Penile Cancer

Definition

Penile cancer is a rare malignant tumor of the penis, most commonly squamous cell carcinoma, arising from the skin or mucosa of the glans, prepuce, or shaft.

Epidemiology

• Accounts for less than 1% of male cancers in developed countries
• Higher prevalence in parts of Africa, Asia, and South America
• Most commonly affects men aged 50–70 years
• Strongly associated with poor hygiene and phimosis
• Increased risk in men with HPV infection (especially HPV-16 and HPV-18)
• Smoking and immunosuppression are additional risk factors
• Rare in circumcised men, particularly if circumcision performed in childhood

Etiology

• Human papillomavirus (HPV) infection, especially HPV-16 and HPV-18
• Chronic inflammation due to phimosis or balanitis
• Poor genital hygiene
• Smoking and tobacco exposure
• Chronic lichen sclerosus or other premalignant penile lesions
• Immunosuppression (HIV, post-transplant patients)
• Genetic predisposition is rare but may contribute

Pathophysiology

• Malignant transformation of squamous epithelial cells of the glans, prepuce, or penile shaft
• HPV-mediated oncogenesis via E6 and E7 viral proteins
• Progression from premalignant lesions (penile intraepithelial neoplasia) to invasive carcinoma
• Local invasion into underlying tissues, including corpora cavernosa and urethra
• Lymphatic spread to inguinal and pelvic lymph nodes
• Hematogenous spread is uncommon but may occur in advanced disease
• Chronic inflammation promotes carcinogenesis and tumor progression