Penile Cancer: Symptoms, Types, Causes and Treatment

Penile cancer is a rare but impactful disease, carrying profound physical, psychological, and social consequences for those affected. While its incidence is relatively low in high-income countries, it poses a significant health challenge in various regions globally. Early detection and understanding of the disease are crucial for improving outcomes and preserving quality of life. This article explores the symptoms, types, causes, and treatment strategies for penile cancer, synthesizing the latest clinical insights and evidence-based recommendations.

Symptoms of Penile Cancer

Recognizing the symptoms of penile cancer early can make a significant difference in treatment outcomes. Many men delay seeking medical advice due to embarrassment or lack of awareness, so understanding the warning signs is vital for prompt intervention.

Symptom	Description	Prevalence/Notes	Sources
Lesion	Lump, ulcer, or growth on the penis	Most common first sign	4 7 11
Discoloration	Redness, white patches, or changes in skin	May be subtle or overlooked	4 6 7
Discharge	Foul-smelling fluid under foreskin	Common with advanced disease	4 6 7
Bleeding	Unexplained bleeding from penile tissue	May signal ulceration	4 7
Pain	Localized discomfort or tenderness	Less common in early stages	6 7

Table 1: Key Symptoms

Understanding the Early and Advanced Symptoms

Visible Lesions and Changes

The most common initial symptom is a visible lesion—such as a lump, ulcer, or wart-like growth—appearing anywhere on the penis, most often on the glans (head) or foreskin. These lesions can be painless at first but may become tender or ulcerated as the disease progresses. Some men notice thickening of penile skin or a persistent sore that does not heal 4 7 11.

Color and Skin Changes

Changes in the color or texture of penile skin, including redness, white patches (leukoplakia), or areas of darkening, may be early warning signs. These are often subtle and mistaken for benign conditions or infections 4 6 7.

Discharge and Bleeding

A foul-smelling discharge under the foreskin is a sign that the cancer may have advanced or become secondarily infected. Unexplained bleeding, especially from an ulcerated lesion, is another red flag that should prompt immediate medical attention 4 6 7.

Pain and Swelling

Pain is not usually an early symptom but may develop as the tumor grows or invades deeper tissues. Swelling of the penis or groin lymph nodes may indicate lymphatic spread of the disease 6 7 11.

Types of Penile Cancer

Penile cancer is not a single disease but comprises several distinct subtypes, each with unique features and clinical implications. Understanding these types helps guide diagnosis, prognosis, and treatment choices.

Type	Features/Description	HPV Association	Sources
Squamous Cell Carcinoma (SCC)	95% of penile cancers; several subtypes	Some subtypes related	1 3 4 7 11
Basaloid	Aggressive, often HPV-related	Strong	3 4
Warty	Papillomatous, HPV-related	Strong	3 4
Warty–Basaloid	Mixed features, high grade	Strong	3
Verrucous	Slow-growing, less aggressive	Rarely	4 7
Other Rare Types	Melanoma, sarcoma, lymphoma	Variable	4 7

Table 2: Penile Cancer Types

The Main Histological Types

Squamous Cell Carcinoma (SCC)

Over 95% of penile cancers are squamous cell carcinomas (SCC), which arise from the squamous epithelial cells lining the penis. SCC itself has several subtypes, each with different clinical behaviors and associations with human papillomavirus (HPV) infection 1 4 7 11.

Basaloid and Warty Subtypes

Basaloid and warty subtypes are particularly important because they are strongly associated with high-risk HPV infection. Basaloid carcinomas tend to be more aggressive and carry a higher risk of lymph node involvement and metastasis. Warty carcinomas, while also linked to HPV, are generally less aggressive, but mixed warty–basaloid tumors are considered high-grade and biologically aggressive 3 4.

Verrucous Carcinoma

Verrucous carcinoma is a rare, low-grade variant of SCC. It is slow-growing and less likely to metastasize, often presenting as a bulky, cauliflower-like mass 4 7.

Other Rare Types

Penile melanoma, sarcoma, and lymphoma are rare types of penile cancer, each requiring specialized management. These are much less common and may behave differently from SCC 4 7.

Causes of Penile Cancer

Penile cancer results from a complex interplay of infectious, behavioral, and genetic factors. Not all men with risk factors will develop the disease, but understanding the causes is key for prevention and early detection.

Cause	Description	Modifiability	Sources
HPV Infection	High-risk strains, especially HPV-16	Preventable	2 4 6 8 9 11
Lack of Circumcision	Higher risk if not circumcised neonatally	Modifiable	4 6 8 11
Chronic Inflammation	Phimosis, balanitis, lichen sclerosus	Modifiable	4 6 7 8 10
Poor Hygiene	Increases chronic irritation	Modifiable	4 6 8 10
Smoking	Chemicals promote carcinogenesis	Modifiable	4 6 8 10
Immunosuppression	HIV, immunosuppressive drugs	Partially	4 8
Genetic Factors	Rare, under investigation	Not modifiable	2 6
UVA Phototherapy	Used for skin conditions; slight risk	Modifiable	8 10

Table 3: Main Causes and Risk Factors

The Role of HPV Infection

HPV, particularly high-risk strains like HPV-16, is the most significant infectious cause of penile cancer. The virus integrates into host DNA and triggers oncogenic changes through its viral proteins. HPV-related penile cancers often have distinct histological features and may respond differently to treatment. HPV vaccination and safe sexual practices (e.g., condom use) are effective preventive measures 2 4 6 8 9 11.

