Penile Cancer: Key Symptoms Men Should Never Ignore

Penile cancer is a relatively rare type of cancer. It forms on the skin or in the tissues of the penis and predominantly affects men over the age of 50. Human papillomavirus (HPV) infection, poor hygiene, smoking habits, and being uncircumcised are all risk factors associated with its development. Early detection of penile cancer symptoms is crucial for successful treatment because, while this cancer is generally slow-growing compared to its peers, it’s often detected very late — by which point the malignancy has spread to other parts of the body.

What is penile cancer?

To understand penile cancer, we can ask some quick questions: Who does this cancer affect the most? What are some early signs of penile cancer? And, significantly: What does penile cancer look like?

As far as malignancies go, penile cancer is relatively rare in the U.S. As the name suggests, it affects the penis: the male sex organ used for emitting sperm and urine from the body.

Squamous cell penile carcinoma is a type of penile cancer that accounts for about 95% of penile cancer cases globally. It starts in the flat skin cells, or squamous cells, of the penis, and forms precancerous lesions that may not be painful or immediately concerning to the individual. Over time, the cells in these lesions can continue to mutate and develop noticeable lumps or sores.

Penile cancer predominantly affects men over the age of 50 and has a higher incidence and mortality in developing countries. That being said, its incidence has been on the rise in some European countries, and, as with any cancer, being aware of the risk factors and symptoms is very important to early detection.

Risk factors

Risk factors for penile cancer can vary; the common thread to look out for is sources of or aggravating factors for inflammation both in the penis and in the body’s general immune system.

Age and lifestyle factors for penile cancer include:

• Smoking
• Poor hygiene of the penis, groin, and genitals
• Multiple sexual partners
• An uncircumsised penis

Hygiene issues and circumcision directly affect the risk of inflammation in the skin around the penis. They are also related; penile hygiene is sometimes easier for circumcised men because of the lack of foreskin, under which bacteria and dead skin can accumulate if it’s not cleaned properly. That accumulation can cause irritation, rashes, and inflammation. Smoking elevates systemic levels of inflammation in the body, suppressing the immune system and increasing cancer risks. Similarly, multiple sexual partners increase the average risk of contracting HPV, which is a virus with known carcinogenic effects.

Human papillomavirus, or HPV, is one of the bigger risk factors associated with penile cancer. HPV refers to a family of viruses, many of which are transmitted primarily through sexual contact; depending on which strain you are exposed to, HPV can be completely asymptomatic, exhibit mild symptoms like genital warts or mouth sores, or result in cervical, anal, and, penile cancer.

Genetic predisposition plays a role in many cancer diagnoses because cancer is fundamentally caused by genetic mutation. In penile cancer, the abnormal presence of certain gene mutations, referred to by scientists as biomarkers, can signify a higher likelihood that you might develop it.

In general, it's hard to detect this kind of predisposition without testing, and the increased risk from lifestyle and environmental factors is on average higher.

Early symptoms of penile cancer

Not all symptoms of penile cancer are immediately or easily visible. However, it is important to know the ones that are, so you can be on the lookout.

Visible symptoms

Early signs include painless lesions and changes in skin texture and color. Other visible symptoms of penile cancer can include:

• Sores or growths: persistent sores, growths, or lumps on the penis, particularly on the glands or foreskin
• Difficulty retracting foreskin: inability to pull back your foreskin due to swelling, sores, or changes in skin texture
• Redness or rashes: red patches, rashes, or areas that appear visibly irritated
• Odored discharge: unusual or unexplainable discharge with a strong, “bad” odor, often coming from under the foreskin

Physical discomfort

Other symptoms are related to physical discomfort. You may feel pain in the penis during urination and sexual activity, and/or persistent itching or burning sensations beneath or around the foreskin. Pain can also come from swelling in lymph nodes, affecting the groin area as a whole.

