Penile cancer surgery in India

Penile cancer is a rare form of cancer that forms in the penis. The
penis contains several types of tissues and different types of penile
cancer may develop in these cells. It is important for your health care
provider to determine which type of penile cells are affected in order
to gauge the seriousness of the disease and plan the best
treatment. Penile cancer is a very rare form of cancer that occurs
mostly in uncircumcised men (men with the foreskin, a piece of skin
covering the head of their penis, intact). The penis is the external
male genital organ, and consists of three chambers of spongy tissue
that contain multiple blood vessels, nerves, and smooth muscle. The
corpora cavernosa make up two of the chambers, and are located on
both sides of the upper part of the penis. The corpus spongiosum is
located below the corpora cavernosa and surrounds the urethra, the
tube through which urine and semen exit the body at an opening
called the meatus. At the tip of the penis, the corpora cavernosa
expands to form the helmet, or glands.

There are several types of penile cancers:

Epidermis carcinoma. Ninety-five percent (95%) of penile cancer is

epidermis, or squamous cell carcinoma. This means that, under a
microscope, the cells resemble the tissues that make up skin. There
is non-melanoma skin cancer that can develop anywhere on the
penis, but most develop on or under the foreskin. When found at an
early stage, epidermis carcinoma can usually be cured.

Basal cell penile cancer. Under the squamous cells in the lower
epidermis (one of the layers of the tissues that cover the penis) are
round cells known as basal cells. These can occasionally become
cancerous. Less than 2% of penile cancers are basal cell cancers.

Melanoma. The deepest layer of the epidermis contains scattered

cells called melanocytes, which produce the melanin that gives skin
color. Melanoma starts in melanocytes, and it is the most serious of
the skin cancer types. While the penis is not usually exposed directly
to sunlight, this sun-related cancer does occasionally occur on the
surface of the penis.
Sarcoma. About 1% of penile cancers are sarcomas, cancers that
develop in the tissues that support and connect the body, such as
blood vessels, smooth muscle, and fat.

Risk Factors and Prevention

A risk factor is anything that increases a person's chance of
developing a disease, including cancer. For cancer in general, there
are risk factors that can be controlled, such as smoking, and risk
factors that cannot be controlled, such as family history. Although risk
factors can influence disease, they do not cause cancer. Some
people with several risk factors never develop the disease, while
others with no known risk factors do. Knowing your risk factors and
communicating with your doctor can help guide you in making wise
lifestyle and health-care choices.

The following factors can raise a person's risk of developing penile

cancer:

Human papillomavirus (HPV) infection. The most important risk

factor is infection with HPV. HPV is passed from one person to
another during sexual intercourse. High-risk sexual behavior that can
lead to HPV infection includes intercourse at an early age, multiple
sexual partners, sex with a person who has had many partners, and
unprotected sex.

Smoking. Smoking may contribute to the development of penile

cancer, especially in men who are also infected with HPV.

Age. Most cases of penile cancer occur in men over age 50, but
occur in men younger than 40 about 20% of the time.

Smegma. Smegma is a thick substance that can accumulate under

the foreskin and is caused by dead skin cells, bacteria, and oily
secretions from the skin. Smegma may contain small amounts of
cancer-causing substances. Uncircumcised men should retract the
foreskin and thoroughly wash the penis on a regular basis, in order to
make sure that smegma does not cause irritation of the penis.
Phimosis. Phimosis occurs when the foreskin becomes constricted
and is difficult to retract, therefore causing a buildup of smegma. Men
with phimosis are less likely to be able to thoroughly clean the penis.

HIV/AIDS infection. Infection with human immunodeficiency virus

(HIV), the virus that causes acquired immune deficiency syndrome
(AIDS), is also a risk factor. When a person is HIV positive, their
immune system is less able to fight off early stage cancers.

Psoriasis treatment. Men who have been treated with the drug
psoralen combined with ultraviolet (UV) light have a higher risk of
developing penile cancer.

Circumcision. Circumcision is a procedure to remove the foreskin of

the penis and may provide some protection from penile cancer due to
improved hygiene. Squamous cell carcinoma of the penis almost
never occurs in men who are circumcised. It is important to note that
circumcision alone cannot prevent penile cancer.

