Malignant tumors of the penis

　　The generally recognized risk factors for penile malignant tumors have always been poor hygiene habits, smegma, phimosis, and long foreskin. In addition, many penile lesions may be related to the occurrence of penile malignant tumors, such as leukoplakia of the penis. In the occurrence and development of tumors, inflammation may play an important role, because many penile malignant tumors originate from the sites of penile infection, chronic irritation, or trauma. Penile malignant tumors can develop from premalignant lesions of penile malignant tumors. Some patients may detect human papillomavirus (HPV) infection, and HPV-related lesions include giant condyloma acuminata, Bowenoid papules, Bowen's disease, and erythroplasia of the penis, while chronic inflammation-related lesions include genital硬化性苔藓, dry and obstructive balanitis, penile horn, mucosal leukoplakia, and keratotic balanitis with pseudo-epitheliomatous hyperplasia.

　　Complete circumcision can prevent most of the above pathological conditions. Because phimosis often leads to the long-term retention of smegma and normal desquamated epithelial cells, and further leads to the long-term chronic irritation environment of the foreskin and glans, with or without bacterial infection. A high proportion of patients with penile malignant tumors have a long foreskin, and long foreskin is one of the important triggering factors for the occurrence of penile malignant tumors.

　　Other risk factors for penile malignant tumors include multiple sexual partners, genital warts, or other sexually transmitted diseases. At least some of these risk factors are related to infection with human papillomavirus (HPV).

　　Radiation therapy for malignant tumors of the penis is controversial. Some advocate radiation therapy alone for penile malignant tumors, as extensive radiation can cause complications such as urethral stricture, fistula, penile necrosis, and edema, limiting its application. Infection and necrosis of penile malignant tumors can also reduce the effectiveness of radiotherapy. Early-stage penile malignant tumors can be treated with X-ray radiation in combination with bleomycin, with good results.

　　The prognosis of malignant tumors of the penis is related to tumor staging: the timing of treatment, the treatment method, the patient's age, and the degree of malignancy of the tumor. About 3/4 of patients with stage I penile malignant tumors survive for 5 years after surgery, and the 5-year survival rate for those diagnosed as stage I clinically decreases to 1/2. For those with metastasis and who have undergone groin lymph node dissection, the 5-year survival rate is only about 1/3.

　　Initially, malignant tumors of the penis are usually manifested as a small, difficult-to-heal lesion on the glans. The exact appearance is diverse, ranging from flat and hard to large exophytic growths. This type of tumor mainly occurs in uncircumcised males, with about half of the tumors located on the glans, 20% on the prepuce, 20% occurring simultaneously on both the glans and prepuce, and the rest on the shaft of the penis. Multiple lesions may appear occasionally.

　　There is often a significant delay from the time a patient first discovers a lesion to seeking treatment, ranging from 8 months to 1 year. The reasons for the delay may be due to the patient's reluctance to seek treatment, incorrect diagnosis, or the patient not paying attention to small lesions. Penile lesions may be misdiagnosed as infections and receive inappropriate treatment until a correct diagnosis is made. Moreover, since penile cancer often occurs in uncircumcised males, sometimes it is not discovered until the primary lesion invades the prepuce of the penis or due to associated infection causing an unpleasant odor. Many patients also find it difficult to examine the glans due to an elongated prepuce.

　　This type of lesion usually does not cause pain, even after extensive tissue destruction. The tumor may initially appear as a patch of congestion on the glans. The erythematous macular changes on the glans, which are confirmed to be in situ carcinoma by biopsy, are also known as erythroplasia. The lesion can also manifest as an ulcer that does not heal for a long time on the prepuce. As the tumor progresses, ulcerative growth patterns can be seen, eroding and destroying the surrounding normal tissue. These lesions often become infected, producing a large amount of foul-smelling pus.

　　To date, there is no ideal treatment for malignant tumors, an important reason being that they are often not discovered early. When symptoms become apparent, the disease is usually in its advanced stage. If detected early, the cure rate for malignant tumors can be significantly improved, and some can even be completely cured. Some reports indicate that the cure rate for cancer detected early can reach 65%. This highlights the importance of early diagnosis and treatment of malignant tumors. So, how can tumors be detected early? Since malignant tumors often do not have very obvious symptoms in the early or even middle stages, it is indeed not easy to detect them early if patients do not pay attention to their health. Therefore, to strive for early diagnosis and treatment of malignant tumors, one should be vigilant and seek medical attention in a timely manner when the following symptoms appear.

　　1. HPV vaccine

　　To date, there are two HPV preventive vaccines registered by the European Medicines Evaluation Agency (EMEA) and the U.S. FDA. Studies have shown that in the female population with negative HPV detection, both vaccines have a high preventive effect on preventing long-term HPV infection or occasional high-grade cervical lesions. Clinical trials after male vaccination with HPV vaccine have proven the safety and effectiveness of the vaccine, so it has been approved for sale in some countries. It is speculated that HPV vaccines may also prevent HPV-positive penile malignant tumors, but the real effect still needs to be verified by future clinical trials.