Advanced symptoms of penile cancer

In penile cancer, advanced symptoms are generally chronic or extreme variations of early warning signs. If you are experiencing a rapidly enlarging lump or mass on the penis that may be painful or tender, open sores that do not heal, wart-like growths, continuous discharge or bleeding, chronic penile pain, or difficulty urinating, it is of vital importance that you see a doctor as soon as possible.

Systemic symptoms

Once a cancer has advanced to a certain point, it metastasizes or infiltrates other systems in your body. Swollen lymph nodes are a big sign of this; swelling in the groin may suggest that the lymph nodes in that area are under pressure from an infection or immune reaction. Similarly, you may experience unexplained weight loss or fatigue because your body’s immune system and other organ systems are too busy fighting the cancer cells to keep the rest of your body in a healthy balance.

Symptoms such as the above, especially paired with early warning signs like lumps, discoloration, or discharge, should always be of concern. If you or a loved one has been experiencing any combination of the above, it is important to see a healthcare professional as soon as possible.

Diagnosis and when to seek help

Getting a cancer diagnosis can sometimes feel like an overwhelming hurdle to cross. We’ve listed some routes you may consider taking as a way of making this first step easier.

Medical evaluations

The best way of catching penile cancer is through preventative or routine checks, which can be a part of a yearly physical exam. Knowing your medical history and keeping tabs on any unusual changes not only makes it easier to catch abnormalities, but it can also empower you to speak up about your health if something does feel different.

If you do find an abnormality or experience early symptoms of penile cancer, you and your doctor can further investigate using imaging tests and biopsy procedures such as ultrasounds, MRIs, and punch biopsies, in which a small piece of tissue is removed, typically from surface level lesions. Imaging can miss early stages of metastasis, which is why other tests like biopsies are important.

Importance of early detection

Because penile cancer is rare, it is also easy to miss or dismiss as a possibility. However, early detection of penile cancer is crucial. It increases the likelihood of successful treatment, preserves more penile function, and reduces the risk of metastasis. Early-stage cancer can often be treated less invasively, leading to better outcomes and fewer complications. As we will discuss, complications of penile cancer can significantly affect patients’ self-confidence, mental health, and quality of life.

Treatment options for penile cancer

Once diagnosed, there are a variety of treatment options available to penile cancer patients. They vary depending on your prognosis.

Surgical interventions

Surgical interventions for treating penile cancer vary based on the stage of the disease. They range from very mildly invasive to more extreme. The aim is to remove the cancer while preserving as much penile function and appearance as possible.

• Laser surgery. If your main concern is a precancerous lesion, laser surgery is one of the more precise tools available. It is able to target a very localized area for prevention purposes.
• Circumcision. Circumcision involves surgically removing the foreskin. This approach is used if the cancer is confined to the foreskin or immediately surrounding area, and works best for superficial cancers.
• Wide local excision. Local excision involves removal of the tumor along with a margin of healthy surrounding tissue to prevent any spread of cancerous cells.
• Mohs surgery. Mohs surgery involves removing cancerous layers of skin one at a time and examining them until no cancer cells remain.
• Partial penectomy. A partial penectomy means removing a part of the penis. This is appropriate for cases where the cancerous growth is large and deep in the tissue.
• Total penectomy. This is a complete removal of the penis, often necessary for advanced cancer diagnoses.
• Inguinal lymphadenectomy. If the cancer has metastasized to the groin, an inguinal lymphadenectomy can be done to remove the lymph nodes in that region and prevent the spread of cancer.
• Pelvic lymphadenectomy. In advanced cases, the cancer may have metastasized to the pelvis; a pelvic lymphadenectomy can be done to remove the lymph nodes in that region and prevent the spread of cancer.

Non-surgical treatments

For more advanced cases, surgical removal of the cancer may not be enough; radiation or chemotherapy may be required to ensure the cancer does not return.