Personal hygiene. Men who carefully and completely clean under

the foreskin on a regular basis can reduce their risk of developing
penile cancer.

While it is not possible to completely prevent penile cancer, a man

can reduce his risk by avoiding the known risk factors, especially
smoking, avoiding sexual practices that could lead to HPV or
HIV/AIDS infection, and practicing good hygiene.

Symptoms
Men with penile cancer often experience the symptoms below.
Sometimes, men with penile cancer do not show any of these
symptoms. Or, these symptoms may be similar to those of other
medical conditions. If you are concerned about a symptom on this list,
please talk to your doctor.

• A growth or ulcer on the penis, especially on the glands or

foreskin, but also on the shaft
• Changes in color on the penis
• Skin thickening on the penis
• Persistent discharge with foul odor beneath the foreskin
 • Blood coming from the tip of the penis or under the foreskin
• Unexplained pain in the shaft or tip of the penis
• Irregular or growing bluish-brown flat lesions or marks beneath
the foreskin or on the body of the penis
• Reddish, velvety rash beneath the foreskin
• Small, crusty bumps beneath the foreskin
• Swollen groin lymph nodes

Irregular swelling at the end of the penis. Penile cancer starts on the
glands (head), or tip, of the penis and spreads from there. Some men
may have obvious symptoms in the early stages, while others may
not have any symptoms until the disease has advanced. Although it
may not mean cancer, any abnormalities of the penis should be
reported to your doctor as soon as possible. Unfortunately, many men
are reluctant to discuss these issues with their physician, and may
delay seeking treatment until the disease is advanced and harder to
treat.

Men who have retained their foreskin need to examine the area
underneath the foreskin regularly, as well as to keep the area clean to
lower their risk. Penile cancer symptoms may include:

• A wart-like growth or lesion

• An open sore that won't heal
• A reddish rash
• Persistent, smelly discharge under the foreskin
•

Diagnosis
Doctors use many tests to diagnose cancer and determine if it has
metastasized (spread). Some tests may also determine which
treatments may be the most effective. For most types of cancer, a
biopsy is the only way to make a definitive diagnosis of cancer. If a
biopsy is not possible, the doctor may suggest other tests that will
help make a diagnosis. Imaging tests may be used to find out
whether the cancer has metastasized. Your doctor may consider
these factors when choosing a diagnostic test:

• Age and medical condition

 • The type of cancer
• Severity of symptoms
• Previous test results

The following tests may be used to diagnose penile cancer:

Biopsy. A biopsy removes a small amount of tissue for examination

under a microscope. Other tests can suggest that cancer is present,
but only a biopsy can make a diagnosis for certain.

Fine needle aspiration. A local anesthetic may be injected into the

skin near the nodule prior to the biopsy. The doctor will insert a thin
needle into the nodule and extract (take out) cells and some fluid.
The procedure may be repeated two or three times to obtain samples
from different areas of the nodule. The report, done by a pathologist,
can be positive (for malignant cells), negative, or undetermined.

Sentinel lymph node biopsy. It is important to know if cancer cells

have spread to other areas. In this technique, the doctor removes one
or a few sentinel lymph nodes, the first node(s) into which the lymph
system drains, to check for cancer cells. In the case of penile cancer,
the sentinel lymph nodes are located just under the skin in the groin.
If cancer cells are detected, it means that the disease may have
spread to other lymph nodes in the region or beyond through the
blood and lymph vessels.

X-ray. A picture is taken of areas inside the body to help the doctor
identify the presence of a tumor. An x-ray is usually used to examine
the lungs for evidence of metastases. This is known as a chest x-ray.

Computerized tomography (CT or CAT) scan. A CT scan creates a

three-dimensional picture of the inside of the body with an x-ray
machine. A computer then combines these images into a detailed,
cross-sectional view that shows abnormalities or tumors.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields,

not x-rays, to produce detailed images of the body.

Treatment
Through ongoing research, the medications used to treat cancer are
constantly being evaluated in different combinations and to treat
different cancers. Talking with your doctor is often the best way to
learn about the medications you've been prescribed, their purpose,
and their potential side effects or interactions.

