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14-September-2008 11:27:25 - of the penis Carcinoma of the penis Classification and external resources ICD-10 C60. ICD-9 187 MeSH D010412 Penile cancer is a malignant growth found on the skin or in the tissues of the penis. A Squamous cell carcinoma usually originating in the glans or foreskin is by far the most common type, occurring in 9 out of 10 cases.1 Penile cancer is very rare in Europe and North America, occurring in about one in 100,000 men in the latter. It accounts for 0.2% of cancers and 0.1% of deaths from cancer amongst males in the United States. However, in some parts of Africa and South America it accounts for up to 10% of cancers in men.2 Contents 1 Symptoms 2 Pathology 3 Staging 4 Treatment 5 Risk factors 5.1 Circumcision 6 Vaccine 7 References Symptoms Redness, irritation, or a sore on the penis or a lump on the penis. Anyone with these symptoms should consult a doctor immediately.3 Pathology A. Precancerous Dermatologic Lesions B. Carcinoma in Situ Bowen Disease, Erythroplasia of Queyrat C. Invasive Carcinoma of the Penis Staging Like many malignancies, penile cancer can spread to other parts of the body. It is usually a primary malignancy, the initial place from which a cancer spreads in the body. Much less often it is a secondary malignancy, one in which the cancer has spread to the penis from elsewhere. Doctors use the extent of metastasis to estimate what stage the disease is in, to aid in treatment decisions and prognosis. The stages are assessed as follows: Stage I - Cancer has only affected the glans and/or foreskin. Stage II - Cancer has spread to the shaft of the penis. Stage III - Cancer has affected the penis and surrounding lymph nodes. Stage IV - Cancer has moved beyond the groin area to other parts of the body. Recurrent - Cancer that has returned after treatment. Prognosis can range considerably for patients, depending where on the scale they have been staged. Generally speaking, the earlier the cancer is diagnosed, the better the prognosis. The overall 5-year survival rate for all stages of penile cancer is about 50%. Treatment There are several treatment options for penile cancer, depending on staging. They include surgery, radiation therapy, chemotherapy, and biological therapy. The most common treatment is one of five types of surgery: Wide local excision - The tumor and some surrounding healthy tissue are removed Microsurgery - Surgery performed with a microscope is used to remove the tumor and as little healthy tissue as possible Laser surgery - laser light is used to burn or cut away cancerous cells Circumcision - cancerous foreskin is removed Amputation penectomy - a partial or total removal of the penis, and possibly the associated lymph nodes. This is the most common and effective treatment. Radiation therapy is usually used adjuvantly with surgery to reduce the risk of recurrence. With earlier stages of penile cancer, a combination of topical chemotherapy and less invasive surgery may be used. More advanced stages of penile cancer usually require a combination of surgery, radiation and chemotherapy. Risk factors The exact cause of penile cancer is unknown. The American Cancer Society provides the following as risk factors for penile cancer:4 human papillomavirus HPV infection, smoking, smegma, phimosis, treatment of psoriasis, age, and AIDS. The other etiologic factor most commonly associated with penile carcinoma is poor hygiene. There is some evidence that lichen sclerosus also known as balanitis xerotica obliterans may also be a risk factor.5 Circumcision There has been some debate over whether circumcision is a form of prevention. The American Medical Association and the Royal Australasian College of Physicians say the use of infant circumcision in hope of preventing penile cancer in adulthood is not justified.67 The American Cancer Society has said that the suggestion that circumcision reduces penile cancer rates, were based on studies that were flawed because they failed to consider other factors that are now known to affect penile cancer risk. It concluded: The current consensus of most experts is that circumcision should not be recommended as a prevention strategy for penile cancer.8 One study reported a lifetime risk of a man in the United States developing invasive penile cancer IPC to be 1 in 600 if he is uncircumcised.9 though this study was found to be flawed.10 Several studies report that the risk is higher if a male was not circumcised neonatally, with relative risk estimates including 3.211 and 2212 associated with the presence of a foreskin, and 0.41 associated with its absence.13 Several authors also state that there is a lower incidence of penile cancer in circumcised men.1415161417 A few studies suggested that circumcision decreased the risk of HPV infection in males.181920 Whether this decreases the risk of developing penile cancer is debatable.citation neededA study that concluded circumcision did not prevent penile cancer was done by Wallerstein, which reported that the risk of penile cancer in Japan, Norway, and Sweden countries with a low rate of circumcision is about the same 1 in 