The causal pathways of penile SCCs are complex, and likely to be multifactorial in origin. Possible etiological factors are chronic irritation, repeated trauma to the penis (such as during sexual intercourse or masturbation), exposure to carcinogens (such as from smoking and/or sunlight), and viral infection. The precise relationship between these possibilities and SCC remains uncertain. Results from a recent paper point to the need for systematic investigations of SCC aetiology in general, rather than focusing on carcinogenic aetiologies alone.
Squamous cell carcinoma of the penis is often treated with external beam radiation therapy (EBRT) and inguinal lymph node irradiation (ILI). Both of these treatments are associated with significant treatment-related toxicity. However, a significant number of patients are able to achieve curative treatment with EBRT and ILI alone. Patients with stage I squamous cell carcinoma, small tumors (<4 cm) that are confined within the perineal skin (involving the foreskin but not the glans penis) may be eligible for EBRT and ILI without the need for a penectomy (complete removal of the penis) for patients choosing or having undergone a normal preoperative examination for carcinoma of the penis.
The incidence of SCCE is rising in the US, with more localized and localized SCCE more common than advanced and metastatic disease. Although less prevalent than penile cancer in men, SCCE remains an important treatment-limiting factor, especially in young males with localized disease.
No recurrence of SCCOP appears during the time of the study. Follow-up after treatment is necessary, however, for patients with SCCOP. This tumour type can probably not be cured. No treatment is possible after recurrence.
Results from a recent paper of the study indicate the need for more precise definitions of various types of SCCs of the penis. This must be done before making definitive conclusions and for the purposes of conducting studies regarding various factors associated with carcinoma development and the prognosis of patients suffering from this type of cancer.
Signs and symptoms of SCC of the penis include a lump in the scrotum that does not go away or seems to worsen and pain when urinating, soreness in the scrotum, painless discharge from the penis, and trouble swallowing, and a thickening or discolouration of the nail. Other symptoms include loss of interest in sex, trouble finding a partner, feeling of lack of enjoyment, decreased physical activity, and an increased appetite. The patient should be informed about risk factors, early symptoms, and treatment plans. Treatment is basically supportive, including control of pain and prevention of infection. Treatment must begin as early as the cancer progresses to minimize cancer related complications.
The [new] knowledge about SCC of the penis, the usual type, is rather modest compared to the [newly] known knowledge about HPV infections. The knowledge about treatment of SCC of the penis, the usual type, is modest too, but new treatment options have [become] more common in the last 20 years.
A higher average age of first exposure to penile carcinoma, usual type has been reported from several studies. The current study suggests that the lifetime risk of SCC of the usual type of penile cancer in the United Kingdom is 1.08% to 1.27%. An estimated 2077 cases of SCC of the usual type will have been diagnosed in England and Wales each year between 2009 and 2015, and 1088 patients (53.3%) were male. These data are significant, and in addition to confirming previously reported incidence and prevalence, they have shown an age-distribution. Data from a recent study also showed that the median age at diagnosis and at death were 70 and 73, respectively.
In our view, the patient with squamous cell carcinoma of the penis, usual type, who has no sign of metastasias at presentation should be invited to be treated with curative intent in a clinical study.
Based on our study, PLND/RT would be associated with prolonged survival. Lymph node dissection plus chemotherapy would be used in combination with RT in selected cases of clinically node-negative patients who have been definitively treated with curative intent, in order to minimize PLND morbidity and thus to optimize disease control and prolong survival.
Given the results, there is clear indication for pelvic lymphadenectomy. The question must be answered of whether the indication should be extended to other lymph nodes. In particular the need to remove lymph nodes in the groin or lower abdominal wall is uncertain. The evidence from individual analysis of subgroups is inconclusive. A randomized study with long-term follow-up seems required.
Pelvic lymph node dissection causes several common side effects and can cause lymphatic obstruction of variable extent. To minimize the side effects of pelvic lymph node dissection, an appropriate patient selection is required. The most important determinants are a low incidence of lymph node metastasis, short time for treatment (1 year) and no complications.