The treatment of penile cancer depends on the size and location of

the tumor, whether the cancer has spread, and the person's overall
health. In many cases, a team of doctors will work with the patient to
determine the best treatment plan.

Surgery
The main penile cancer treatment (taking out the cancer in an
operation).

Surgery is the most common treatment of all stages of cancer of the

penis. A doctor may take out the cancer using one of the following
operations: Different types of surgical procedures given below.

Wide local excision takes out only the cancer and some healthy
tissue on either side. This is used when cancer has spread over a
wider area.

Microsurgery is an operation that removes cancerous tissue and the

smallest amount of healthy tissue. During this surgery, the doctor
uses a microscope to check at the cancerous area to make sure all
the cancer cells are removed.

Laser (Light Amplification by Stimulated Emission of Radiation)

surgery uses a narrow beam of light to dissolve or burn away cancer
cells. Its advantage is that is causes very little post operative scarring
and is very exact, not damaging surrounding tissues.

Circumcision (A circumcision is an operation in which the doctor takes

away part or the entire foreskin from the penis- The foreskin is the
skin, which covers the tip of the penis.)

Removing the penis (penectomy) is an operation that takes out the

penis. It is the common and most effective treatment for the penile
cancer. This may be advised if the cancer is large and is covering a
large area of the penis. This is an operation. In a partial penectomy,
part of the penis is taken out. In a total penectomy, the whole penis is
removed. Lymph nodes in the groin may be taken out during surgery.
If the tumour is near the base of the penis, total penectomy may be
the only option.

2. Radiation therapy

In Radiation therapy uses high-dose x-rays or other high-energy rays

to kill malignant cells and shrink tumors. This is used alone or as an
alternative to surgery. Radiation therapy to the penis may work best
in patients with low stage disease. This may improve effectiveness
after resection of localized lesions without metastasis; it may also
reduce the size of lymph nodes before nodal resection. Radiation
may come from a machine outside the body (external radiation) or
from putting materials that contain radiation through thin plastic tubes
into the area where the cancer cells are (internal radiation). Each
treatment takes 10–15 minutes. The number of treatments will
depend on the type and size of the cancer but the whole course of
treatment for early cancer will usually last up to six weeks.

3. Chemotherapy

Chemotherapy (using drugs to kill the cancer cells). It can be one

drug or several drugs used together. It is not commonly used to treat
cancer of the penis. Chemotherapy cream may sometimes be used to
treat very small, early cancers that are confined to the foreskin and
end of the penis (glands). Chemotherapy may also be given as
tablets or by injection into a vein for more advanced cancer. It may be
given along with surgery or radiotherapy (or both). This treatment is
still experimental and is given as part of research trials (clinical trials).
The side effects of chemotherapy are hair loss, nausea, vomiting,
diarrhea, lowered blood counts, and an increased risk of infection.

4. Biological therapy

Biological therapy (BRM Therapy restores the body's natural

defenses against disease)
The chance of recovery and choice of treatment depend on the stage
of the cancer and the patient's general state of health. There are
incidents of the cancer recurring after it has been treated.

Treatment by Stage
Treatment of penile cancer depends on the type of cancer and the
stage of the cancer.

• For stage I - If cancer is limited to the foreskin, treatment will be

wide local excision and circumcision. If cancer is only on the
glans, treatment may involve the use of a Fluorouracil cream
or microsurgery. If the tumour originating from the glands, has
started to invade adjacent parts of the penis, partial penectomy
with or without groin node dissection (GND), teletherapy.
Microsurgery, laser may involve.
• For stage II - Stage II cancer may managed by amputation of
the penis that is; partial penectomy, total penectomy or radical
penectomy is an alternative approach. Radiation treatment may
also involve.
• For stage III - Treatment may be amputation of the penis,
followed by removal of lymph nodes on both sides of the groin
or amputation of the penis followed by partial or total
penectomy, with one sided (unilateral) or both sided (bilateral)
GND. Some form of penectomy followed by irradiation,
Chemotherapy with or without irradiation.
• For stage IV - Treatments are similar to that for Stage III cancer.
• For recurrent - If the cancer has come back, treatment may
partial or total penectomy, radiation, or chemotherapy.
Biological therapy is also being conducted.

