Penile Cancer: Causes, Symptoms, Risk Factors, Treatment, and How to Reduce the Risk

Research Consult Uganda | Health Education and Awareness

Introduction

Penile cancer is a relatively uncommon type of cancer that develops in the tissues of the penis, the male reproductive organ responsible for passing urine and delivering semen during sexual intercourse. Although it is uncommon compared with several other cancers, penile cancer can have serious consequences if it is not identified and treated early.

The disease most commonly develops in the skin cells of the penis, particularly those covering the head of the penis (glans) or the foreskin in uncircumcised men. Early symptoms may include a persistent sore, a lump, a change in skin colour, abnormal growth, or bleeding.

Understanding penile cancer, its risk factors, warning signs, diagnosis, and available treatment options can help men make informed decisions about their health. Early medical assessment is particularly important because some early penile cancers can be treated successfully while preserving as much normal penile function as possible.

1. What Is Penile Cancer?

Penile cancer occurs when cells in the tissues of the penis begin growing uncontrollably. These abnormal cells may form a tumour and, in some cases, spread to nearby lymph nodes or other parts of the body.

The most common type is penile squamous cell carcinoma, which develops from the flat cells lining the surface of the penis.

Other, less common types include melanoma, basal cell carcinoma, and certain other rare cancers.

Penile cancer can develop on different parts of the penis, including:

• The glans, or head of the penis.
• The foreskin, particularly in men who have not been circumcised.
• The shaft of the penis.
• Other tissues within or around the penile structures, depending on the tumour type.

The disease is more common in older men, but younger men can also develop it.

2. What Causes Penile Cancer?

Penile cancer develops when genetic changes cause cells to grow abnormally. In most cases, there is no single identifiable cause. However, researchers have identified several factors that increase the likelihood of developing the disease.

A. Human papillomavirus (HPV) infection

Human papillomavirus (HPV) is a group of viruses transmitted primarily through intimate skin-to-skin contact, including sexual contact.

Certain high-risk HPV types can cause changes in cells that may eventually lead to cancer. Persistent infection with high-risk HPV is associated with a proportion of penile cancer cases.

Most HPV infections clear naturally without causing serious problems. However, persistent infection with cancer-associated HPV types can increase cancer risk.

HPV vaccination can help prevent infections caused by several high-risk HPV types and may reduce the risk of HPV-associated penile cancer.

B. Poor penile hygiene and chronic inflammation

Persistent inflammation of the glans or foreskin may contribute to the risk of penile cancer.

In uncircumcised men, a tight foreskin can make it difficult to clean and inspect the head of the penis. This may contribute to recurrent inflammation or a condition called balanitis, which is inflammation of the glans.

However, penile cancer should not be attributed simply to being uncircumcised or to poor hygiene. Many uncircumcised men never develop penile cancer, and the disease can also occur in circumcised men.

Maintaining appropriate genital hygiene and seeking treatment for persistent inflammation are sensible preventive measures.

C. Phimosis

Phimosis occurs when the foreskin is too tight to retract comfortably over the head of the penis.

Severe or persistent phimosis can make cleaning difficult and is associated with an increased risk of penile cancer. It can also contribute to recurrent inflammation and infections.

Men with painful foreskin tightness, repeated inflammation, or difficulty passing urine should seek medical advice.

The foreskin should never be forcibly retracted, because doing so can cause injury.

D. Smoking and tobacco use

Smoking is associated with an increased risk of penile cancer. Tobacco contains carcinogenic substances that can contribute to cellular damage and cancer development.

Avoiding tobacco and stopping smoking are important measures for reducing the risk of several cancers and other serious diseases.

E. Increasing age

Penile cancer is diagnosed more frequently in older men, although it can occur at any age.

Age alone does not mean that a person will develop the disease. Other factors, including HPV infection, chronic inflammation, and individual medical history, also influence risk.

F. Weakened immune system

People whose immune systems are weakened, including some individuals living with HIV or taking immunosuppressive medicines, may have an increased risk of persistent HPV infection and certain cancers.

Appropriate medical care and management of underlying conditions can help support overall health.

G. Previous penile skin conditions

Certain persistent inflammatory or precancerous skin conditions, including lichen sclerosus and penile intraepithelial neoplasia, are associated with an increased risk of penile cancer.

Changes in penile skin that persist, worsen, or do not respond to treatment should be assessed by a healthcare professional.

3. Symptoms and Early Warning Signs of Penile Cancer

Recognising possible symptoms is important because early penile cancer may initially resemble an infection, skin irritation, or another less serious condition.

Possible warning signs include the following.

A. A persistent sore or ulcer

A sore that does not heal on the penis may be a warning sign. It may occur on the glans, foreskin, or shaft.

Not every penile sore is cancerous. Sexually transmitted infections, injuries, and inflammatory skin conditions can also cause sores. Nevertheless, a persistent or unexplained lesion should be examined by a healthcare professional.

B. A lump or abnormal growth

Penile cancer may appear as a lump, thickened area, wart-like growth, or abnormal tissue on the penis.

