Penile Cancer: Role of Hygiene, Smoking & Sexual Health Habits - Dr Suhail Ahmed M

Penile cancer is rare but is a serious malignancy that arises from the tissues of the penis, commonly from the squamous cells of the skin. Globally in 2020 there were over 36,000 newly diagnosed cases and more than 13,000 deaths associated to penile carcinoma. Hence, this highlights the rarity as well as its severity when it is detected late.

Penile cancer is diagnosed majority in older men, most commonly from the ages of 50 to 60 years, and it begins in the skin of the glans or the tip of the foreskin (in uncircumcised men), histologically as squamous cell carcinomas. It is important to understand the interplay of both modifiable as well as non-modifiable risk factors that include genital hygiene, sexual habits and tobacco use.

Genital health plays an important factor in risk modulation. Men who are uncircumcised, and do not thoroughly clean under the foreskin can develop a buildup of smegma, which is the secretion that is composed of skin oils, dead cells and moisture. This accumulation leads to chronic irritation and inflammation which is a strong factor associated with developing penile cancer.

Another condition that can interrupt genital health is Phimosis, in which the foreskin cannot be retracted, which further gives way to poor hygiene which significantly increases cancer risk.

Sexual health also influences the risk of penile cancer. The human papillomavirus also known as HPV, along with subtypes of HPV -16 and HPV -18 is associated with significant proportion (40-50%) of penile cancer since the transmission occurs through skin-to-skin genital contact, that includes, vaginal, anal and oral.

Men with early sexual debut or history of having multiple partners and having a history with other sexually transmitted infections have an increased risk of acquiring persistent HPV infection, in turn increasing the risk of penile cancer.

Smoking as well as tobacco use via cigarettes, chewing tobacco is an important risk factor. Carcinogens in tobacco will damage DNA, it also supresses the local immune defences which makes the tissues more receptive to malignant transformation. Smokers are more prone by 4.5 folds to have an increased risk of developing penile cancer rather than non-smokers.

What are the symptoms one must look out for:

Penile cancer is not drastic, it usually beings subtly, hence this makes awareness and the warning signs important.

The common symptoms are:

- Painless ulcer or wart on the penis that can bleed.

- Change in texture or colour of the skin, including thickening or rashes.

- Discharge with odour

- Flat growths that are usually bluish brown in colour

- Irritation or swelling on the foreskin or glans.

As the disease progresses and if it is left untreated then additional signs such as weight loss and swollen lymph nodes in the groin region or fatigue can be seen. As these symptoms are seen, it is advised to have a prompted evaluation by a healthcare provider since these are also common symptoms to infections or inflammatory conditions, which makes it difficult to distinguish.

What are the prevention strategies to look out for:

Not all cases are preventable, but this does help in substantially lowering the risk.

- Good genital hygiene: cleaning the area daily, including retracting the foreskin which in turn reduces smegma build up and helps in reducing inflammations.

- Quitting smoking tends to decrease the risk of systemic carcinogen exposure. This in turn improves immune function too.

- Safe sexual practices such as using of condoms, not having multiple sexual partners and a regular screening of STI can always reduce the risk of STI or HPV acquisition.

- Vaccinations against sexually transmitted infections are advised; this is ideally before the sexual debut of an individual which protects high risk strains that are associated to penile cancers.

It is important to understand penile cancer as a significant healthcare concern due to it highly impacting the quality of life. Hence, early symptom recognition and consistent medical evaluations and preventive actions are essential.

Disclaimer: The views expressed in this article are of the author and not of Health Dialogues. The Editorial/Content team of Health Dialogues has not contributed to the writing/editing/packaging of this article.