Side Effects of Cancer and Cancer Treatment

Cancer and cancer treatment can cause a variety of side effects;
some are easily controlled and others require specialized care. Below
are some of the side effects that are more common to penile cancer
and its treatments.

Fatigue (tiredness). Fatigue is extreme exhaustion or tiredness, and

is the most common problem that people with cancer experience.
More than one-half of patients experience fatigue during
chemotherapy or radiation therapy, and up to 70% of patients with
advanced cancer experience fatigue. Patients who feel fatigue often
say that even a small effort, such as walking across a room, can
seem like too much. Fatigue can seriously impact family and other
daily activities, can make patients avoid or skip cancer treatments,
and may even impact the will to live.

Hair loss (alopecia). A potential side effect of radiation therapy and

chemotherapy is hair loss. Radiation therapy and chemotherapy
cause hair loss by damaging the hair follicles responsible for hair
growth. Hair loss may occur throughout the body, including the head,
face, arms, legs, underarms, and pubic area. The hair may fall out
entirely, gradually, or in sections. In some cases, the hair will simply
thin-sometimes unnoticeably-and may become duller and dryer.
Losing one's hair can be a psychologically and emotionally
challenging experience and can affect a patient's self-image and
quality of life. However, the hair loss is usually temporary, and the
hair often grows back.

Infection. An infection occurs when harmful bacteria, viruses, or fungi

(such as yeast) invade the body and the immune system is not able
to destroy them quickly enough. Patients with cancer are more likely
to develop infections because both cancer and cancer treatments
(particularly chemotherapy and radiation therapy to the bones or
extensive areas of the body) can weaken the immune system.
Symptoms of infection include fever (temperature of 100.5°F or
higher); chills or sweating; sore throat or sores in the mouth;
abdominal pain; pain or burning when urinating or frequent urination;
diarrhea or sores around the anus; cough or breathlessness;
redness, swelling, or pain, particularly around a cut or wound; and
unusual vaginal discharge or itching.

Mouth sores (mucositis). Mucositis is an inflammation of the inside

of the mouth and throat, leading to painful ulcers and mouth sores. It
occurs in up to 40% of patients receiving chemotherapy treatments.
Mucositis can be caused by a chemotherapeutic drug directly, the
reduced immunity brought on by chemotherapy, or radiation
treatment to the head and neck area.
Nausea and vomiting. Vomiting, also called emesis or throwing up,
is the act of expelling the contents of the stomach through the mouth.
It is a natural way for the body to rid itself of harmful substances.
Nausea is the urge to vomit. Nausea and vomiting are common in
patients receiving chemotherapy for cancer and in some patients
receiving radiation therapy. Many patients with cancer say they fear
nausea and vomiting more than any other side effects of treatment.
When it is minor and treated quickly, nausea and vomiting can be
quite uncomfortable but cause no serious problems. Persistent
vomiting can cause dehydration, electrolyte imbalance, weight loss,
depression, and avoidance of chemotherapy.

Nervous system disturbances. Nervous system disturbances can

be caused by many different factors, including cancer, cancer
treatments, medications, or other disorders. Symptoms that result
from a disruption or damage to the nerves caused by cancer
treatment (such as surgery, radiation treatment, or chemotherapy)
can appear soon after treatment or many years later. See Managing
Side Effects: Nervous System Disturbances for the most common
symptoms.

Sexual dysfunction. Sexual dysfunction is common in all people,

affecting up to 43% of women and 31% of men. It may be even more
common in patients with cancer, as a result of treatments, the tumor,
or stress. Many people, with or without cancer, find it intimidating to
discuss sexual problems with their doctors. Sexual problems are
most commonly caused by body changes from cancer surgery,
chemotherapy or radiation therapy, hormone changes, fatigue
(tiredness), pain, nausea and/or vomiting, medications that reduce
libido (desire for sex), fear of recurrence, stress, depression, and
anxiety. Symptoms of sexual dysfunction generally fall into four
categories: desire disorders, arousal disorders, orgasmic disorders,
and pain disorders. Specific problems may occur in the patient who
has had surgery to remove all or part of the penis, and this requires
careful counseling and assistance by experts in the field.