100,000 per year as in the US.21 Vaccine Main article: HPV vaccine Infection with HPV is associated with some penile cancers. A quadri-valent vaccine Gardasil to prevent infection by some types of HPV has been developed, successfully tested and approved for women by the US Food and Drug Administration.22 Approval for men is expected in 2008.citation needed It is licensed and in production, and could substantially reduce the incidence of HPV infection in men, the incidence of genital warts and ano-genital cancers including penile cancer, and mortality.23 References ^ Cancer Research UK: Types of penile cancer. Retrieved on 2008-06-24. ^ ACS :: What Are the Key Statistics About Penile Cancer?. Retrieved on 2007-12-13. ^ Penis Cancer. Retrieved on 2008-06-24. ^ ACS :: What Are the Risk Factors for Penile Cancer?. Retrieved on 2007-12-13. ^ bmj.com Rapid Responses for Rickwood et al., 321 7264 792-793. Retrieved on 2007-12-13. ^ AMA CSAPH Report 10 of the Council on Scientific Affairs I-99 Full Text. Retrieved on 2007-12-13. ^ racp.edu.au. Retrieved on 2007-12-13. ^ Can Penile Cancer Be Prevented?. ^ Kochen M, McCurdy S 1980. Circumcision and the risk of cancer of the penis. A life-table analysis. Am. J. Dis. Child. 134 5: 484-6. PMID 7377156. ^ Ronald L. Poland 1990. The question of routine neonatal circumcision. The New England Journal of Medicine 22 18: 1312-1315. ^ Maden C, Sherman KJ, Beckmann AM, et al 1993. History of circumcision, medical conditions, and sexual activity and risk of penile cancer. J. Natl. Cancer Inst. 85 1: 19-24. doi:10.1093/jnci/85.1.19. PMID 8380060. ^ Schoen EJ, Oehrli M, Colby C, Machin G 2000. The highly protective effect of newborn circumcision against invasive penile cancer. Pediatrics 105 3: E36. doi:10.1542/peds.105.3.e36. PMID 10699138. ^ Tsen HF, Morgenstern H, Mack T, Peters RK 2001. Risk factors for penile cancer: results of a population-based case-control study in Los Angeles County United States. Cancer Causes Control 12 3: 267-77. PMID 11405332. ^ a b Dillner J, von Krogh G, Horenblas S, Meijer CJ 2000. Etiology of squamous cell carcinoma of the penis. Scand J Urol Nephrol Suppl 34 205: 189-93. doi:10.1080/00365590050509913. PMID 11144896. ^ Gajalakshmi CK, Shanta V 1993. Association between cervical and penile cancers in Madras, India. Acta Oncol 32 6: 617-20. PMID 8260177. ^ Sánchez Merino JM, Parra Muntaner L, Jiménez Rodríguez M, Valerdiz Casasola S, Monsalve Rodríguez M, García Alonso J 2000. Epidermoid carcinoma of the penis in Spanish; Castilian. Arch. Esp. Urol. 53 9: 799-808. PMID 11196386. ^ Schoeneich G, Perabo FG, Müller SC 1999. Squamous cell carcinoma of the penis. Andrologia 31 Suppl 1: 17-20. PMID 10643514. ^ Castellsagué X, Bosch FX, Muñoz N, et al 2002. Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. N. Engl. J. Med. 346 15: 1105-12. doi:10.1056/NEJMoa011688. PMID 11948269. ^ Baldwin SB, Wallace DR, Papenfuss MR, Abrahamsen M, Vaught LC, Giuliano AR 2004. Condom use and other factors affecting penile human papillomavirus detection in men attending a sexually transmitted disease clinic. Sex Transm Dis 31 10: 601-7. PMID 15388997. ^ Svare EI, Kjaer SK, Worm AM, Osterlind A, Meijer CJ, van den Brule AJ 2002. Risk factors for genital HPV DNA in men resemble those found in women: a study of male attendees at a Danish STD clinic. Sex Transm Infect 78 3: 215-8. doi:10.1136/sti.78.3.215. PMID 12238658. ^ Wallerstein E February 1985. Circumcision. The uniquely American medical enigma. Urol. Clin. North Am. 12 1: 123-32. PMID 3883617. ^ Access to articles : Nature Reviews Drug Discovery. Retrieved on 2007-12-13. ^ Vaccination against human papillomaviruses shows great promise. Retrieved on 2007-12-13. v d e Tumors: urogenital neoplasia - genital neoplasia C51-C63/D25-29, 179-187/218-222 Female Ovaries Surface epithelial-stromal tumor, Luteoma, Meigs syndrome, Krukenberg tumor, Teratoma, Clear cell adenocarcinoma, Endometrioid tumor, Fibroma Fallopian tube Primary fallopian tube cancer, Adenomatoid tumor Uterus Uterus Uterine sarcoma, Leiomyosarcoma Endometrium Endometrioid tumor Cervix SCC, Cervical intraepithelial neoplasia Vagina Vagina SCC, Botryoid rhabdomyosarcoma, Adenocarcinoma/Clear cell adenocarcinoma Vulva Vulva Papillary hidradenoma, Extramammary Paget's disease Male Testicles Seminoma - Spermatocytic seminoma - Endodermal sinus tumor yolk sac tumor - Embryonal tumor - Choriocarcinoma - Teratoma - Leydig cell tumor - Sertoli cell tumor Prostate Prostate - Transitional cell carcinoma - Prostatic intraepithelial neoplasia Penis Penis Extramammary Paget's disease Male/female Sex cord-stromal tumour Sertoli-Leydig cell tumour, Thecoma, Granulosa cell tumour - Germ cell tumor - Gonadoblastoma - Brenner tumour - Embryonal carcinoma See also noncongenital, congenital Retrieved from http://en..org/wiki/Carcinoma_of_the_penis Categories: Andrology | Types of cancer | PenisHidden categories: All articles with statements | Articles with statements since June 2008 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Español Hrvatski 日本語 Suomi 中文 This page was last modified on 25 August 2008, at 04:35
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