Circumcision and Phimosis

Neonatal circumcision dramatically reduces the risk of penile cancer, likely due to lower rates of chronic inflammation and HPV infection. In contrast, men with phimosis (an inability to retract the foreskin) are at increased risk, as this condition promotes trapping of smegma, chronic irritation, and infection 4 6 8 11.

Chronic Inflammation and Poor Hygiene

Chronic inflammatory penile conditions, such as balanitis, lichen sclerosus, and persistent infections, can drive carcinogenesis over time. Poor genital hygiene exacerbates these risks, especially in uncircumcised men 4 6 7 8 10.

Lifestyle and Environmental Factors

Smoking is a well-established risk factor, as tobacco carcinogens are concentrated in smegma and can directly damage local tissues. UVA phototherapy, used in some skin diseases, has also been implicated in increasing risk, though this is relatively rare 4 6 8 10.

Immunosuppression and Genetic Factors

Men with weakened immune systems, whether due to HIV infection, organ transplantation, or immunosuppressive medications, have an elevated risk of penile cancer. Genetic and molecular factors are under active investigation but currently play a minor role in risk stratification 2 4 8.

Treatment of Penile Cancer

Treatment of penile cancer aims to completely remove the tumor while preserving as much penile function and appearance as possible. The therapeutic approach depends on the stage, histological type, and lymph node involvement, and often requires a multidisciplinary team for optimal outcomes.

Treatment	Indications	Key Considerations	Sources
Organ-preserving Surgery	Early-stage/localized disease	Maximize function/QOL	1 4 7 11
Topical Therapy/Radiation	Superficial or in situ lesions	Non-invasive, preserves organ	1 4 7
Partial/Total Penectomy	Advanced/local tumors	Higher morbidity/psychosocial	1 4 10 11
Lymph Node Dissection	Node-positive or high-risk cases	Crucial for prognosis	1 4 7 11 12
Chemotherapy	Advanced/metastatic disease	Often cisplatin-based	1 4 5 11 12
Radiotherapy	Adjuvant in selected cases	May follow surgery	4 12
Multimodal Therapy	Advanced or recurrent disease	Combines surgery + chemo ± RT	1 4 5 11 12

Table 4: Major Treatment Approaches

Organ-Preserving Treatments

For small, localized tumors, organ-preserving strategies are preferred. These include topical therapies (such as imiquimod or 5-fluorouracil), laser ablation, or limited surgical excision. The goal is to eradicate the tumor while maintaining sexual and urinary function. Local radiotherapy is also an option for superficial cancers 1 4 7 11.

Surgery: Partial and Total Penectomy

Larger or more invasive tumors may require partial or total penectomy. While effective for tumor control, these procedures carry significant physical and psychological consequences. Advances in surgical techniques have improved outcomes, but the impact on quality of life remains a major consideration 1 4 10 11.

Lymph Node Management

The status of regional (inguinal) lymph nodes is the most important prognostic factor in penile cancer. Even in the absence of palpable nodes, patients with high-risk tumors require invasive lymph node staging, such as sentinel node biopsy or early lymph node dissection. Early intervention in node-positive disease improves survival 1 4 7 11 12.

• Surgical lymphadenectomy is the mainstay for node-positive disease.
• Videoendoscopic approaches may reduce morbidity compared to open surgery 12.
• Individualized management is necessary, especially in advanced cases, emphasizing treatment at specialized centers 11 12.

Chemotherapy and Radiotherapy

Systemic chemotherapy, often cisplatin-based, is used for advanced or metastatic penile cancer, especially when there is lymph node involvement or distant spread. Adjuvant radiotherapy may be used to improve local control after surgery, particularly in patients with high-risk node-positive disease 1 4 5 11 12.

• Neoadjuvant (pre-surgical) chemotherapy can shrink tumors and improve surgical outcomes in advanced cases.
• Adjuvant chemoradiotherapy may provide additional benefit in selected high-stage patients 12.

Multimodal and Emerging Therapies

Most patients with advanced or recurrent disease benefit from a combination of therapies—surgery, chemotherapy, and sometimes radiotherapy. New targeted agents and immunotherapies are being investigated in clinical trials, reflecting an urgent need for more effective and less toxic treatments 4 5 11 12.

Quality of Life and Psychosocial Support

The impact of diagnosis and treatment on sexual function, body image, and mental health cannot be underestimated. Multidisciplinary care, including psychological support and rehabilitation, is critical for long-term well-being 4 11.

Conclusion

Penile cancer, though rare, remains a serious and potentially life-altering disease. Awareness of the symptoms, risk factors, and available treatments is essential for early detection and optimal management.

Key Points:

• Penile cancer most often presents with visible lesions, discoloration, or discharge; early recognition is vital 4 7 11.
• The majority of cases are squamous cell carcinomas, many associated with high-risk HPV infection 1 3 4 7 11.
• Major causes include HPV infection, lack of neonatal circumcision, chronic inflammation, poor hygiene, and smoking 2 4 6 8 9 11.
• Treatment is tailored to disease stage and may include organ-preserving surgery, lymph node management, chemotherapy, and radiotherapy 1 4 5 7 11 12.
• Lymph node involvement is the single most important prognostic factor; early and proper management is critical 1 4 7 11 12.
• Multidisciplinary care and treatment at specialized centers improve outcomes and quality of life 1 4 11 12.
• Prevention strategies—HPV vaccination, good hygiene, neonatal circumcision, and smoking cessation—can significantly reduce risk 4 6 8 9 11.

Early intervention saves lives—if you notice any persistent changes or lesions on your penis, consult a healthcare professional promptly.