Penile Cancer

Penile Cancer

Yup. We sure did. 

We sure did perform a penis transplant at Seattle Grace Mercy West Hospital. And as if that weren't awesome enough, the amazing Debbie Allen played the role of the world-class urologist who helped pioneer the procedure. How fantastic was she as a surgeon AND Jackson's mom? BUT. As we ponder (and applaud) the innovation of a penis transplant procedure, we do need to be very clear on something…

For the loss of a penis? A transplant isn't the standard of care. A penis transplant has been performed in the past, but many surgeons oppose the idea because proven and reliable methods exist for reconstruction, using the patient's own tissue. They argue against using a different patient's tissue (such as a transplant) due to the risk of rejection. The treatment to prevent rejection, immunosuppressive medication, can be extremely difficult on the patient – it is a life long commitment of controlling the immune system. For other transplants, the bargain made in suppressing the immune system is that if you receive an organ like a heart, it's life-saving.

Ryan lost his penis through a battle with penile cancer. Is that common?

In the United States, penile cancer is rare. According to the Official Foundation of the American Urological Association, several general practitioners and urologists only see two or three penile cancer cases throughout their entire practice. However, there lies one of the problems. Due to its relative infrequency, many cases unfortunately do not get diagnosed in early stages.

Like Ryan, right? His cancer had reached a more advanced stage.

Indeed. Many patients are just like Ryan, in that they may be embarrassed and hesitant to see a doctor when they experience symptoms around the penis. However, as all cancers, the earlier the diagnosis? The better for the patient. Patients should see a medical professional for the following symptoms:

  • - Skin erosions.
  • - Ulcers.
  • - Sores.
  • - Irritation.
  • - Noticeable discoloration around the foreskin, the skin of the shaft of the penis, or the surface of the head of the penis.

Most likely, these symptoms could be caused from a bacterial/fungal infection or even an allergic reaction, and they can be treated with medications. But if the symptoms do not disappear or return, they should be evaluated further through a tissue biopsy.

After diagnosis, how is the cancer treated?

Treatment will in fact depend on how far the cancer has reached. For example, if the tumor only appears to be on the skin, then the urologist may only need to prescribe a topical cream. If the lesion has grown, to the size of a pea or so, a Moh's surgery may need to be performed. The doctor will do a local excision in which the abnormal tissue will be, essentially, shaved off. The penis will not lose shape or function, but extremely vigilant follow-up is advised.

More advanced cases often require greater amounts of cancerous tissue of the penis to be removed – these procedures include partial penectomies or total penectomies. If a patient has his entire penis removed, like Ryan, doctors will perform an urethrostomy in order to preserve urinary function; an opening is surgically created in the groin area to allow urine to exit the body.

Chemotherapy and radiation therapy often accompany surgery for penile cancer. The chemotherapy drugs used include: bleomycin, cisplatin, or methotrexate alone or together. For the radiation, external beam therapy delivers radiation to the penis from outside the body for five days a week for six to eight weeks.

So if Ryan didn't have the option of the transplant, how would the surgeons have reconstructed his penis?

Reconstruction can be done in a surgery that typically takes about eight hours. Basically, doctors will use a flap from the forearm – a very large rectangle that goes down to the vascular covering of the muscle, along with the blood vessels and the nerve. They wrap it to form a tube, add layers of skin, and then use a catheter to essentially form a skin-lined urethra. Using complex microsurgical techniques, they connect the blood vessels from the forearm flap (which has now been reconstructed to look like a penis) to the vessels waiting from the pelvis. They thread the catheter into the bladder, revascularize, and knit the base to the surrounding open wound.

Can penile cancer be prevented?

Well, the exact cause is unknown. But safe sex (such as abstinence, limiting the number of sexual partners, and use of condoms to prevent HPV infection) and practicing good personal hygiene are strongly recommended to help decrease risks.

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