• Radiation therapies for penile cancer include external beam radiation and brachytherapy (use of radioactive material that's placed into or near the tumor), which target tumors while sparing surrounding tissue.
• Chemotherapy options can be both topical or systemic. Topical creams are recommended for early stage penile cancer while systemic therapies (e.g., cisplatin, fluorouracil) are used for advanced or metastatic cases. Advanced stage cancer is often treated with combination therapies of both non-surgical and surgical treatments.

Emerging treatments

For many types of cancer, gene-targeting therapies are an emergent approach to treatment that can focus on managing the over- or under-expression of certain genes most strongly associated with that cancer. These treatments are generally more recommended for advanced or metastasized stages.

Recent research has also shown the potential efficacy of combining a vaccine developed from a gene-modified HPV virus with the drug durvalumab, which is commonly used to treat HPV-related cancers such as cervical or penile.

Always consult with an oncologist about what options are available to you.

Preventive measures

Penile cancer is caused by a specific combination of factors. Because it is rare, it can be prevented through certain lifestyle changes and regular, responsible monitoring.

Lifestyle changes

As is the case with the prevention of all cancers, keeping your immune system as strong as possible is an important first step. A healthy balanced diet rich with vitamins, minerals, and antioxidants, coupled with regular exercise can go a long way in reducing your risks of cancer as rare as this one.

You can also avoid known risk factors. Smoking aggravates systemic inflammation and is associated with a higher incidence of penile cancer. Maintain consistent and rigorous hygiene to ensure that the skin around your genitals is clean and does not become inflamed, irritated, or prone to chafing. Finally, getting an HPV vaccine, safer sexual practices (e.g., protected sex), and limiting your number of sexual partners may lower the risk of developing penile cancer as a result of exposure to the HPV virus.

Regular check-ups

In addition to lifestyle changes, regular monitoring through routine medical screenings and physical exams can catch any abnormalities early and avoid the need for more invasive treatment options.

Beyond going to the doctor’s office, you can also self-monitor. Keep an eye out for redness, irritation, abnormal discharge, lesions, and soreness. Lesions may be painless at first, but it is important to report them to your doctor early on so they can be examined and resolved. Check whether the skin of your penis has thickened in texture or displays white or darkened spots. This discoloration may also look like your penis has been bruised, which is a more severe symptom that should be reported immediately.

Living with penile cancer

Like many aspects of men’s health, the repercussions of this diagnosis are not often discussed. Seeking and receiving a penile cancer diagnosis can be an embarrassing, shocking, and uncomfortable experience for many patients. Living with penile cancer can negatively impact individuals’ quality of life and mental health.

While early detection is the best way of mitigating this impact, there are some coping strategies available to people living with penile cancer.

1. Coping with penile cancer can involve attending support groups, seeking professional psychological counseling, and open communication with any sexual or romantic partners you may have.
2. A healthy lifestyle, mindfulness practices, and sexual health resources can also aid physical and mental recovery.
3. Support for individuals with rare types of cancer can be found at websites like cancercare.org or through the American Cancer Society.

Post-treatment care

In the aftermath of treatment, you may experience changes to your ability to urinate, sexual activity, and lymph node health. Depending on which treatment you receive, you may have to sit to urinate. Sexual habits and practices may have to be adjusted to accommodate for the post-surgery changes to your genitals.

If the lymph nodes in your groin or pelvis have been removed or treated with radiation, you may be at risk of developing lymphedema, in which your lymph nodes have difficulty draining fluid and become swollen. Schedule regular follow-ups with your healthcare provider to monitor these changes and address them as they come up.

Bottom line

The best way of catching penile cancer is through preventative or routine checks, which can be a part of a yearly physical exam. Look out for discoloration, changes in foreskin texture, painless lesions, sores, and discharge. Treatment options include different surgical procedures, and radiation, chemo-, and gene therapies. Advanced penile cancer sometimes requires surgical removal of the penis, which can be an emotionally and psychologically difficult process for many patients. As a result, early detection is critically important.

If you have experienced any of the symptoms listed in this article, reach out to a healthcare provider as soon as possible.