Skin problems. The skin is an organ system that contains many

nerves. Because of this, skin problems can be very painful. Because
the skin is on the outside of the body and visible to others, many
patients find skin problems especially difficult to cope with. Because
the skin protects the inside of the body from infection, skin problems
can often lead to other serious problems. As with other side effects,
prevention or early treatment is best. In other cases, treatment and
wound care can often improve pain and quality of life. Skin problems
can have many different causes, including chemotherapeutic drugs
leaking out of the intravenous (IV) tube, which can cause pain or
burning; peeling or burned skin caused by radiation therapy; pressure
ulcers (bed sores) caused by constant pressure on one area of the
body; and pruritus (itching) in patients with cancer, most often caused
by leukemia, lymphoma, myeloma, or other cancers.

Ways to Reduce Penile Cancer

Penile cancer is very treatable and is often cured. Adding these tips
to your daily routine can help to lower your penile cancer risk. The
chance of recovery and choice of treatment depend on the stage of
the cancer (whether it is just in the penis or has spread to other
places), and the general state of health of the patient.

• Clean the penis routinely and effectively, especially under your

foreskin.
• Practice safe sex and limit the number of sexual partners during
your lifetime.
• Do not smoke cigarettes. Cigarette smokers have a higher risk
of developing penile cancer than non-smokers.
• Know the symptoms of penile cancer (growths or sores on the
penis or abnormal discharge or bleeding from the penis). Notify
your doctor if you notice any of these changes.

After Treatment
After the treatment of penile cancer, a patient will be followed
regularly by his oncologist or surgeon. The patient will typically have
regular physical examinations, with specific examination of the penis
itself and the lymph nodes in the groin. Depending on the anticipated
level of risk of relapse, a patient may need to undergo occasional
chest x-rays or CT scans, as well as some blood tests.

Once the patient has been effectively treated for penile cancer, it is
wise to practice safe sex and to ensure that careful hygiene is
practiced. There are no drugs or remedies proven to reduce the
chances of relapse or second primary cancers in this setting.

Medical tourism India

From Some years international patients are frequently coming to
India for quality medical treatment, from developed countries like the
US, UK and Canada, Now days the hospitals of penile cancer
surgery in India are in boom due to the low cost and better medical
healthcare facilities. There are a number of good reasons for the
international patients to travel to India for penile cancer surgery:
Cost of Treatment, quality of care, quality of equipment & facilities,
quality of overall experience, prompt access to treatment, excellent
Doctors with international experience, modern Hospitals with state of
the art equipment, typical savings of 70% of treatment cost, exciting
environment, complete treatment packages - you don’t go home after
3 days, dedicated nursing staff & deluxe rooms. Indian hospitals are
recording increasing number of international patients for penile
cancer surgery in India. The cancer surgery hospitals of Delhi and
Mumbai have hired abroad trained medical experts to provide penile
cancer surgery in India to abroad patients having penile cancer
disorder. In recent years the outsourcing of international patient
cases to India to cure diseases in the uro-reproductive organs has
increased and each year many cases of penile cancer approach
cancer surgeons of Delhi and Mumbai for cure. Penile cancer
surgery in India is available at a comparative cheap cost. Penile
cancer surgery serves as a medical solution when cancer tumors
take over the region of male penis thus hindering urination process
and normal sexual activity. As a medically invasive procedure penile
cancer surgery in India is being operated by JCI accredited cancer
surgeons at Delhi, Bangalore, Chennai and Hyderabad. The cost of
medical treatment in India can save you money up to 60% along with
the benefit of getting world class healthcare in a developing Asian
country. Getting all arrangements in advance for medical treatment in
India is now very as medical tourism in India having tie ups with the
best cancer surgeons and cancer surgery hospitals of India is helping
patients to get recovery from penile cancer disorder with a
medically safe penile cancer surgery in India with a positive
outcome and less cost. For further details on the low cost penile
cancer treatment in India visit us
atwww.indiancancersurgerysite.com or mail your queries at
info@indiacancersurgerysite.com or talk to us at +91
9579034639.

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