A new growth that persists, enlarges, bleeds, or changes in appearance should not be ignored.

C. Changes in skin colour or texture

Some penile cancers cause an area of skin to become darker, redder, thicker, or otherwise different from the surrounding tissue.

Persistent changes may require examination and, in some cases, a biopsy.

D. Bleeding or unusual discharge

Unexplained bleeding from a penile lesion or discharge beneath the foreskin can be a warning sign.

These symptoms may also result from infections or inflammation, so clinical assessment is necessary to establish the cause.

E. Persistent itching, irritation, or pain

Some men experience ongoing irritation, pain, tenderness, or an unpleasant smell associated with an abnormal penile lesion.

These symptoms are not specific to cancer, but persistent symptoms deserve medical attention, particularly when accompanied by a sore, lump, or skin change.

F. Difficulty retracting the foreskin

A new or worsening inability to retract the foreskin may result from inflammation, scarring, or other conditions. In some cases, an underlying penile lesion may contribute.

Medical assessment is appropriate, especially when the change is new or associated with bleeding, pain, or abnormal growth.

G. Swelling in the groin

Penile cancer can spread to lymph nodes in the groin, causing enlarged lumps or swelling.

Groin swelling has many possible causes, including infections. However, persistent or unexplained swelling alongside penile symptoms requires prompt investigation.

Important: Penile cancer may not cause pain in its early stages. The absence of pain does not rule it out.

4. How Can Penile Cancer Be Prevented?

There is no guaranteed way to prevent every case of penile cancer. However, several evidence-based measures may reduce the risk.

A. Practise appropriate genital hygiene

Wash the external genital area gently with clean water and mild, non-irritating soap if tolerated.

Men with a retractable foreskin can gently retract it, clean underneath, rinse, dry the area, and return the foreskin to its normal position.

Do not force the foreskin back if it is tight or painful. Avoid harsh chemicals, strong antiseptics, and unverified herbal preparations on genital skin, as these can cause irritation or injury.

B. Consider HPV vaccination

HPV vaccination protects against several HPV types responsible for genital warts and cancers, including some HPV-associated penile cancers.

Vaccination is most effective when administered before exposure to the relevant HPV types. Eligibility, recommended ages, and availability vary by country.

Men should ask a qualified healthcare professional about HPV vaccination and the applicable national recommendations.

The vaccine does not treat an existing HPV infection or an established cancer, and it does not protect against every HPV type.

C. Avoid smoking

Avoiding tobacco or quitting smoking can reduce the risk of several cancers and improve general health.

People who smoke can seek support from healthcare professionals or established smoking cessation programmes.

D. Reduce HPV exposure

Using condoms correctly and consistently can reduce the risk of HPV transmission and other sexually transmitted infections, although condoms do not provide complete protection against HPV because uncovered skin can also transmit the virus.

Mutual monogamy between partners who are not infected can reduce opportunities for exposure, but no sexual behaviour guarantees complete protection against HPV.

Sexual health education, vaccination, and appropriate screening or assessment of symptoms are important components of prevention.

E. Seek treatment for persistent inflammation

Recurring balanitis, phimosis, persistent irritation, and other penile skin conditions should be assessed by a healthcare professional.

Appropriate treatment can relieve symptoms and address underlying causes. Persistent lesions should not simply be treated repeatedly with creams without confirming the diagnosis.

F. Seek medical attention for unusual penile changes

Men should seek medical advice if they develop a persistent sore, unexplained lump, abnormal skin change, bleeding, or a growth that does not heal.

Prompt assessment can help distinguish benign conditions from precancerous changes and cancer.

G. Understand the role of circumcision

Circumcision involves surgical removal of the foreskin. Studies have found associations between circumcision, particularly in childhood, and a lower risk of penile cancer in some populations.

However, penile cancer is uncommon, and the evidence does not mean that every man should undergo circumcision specifically to prevent cancer.

Circumcision does not eliminate the risk of penile cancer, HPV infection, or other sexually transmitted infections. Men considering circumcision should discuss its benefits, risks, alternatives, and suitability with a qualified healthcare professional.

5. Is Penile Cancer the Same as a Sexually Transmitted Infection?

No. Penile cancer is not itself a sexually transmitted infection.

However, persistent infection with certain high-risk HPV types can contribute to the development of some penile cancers.

Other penile cancers arise through different biological pathways, and not every case is associated with HPV.

Penile cancer cannot be diagnosed simply by a person’s sexual history, and having HPV does not mean that a person will develop cancer.

A medical examination is needed when symptoms suggest a possible penile lesion.

6. How Is Penile Cancer Diagnosed?

Diagnosis generally begins with a medical consultation and physical examination.

A. Medical history and examination

The healthcare professional asks about the duration of symptoms, changes in the lesion, pain, bleeding, infections, and other relevant medical history.

The penis and groin may be examined for abnormal tissue and enlarged lymph nodes.

B. Biopsy

A biopsy involves taking a small tissue sample from the abnormal area for examination under a microscope.

A biopsy is usually necessary to confirm penile cancer and determine the type of cells involved.

