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Disorders of the Reproductive System

Reproductive System

178 to the human papillomavirus (HPV; see page 184), which also causes cervical

The cancer in women.

Penile cancer can occur anywhere on the penis, but the most common sites are the glans (the head of the penis) and the foreskin (the fold of skin covering the glans). These cancers are usually slow growing, so the penis can be saved in most cases when the cancer is diagnosed early.

Penile cancer is most common in older men and African Americans, and the incidence rises steadily after age 55. Poor hygiene may be a risk factor for penile cancer in men who are uncircumcised. The theory is that if the penis is not kept clean, smegma, which is a buildup of mucus and other secretions, can collect under the foreskin and cause irritation and inflammation of the glans. This chronic irritation may set the stage for the development of cancer. Almost all cases of penile cancer occur in men who were not circumcised at birth.

Symptoms of penile cancer include a red spot, crust, wartlike growth, or sore on the penis; discharge from the penis; pain; a lump in the groin; or bleeding during an erection or intercourse. If you have any of these symptoms, see your doctor.

For a definitive diagnosis of cancer, affected areas of the penis are biopsied (tiny bits of tissue are removed for examination under a microscope). If cancer is detected, more tests are ordered to see if the cancer has spread to other parts of the body. In one test, called lymph node dissection, a needle is used to draw cells out of a lymph node (a gland that is part of the immune system) in the groin area. The cells are then examined to see if the cancer has spread to the lymph nodes.

The most common treatment for penile cancer is surgery, using one of the following methods. Surgery may be followed by other treatments such as radiation or chemotherapy.

  • Wide local excision. The cancer and some normal tissue on either side of the abnormal area are surgically removed.
  • Microsurgery. The cancerous area, but little normal tissue, is removed. To do this, the doctor removes the cells while looking through the microscope.
  • Laser surgery. The cancerous area is destroyed using a narrow, concentrated beam of light.
  • Penectomy. The penis is partially or totally amputated. Although this is the most drastic method, amputation is the most common and most effective treatment for penile cancer. Lymph nodes also may be removed during this procedure. In partial penectomy, in which part of the penis is removed, some men remain capable of erection, orgasm, and ejaculation. Total penectomy leaves men significantly impaired sexually, but in some cases, stimulation of the remaining tissue can produce orgasms.
  • Radiation therapy and chemotherapy. These treatments are used after surgery.
  • Biological therapy. This relatively new treatment involves injections of the 179

protein interferon to enhance the body's natural defenses against cancer. It is Disorders still considered experimental. OF THE

Reproductive

Other growths on the penis, such as warts, sores, and blisters, are almost System always caused by infection (see chapter 9).

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