　　2. Use condoms

　　Although there is no 100% preventive effect, the use of condoms has a very obvious role in preventing and treating sexually transmitted diseases. A related clinical study is underway, in which condoms are randomly given to sexual partners, and it is found that the healing time of HPV-related genital lesions in the condom use group is significantly shortened.

　　3. Quit smoking

　　Although the specific role of smoking in the development of penile malignant tumors is not clear, it is undoubtedly one of the risk factors for penile malignant tumors. Smokers have a much higher chance of developing penile malignant tumors than non-smokers, therefore, actively promoting smoking cessation is one of the measures to prevent penile malignant tumors.

　　4. Other

　　Other preventive measures include preventing phimosis, treating chronic inflammatory diseases of the reproductive organs, and improving hygiene.

　　For patients with penile malignant tumors, when the lesion is only a hard nodule and has not ulcerated, if the foreskin covers it, then a circumcision should be performed to expose the lesion site, and a local tissue pathology examination can be conducted to make an accurate diagnosis.

　　1. Lymphography: It can be helpful in diagnosing metastasis, but it is generally not considered a routine examination. The choice of foot back, penis, and spermatic cord lymphatic injection method. If there is metastasis, it can show irregular lymph nodes, filling defects, lymphatic deformation, compression obstruction, and other signs.

　　2. Ultrasound: Can determine if there are metastatic foci in the liver and abdomen.

　　3. CT, MRI: Check for post-peritoneal and organ metastasis.

　　Health knowledge intervention for patients not only enables them to receive treatment in a timely and proactive manner but also helps patients regain confidence and improve their quality of life.

　　1. Increase the intake of foods that enhance immunity and have anti-testicular malignant tumor effects: such as: turtle, crucian carp, shrimp, crucian carp, mulberry, lychee, walnut, and other foods.

　　2. Infection and ulcers are recommended to consume watercress, needlefish, chrysanthemum, rapeseed, mung beans, adzuki beans, and other foodstuffs.

　　3. Lymph node enlargement is recommended to consume taro, hawthorn, lily, water chestnut, and other foods.

　　4. Abstain from smoking, drinking, and spicy刺激性 foods.

　　5. Avoid moldy and pickled foods.

　　6. Avoid fried, greasy, smoked, and grilled foods.

　　7. Avoid all warm foods such as mutton, dog meat, chives, etc.

　　8. Anticancer and anti-infection foods should be included in the diet of tumors, such as walnuts, loofah, soy sauce, olives, almonds, luffa, crucian carp.

　　9. To enhance the immune effect, you can take softshell turtle, turtle, shrimp, sandworm, crucian carp, sand fish, etc.

　　10. Use anti-ulcer foods according to symptoms, such as shepherd's purse, screws, golden vegetable, sea gull fish, rapeseed, taro, mung bean, adzuki bean, wheat flour, malan head, loach, herring.

　　11. For those with lymph node enlargement, you can take taro, red bean, lily, mulberry, snails, sheep's stomach.

　　Once the diagnosis of malignant tumor of the penis is confirmed, surgical treatment should be performed immediately. Radiation therapy and chemotherapy, as adjuvant measures to surgery, can play a certain role in improving the cure rate and survival rate.

　　(1)Surgical Treatment

　　If the tumor is relatively localized, partial penile resection can be performed, with the cutting line 2 cm outside the tumor. If the lesion has spread to most of the penis, a total penile resection should be performed, and the urethral opening will be transplanted in the perineum, and urination will be performed in a squatting position.

　　Most patients with penile cancer have enlarged inguinal lymph nodes, but most of the enlarged lymph nodes are caused by concurrent infection with penile cancer, and only a small part is caused by lymph node metastasis of the tumor. For those with lymph node metastasis, bilateral inguinal lymph node dissection should be performed, and it is necessary to include the dissection and resection of the femoral canal and iliac fossa lymph nodes. The operation for the removal of penile cancer and the lymph node dissection can be performed simultaneously or in stages. For lymph nodes with unclear nature of the lesion, it can be decided whether to perform bilateral inguinal lymph node dissection after 2-3 weeks of observation of lymph node changes after the operation for the removal of penile cancer.

　　(2)Radiation Therapy

　　Radiation therapy as an adjuvant measure after surgery can improve the therapeutic effect.

　　(3)Chemotherapy

　　Cisplatin has a good effect on penile cancer and can improve the efficacy when combined with surgical treatment.

　　For patients with penile cancer without bilateral inguinal lymph node metastasis, after surgical treatment, the treatment success rate is 90%, and for those with lymph node metastasis, the 5-year survival rate is 19-38%. In addition, young cases, early metastasis of cancer, and poor prognosis.