C. Imaging investigations

Depending on the findings, ultrasound, magnetic resonance imaging (MRI), computed tomography (CT), or other investigations may be used to assess the depth of the tumour, involvement of nearby structures, lymph nodes, or possible spread.

Not every patient requires every imaging test. The investigations depend on the tumour’s characteristics and the clinical assessment.

D. Assessment of lymph nodes

The lymph nodes in the groin are important because penile cancer may spread to them.

If cancer is confirmed, the medical team determines whether further lymph node assessment is needed to establish the stage and guide treatment.

7. How Is Penile Cancer Treated?

Treatment depends on the type of cancer, its stage, location, size, and the person’s general health.

A. Local treatments

Very early or superficial disease may sometimes be treated with specialised creams, laser treatment, or procedures that remove affected tissue. These approaches are appropriate only for selected lesions after careful assessment.

B. Organ-preserving surgery

For some early cancers, surgeons can remove the tumour while preserving much of the penis and its function.

Depending on the case, procedures may include local excision, glans resurfacing, or glansectomy.

The choice depends on the extent and location of the cancer and the likelihood of completely removing it.

C. Partial or total penectomy

For more extensive disease, partial or total removal of the penis may be necessary to achieve adequate cancer control.

These operations are generally considered when less extensive treatment cannot safely remove the tumour. The decision should involve specialist discussion about cancer control, urinary function, sexual function, reconstruction where appropriate, and psychological support.

D. Treatment of lymph nodes

When cancer has spread to nearby lymph nodes, surgery or other treatments may be required.

Managing lymph node involvement is important because it can influence the risk of further spread and the patient’s prognosis.

E. Chemotherapy and radiation therapy

Chemotherapy may be used for selected advanced cancers or in combination with surgery or radiation.

Radiation therapy may be appropriate for certain patients depending on the tumour’s characteristics and stage.

Specialist teams determine the best approach based on the clinical evidence and individual circumstances.

8. Can Penile Cancer Be Cured?

Penile cancer can be curable, particularly when it is detected and treated at an early stage before it spreads to lymph nodes or distant organs.

The outlook depends on the tumour type, stage, grade, treatment response, and whether lymph nodes are involved.

Early diagnosis may allow treatment that preserves more of the penis and its normal function. More advanced disease can be harder to treat, which makes timely assessment particularly important.

Anyone diagnosed with penile cancer should receive care from an appropriate specialist team and follow the recommended treatment and follow-up plan.

9. Penile Cancer and Men’s Sexual Health

A diagnosis of penile cancer can affect physical health, sexual function, fertility-related concerns, confidence, and emotional well-being.

The impact depends on the tumour’s location and stage and the treatment required.

Some men retain normal or near-normal sexual function after treatment for early disease. Other treatments may affect erection, sensation, ejaculation, urination, or body image.

Counselling, psychological support, sexual health advice, and discussions with the treating team can help men and their partners manage these challenges.

Men should not delay seeking care because of embarrassment. Healthcare professionals are trained to assess genital symptoms respectfully and confidentially.

10. Myths and Facts About Penile Cancer

Myth 1: Penile cancer only affects older men.

Fact: It is more common in older men, but younger men can also develop it.

Myth 2: Every sore on the penis is cancer.

Fact: Penile sores can result from infections, injuries, or inflammatory skin conditions. Persistent or unexplained sores need medical evaluation.

Myth 3: Penile cancer always causes pain.

Fact: Some penile cancers cause little or no pain during their early stages.

Myth 4: Circumcision completely prevents penile cancer.

Fact: Circumcision may reduce certain risks, but it does not eliminate the possibility of developing penile cancer.

Myth 5: HPV infection always leads to cancer.

Fact: Most HPV infections clear naturally. Only a proportion of persistent infections involving high-risk HPV types contribute to cancer development.

Myth 6: Herbal remedies can cure penile cancer.

Fact: No herbal remedy has been proven to cure penile cancer. Unverified treatments can delay diagnosis and appropriate medical care.

Conclusion

Penile cancer is an uncommon but potentially serious disease that develops in the tissues of the penis. Risk factors include persistent infection with certain high-risk HPV types, smoking, chronic inflammation, phimosis, and some underlying skin conditions.

Although it is not possible to prevent every case, appropriate genital hygiene, HPV vaccination where recommended, avoiding tobacco, and seeking medical assessment for persistent penile abnormalities can help reduce certain risks and improve the likelihood of early diagnosis.

A persistent sore, lump, skin change, unexplained bleeding, or abnormal growth should never be ignored. Early assessment is important because treatment is often more successful when penile cancer is detected before it spreads.

The most important message is simple: awareness, prevention where possible, and timely medical care can help protect men’s health.

Medical Disclaimer

This article is intended for general health education and does not replace professional medical advice, diagnosis, or treatment. Anyone with a persistent penile sore, lump, unexplained bleeding, or other concerning genital symptoms should consult a qualified healthcare professional.

Published by: Research Consult Uganda

Website: https://www.researchconsultuganda.com

Promoting research, health education, and informed decision-making.