic".

The signal to fill with blood for an erection, or conversely to drain blood and become flaccid, are controlled by nerves to the penis. The "parsympathetic" nerves from the "nerves erigentes" in the pelvis cause blood to flow into the corpus cavernosum, engorging and enlarging the penis. The "sympathic" nerves from the "sympathetic chain" along the spinal cord allow the draining veins to dilate and the penis to shrink to flaccidity. The parasympathetic system is more active at night, explaining why men have erections while sleeping ("nocturnal erections"). Monitoring for the presence of these with a pressure gauge ("plethysmography") can distingish physical inability to achieve erection ("impotency") from psychological inability to do so. Over 70% of the time the failure to achieve erection is for psychological reasons, but even so many of these men can get an erection with new drugs like "Viagra" (Pheizer Pharmaceuticals) which stimulate blood flow to the penis.

The penis also has a system of "lymph channels" which collect the tissue fluid that seeps out of the smallest blood vessels ("capillaries") to nourish individual "cells" (the smallest unit of life). There are two sets of lymphatics to the penis, the "superficial" and "deep" lymphatics. The former collect "lymph fluid" from the skin, prepuce and inner lining ("mucosa") of the urethera, while the latter emerge from the corpus spongiosum and corpus cavernosum. The lymph channels carry the lymph fluid to regional "lymph nodes" , which are normally pea-sized glands that are filled with White Blood Cells. These "nodes" filter and purify the lymph fluid, which is acually the fluid ("serum") portion of the blood. When germs or cancer cells are trapped by lymph nodes, they swell ("lymphadenopathy"). By definition, swelling means the lymph nodes are larger than 1 cm. (~1/2 inch) apiece. The lymph nodes "chains" tend to interconnect, but generally follow established pathways. The "superficial" lymph nodes of the penis drain to the "external inguinal" nodes, they are located on both inner upper thighs. The "deep" lymph nodes of the penis drain into the deep "pelvic" lymph nodes, and eventually these a continuous with "para-aortic" lymph nodes which run back up toward the heart. Ultimately, all the lymph fluid from whatever location converges to rejoin the bloodstream, at the "left thoracic duct" region near the heart. The lymph system can act as a conduit for the spread of infections or cancer, but may also help trap these diseases to keep them localized.

What is Penile Cancer?

The penis is composed of various "cells" , which are intricately combined together into "tissues" which form the "organ". The penis contains fat, muscle and skin cells. These cells divide to produce new ones, and grow very rapidly during womb life, early childhood and puberty. In adulthood, new cells are produced only to replace those that die of old age, injury or disease. Normally, division of cells is under very tight control. This control is exerted by the "genes" inside each cell, which are housed in long clumps forming "chromosomes" , which are visible under a light microscope. The genes themselves are made up of DNA , the master genetic code material. If the genes are damaged, say by chemicals or radiation, the control over cell division may be lost in one particular cell. Ultimately, cancer is considered a disease of the DNA. Penile cancer starts in a single cell. That cell starts dividing haphazardly, making millions and billions of copies of itself. It takes up the nourishment needed by other cells, depriving them so the cancer can continue to grow. Quickly growing cells can clump up to form a "tumor". A tumor simply means a swelling, it can be caused by inflammation or infection. A "benign" tumor only grows in it's local area (although it may get quite large)-- it cannot spread and is not cancer. By contrast, a tumor which can spread to other body areas is called "malignant" and this is cancer. The process of cancer spread to other areas is called "metastasis" , so only malignant tumors (i.e. cancer) can metastasize. Theoretically, cancer can spread to any area of the body, and it often grows better in it's area of spread than in it's area of origin ("primary site"). It is this capacity for spread that makes cancer so dangerous. If not treated successfully, penile cancer ultimately kills by urinary blockage, debility, anemia, infection, and damage to distant organs like the liver and brain.

How Common is Penile Cancer?

Penile cancer is relatively rare; each year there are 1500 new cases in the USA. It causes 400 deaths annually. It represents 4% of all "urogenital" cancers; urogenital means those of the kidneys, bladder, prostate, testicles and penis. Obviously, all cases are in males, and the average age is 60 years old. In America, an average of 1 out of 100,000 men per year develop penile cancer. In other areas of the world (i.e. Africa, Asia) where fewer men are circumsized, penile cancer is more common. In Paraguay, for instance, it is the most common urogenital malignancy, accounting for over 50% of male cancers! Also in Uganda, where men are not circumsized, penile cancer is the most common type of cancer found in males. In general, the incidence (meaning number of new cases per year) of penile cancer in the United States has been increasing, owing to sexually transmitted diseases that predispose to cancer-- especially in homosexual men.

The penis is a wonderfully designed organ- it is multifunctional for both waste excretion (urine) and reproduction (sperm). There are hollow areas within the penis which can fill with blood to produce an erection. Cancer can strike the skin of the penis, the inner spongy areas, or the urethra tube which conveys urine and semen. Penis cancer frequently spreads to local glands, causing swelling in the groin.

It is critical to get proper treatment for a diagnosis of penile cancer, this can make the difference between losing or preserving the organ, or even between life and death. Understanding your options for a penile cancer problem will give you the peace of mind knowing that you have done everything possible for a happy outcome.

CancerAnswers' material explains, in plain English, the definition, types, frequency, symptoms, evaluation, historical and latest treatment for penile cancer. We tell you everything you need to know to make the right choices today to deal with a Penile Cancer problem.

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