Tumors of the penis

Tumors of the penis is divided into benign and malignant. The first most common viral HPV (genital warts). It villous, usually a multiple of education in size from 1 mm to 1 cm in diameter, pink or red, located at the head of the penis or the inner leaf of the foreskin (printing. Fig. 9). Proven viral etiology of these papillomas, they are contagious and are spread through sexual contact. Treatment - electrosurgical (excision of their electrocautery or electrocoagulation).
A malignant tumor of - penile cancer is rare. One of the causes of cancer of the penis is long stagnation content prepucialna bag, i.e. of smegma. So to cancer of the penis has very long phimosis, especially beginning in early childhood.

warts and penile cancer
Fig. 9. HPV (genital warts) of the penis. Fig. 10. Cancer of the penis.

Cancer of the penis begins in the form of cracks, sores on the head or the inner leaf of the flesh, in the form of seals, apparently under the narrow foreskin when phimosis. Often penile cancer, hidden under a narrow the foreskin, attracts attention only when layering of inflammatory changes, when there purulent discharge from prepucialna bag. Developing cancer takes the form of a mushroom-like growths or deep plague upon the head or the inner leaf of the foreskin (printing. Fig. 10). Spreads penile cancer in the inguinal femoral and pelvic lymph nodes.
Treatment of penile cancer in the early stages can be radiation (close-focus radiotherapy, telehomecare, radium therapy). In most cases applied the combined operative radiation therapy. Radiation therapy before and after surgery. Surgery is to remove part of the penis in healthy tissues (amputation of the penis) and the destruction of the inguinal femoral fatty tissue from a lymph nodes (operation Dyukena) if there is evidence of metastases.
Prevention of penile cancer is the observance of personal hygiene, daily wash the head of the penis and the inner surface of the foreskin. Hygiene penis need from childhood. Longer than usual (i.e. after 3-4 years), the so-called physiological phimosis in children with whom boys are born, requires enforced disclosure prepucialna cavity bloodless methods (manually or with the help of the probe). When the true phimosis producing operation circular excision of the prepuce (see Circumcise).

Benign tumors of the penis are epithelial (skin) and connective tissue (angiomas, fibroma, lipoma, and so on). The latter are rare and do not differ from similar tumors of different localization. Papillomas are much more common; they can be viral and non-viral origin. Viral papilloma (the so-called genital warts) are the most frequently used. It warty, villous education that appear on the inner leaf of the foreskin, less often on the head P. o'clock and have some histological features (vacuolation of epithelial cells, sponges). Viral papilloma in some cases can malignities (optional precancer). Treatment: times papillomas, with extensive papillomatosis foreskin - circumcise.
Non-viral papilloma penis developing, as a rule, in a closed prepucialna bag, precede papillary cancer (obligatory precancer). Treatment should be operational (organoboranes) or radiation.
Malignant tumors. The most common malignant tumor of the penis is cancer. It is particularly common in several countries in Asia and Latin America, India, China, Ceylon, Mexico, Paraguay and others), which is one of the first places in frequency among all types of cancer in men. In the USSR cancer P. o'clock is 0.5-1% of all cancers of men; it occurs at a relatively young age (about a quarter of up to 40 years).
The cancer only within prepucialna bag, frequent combination with congenital phimosis (up to 60-80% cases), lack cancer P. o'clock in persons, subjected to circumcision in the first days of life, and low frequency after his circumcision in later childhood (Muslims) are evidence etiopathogenetic the value of stagnation content prepucialna bag - smegma (see), carcinogenic properties, which are shown in animal experiments.
Pathological picture of penile cancer corresponds epidermoid cancer at other sites. Is characterized by the constant presence of inflammatory infiltration in tumor tissue and in circumference.
The clinical picture cancer P. o'clock in the beginning is not always clear-cut, since the tumor is often develops under narrow the foreskin and the sick later go to the doctor. Often the disease attracts attention only after the layering of inflammatory events that long-treated dermatovenereologists. The first symptoms are gnetaceae from a closed prepucialna bag, pitting him, apparently in him the seal.
There are exophytic (papillary and endophytic clinical forms of penile cancer First has the form of a mushroom or papillary tumors, the second - deepest node or ulcers. Endophytic form is observed more often in congenital phimosis and most malignant. The tumor occurs more frequently in coronal sulcus, then on the head, and less often on the inner leaf of the foreskin.
The most frequent way of metastases in regional (inguinal, femoral and iliac) lymph nodes. Thick, lumpy, fixed units is a sign of cancer metastasis. In cancer of the penis enlarged lymph nodes are often caused not by metastases and reactive inflammation. In the latter case, the lymph nodes smooth, elastic, mobile.
There are 4 stages of penile cancer: stage I - limited swelling inside prepucialna bag without increasing lymph nodes; II - cancer has spread to the outer leaf of the foreskin or on the skin of the penis, groin - small elastic consistence mobile lymph nodes; III - destruction of cavernous bodies or regional metastases (thick lumpy fixed lymph nodes); IV - the destruction of the entire body, the germination of cancer in suprapubic region, massive metastatic infiltrates groin and iliac areas, distant metastases (seldom).
In the diagnosis of cancer of the penis to play the main role biopsy, which should be applied when any longer and progressive changes of skin heads P. o'clock and the inner leaf of the foreskin, especially when phimosis.
Treatment depends on the stage of the disease. In stage I - beam or limb-salvation surgical treatment (circumcise, amputation of the head). In And phase - amputation PC in healthy tissues and operation Dyukena that most authors recommend as a second stage, in 1-1,5 months. after the amputation P. o'clock, if the regional lymph nodes remain increased. In stage III - amputation or husking P. o'clock with the simultaneous operation Dyukena. In the fourth station - palliative radiation therapy or chemotherapy. Some authors (M. I. Shkolnik) to perform surgery Dyukena oseltamivir and in stage I. In some cases, can be applied organ-sparing surgery scalping P. h (operation efficiency Sapozhkova). Operative treatment in the II and III stages should be combined with pre - and postoperative radiation therapy. Some authors extend indications for radiation therapy as an independent method of treatment. Most often used close-focus x-ray treatments and telehomecare, at least - radium treatment.
The results of cancer treatment P. including both surgery and radiation unsatisfactory. Different authors from 30 to 60% 5-year survival: in stage I, the rate is relatively high, in the II recovers about half of patients in stage III of the forecast questionable, and in the IV - hopeless.
The most effective prevention method - regular flushing of smegma (circumcision is shown only when the true phimosis). Hygiene prepucialna bag should start with 1-2 years of age. Bloodless disclosure prepucialna bag in children or purely by hand or in a circular motion metal probe with further regular flushing of smegma be the best method of preventing cancer P. H.
Endothelioma, melanoma and sarcoma are rare and usually occur in the body of the penis. In differential diagnosis, the main role belongs to the biopsy. Metastasis - most often in the regional lymph nodes, but not uncommon, and distant metastases. Treatment - amputation P. o'clock with the advanced removal of regional lymph nodes. Most of these tumors radioresistance. The prognosis is poor.
Secondary (metastatic tumor penis occasionally observed in cancer of the pelvis (bladder, prostate, rectum). Tumor site is localized in the cavernous bodies. Often the first sign of the disease is priapism. Treatment - amputation or husking P. H. the prognosis depends on the state of the primary lesion.