Excision Tumor / Cyst
- What is an Excision Tumor / Cyst
- Effects of Excision Tumor / Cyst
- Candidates for Excision Tumor / Cyst
- Your Consultation
- The Excision Tumor / Cyst Procedure
What is an Excision Tumor / Cyst
Effects of Excision Tumor / Cyst
Candidates for Excision Tumor / Cyst
After performing a physical examination, it is usually necessary to obtain a tissue sample, or biopsy, of the cancerous cells for examination under the microscope. Tissue is obtained by inserting a needle into the area of abnormal skin or tissue or by removing the entire tumor in a surgical procedure called a wide local excision. Cancers are described by the type of cells from which they arise.
The Excision Tumor / Cyst Procedure
Surgery forms the foundation of treatment and can involve excision of the primary tumor and foreskin only, the entire penis, and/or the lymph nodes in the groin and pelvis. Patients with small Tis, Ta, or T1 tumors generally have only the foreskin and primary tumor (tumor involving the penis itself) resected. This is called a wide local excision. Larger tumors generally require removal of the entire penis. For patients with T2 and higher tumors without lymph nodes that can be felt on exam or seen on imaging studies, surgical removal of the shallow nodes on both sides of the groin is done in addition to resection of the primary tumor. If multiple groin lymph nodes are found to be involved with cancer, or if a patient presents with groin nodes that can be felt on exam or seen on imaging studies, the surgeon may also remove nodes from both the deep groin and pelvis to assess for further spread of disease.
Patients who have undergone treatment for penile cancer should be seen and carefully examined by a physician every 2 to 4 months for the first year. This is especially important for those patients who have not undergone removal of lymph nodes. The risk of developing spread to lymph nodes in the groin is greatest in the first 6 months after treatment. The cornerstone of follow-up care is physical examination, although sometimes imaging studies such as ultrasound of the groin may detect spread of cancer to lymph nodes even before those nodes can be felt on examination. CT scanning of the pelvis is also helpful in detecting abnormal nodes which cannot be detected on physical examination. If a patient has undergone removal of the penis, reconstruction of the penis by plastic surgery may be considered once a patient has been in remission for 2 years or more.
Penis cancer is an extremely rare tumor in North America where it affects less than 1 in 100,000 men. It often affects older men between the ages of 50 and 80 although a quarter of the cases involve men under the age of 50. It is a cancer that occurs on the shaft or tip of the penis and can be very dangerous, but in most cases can be treated very well.
What are the symptoms of penis cancer?
Penis cancer usually begins as a small lump or ulcer on the glands (head) but gradually enlarges and spreads to the rest of the penis shaft. It may develop into a fungating mass with foul smelling discharge and bleeding in advanced stages. Pain is not a common presenting complaint. Some men are embarrassed by their condition and are reluctant to seek medical help until the disease is advanced and harder to treat. The early signs of penis cancer include: 1) a wart like growth; 2) an open sore that won’t heal; 3) a reddish rash; 4) a persistent foul smelling discharge under the foreskin. Penis cancer first spreads to the lymph nodes in the groin and therefore another symptom might be swelling and/or pain in the groin. From there, penis cancer spreads to other lymph nodes in the body and to other organs.
Are there any self-care tips that I should be aware of?
It is important that all men periodically examine their penis for any lesions. In patients who aren’t circumcised, it is imperative that they periodically retract the foreskin to see if any lesions are present at the head of the penis. If anything looks suspicious, they should immediately contact their primary care physician and if there is any uncertainty they should be seen by a urologist. It is also imperative that if penis cancer is found, that the patient seeks out physicians at institutions that have significant experience in this rare cancer.
How can I prevent penile cancer?
Circumcision may decrease the risk. Men who are not circumcised should be taught at an early age the importance of cleaning beneath the foreskin as part of their personal hygiene. Good personal hygiene and safer sexual practices, such as abstinence, limiting the number of sexual partners, and use of condoms to prevent genital herpes infection, may decrease the risk of developing penile cancer.