Introduction:
Penis cancers are uncommon and rare types of malignancy of the penis in men. Thus, they are the most challenging to diagnose and treat. The primary cause of its late diagnosis is the patient's late presentation to the doctor, and even if it occurs, therapy is symptomatic mainly at first. Carcinomas are to be predicted later in the lesion's development. The smooth muscles and the skeletal components comprise it that distinguish this organ. The periosteum connects it to the pubic ramus and ischium, and the suspensory ligaments support it. The tunica albuginea is a two-layered structure made up of smooth muscles. The sinusoids of the corpora cavernosa, corpus spongiosum, and glans penis are made up of smooth muscles. The penis is considered one of the body's two end artery organs. These arteries are thought to have a crucial role in erectile function.
How Does Malignancy Develop in the Penis?
The malignancy, frequently of the squamous cell type, develops on the glans or the prepuce. This then spreads and penetrates deeper into the corpora or the shaft of the penis. It has been found that flat lesions have a higher risk of early metastasis than papillary lesions and nodal involvement. The femoral and inguinal nodes are the first to be damaged. The consequences of this malignancy include bleeding caused by femoral vascular erosion, sepsis, and distant metastasis.
What Are the Signs and Symptoms of Penile Cancer?
Penile cancer can manifest as a visible lesion along the glans, prepuce, or penile shaft. Depending on the stage of the disease, it may be linked to discomfort, discharge, bleeding, or odor. The illness can be classified as ulcerative, nodular, or fungating. Constitutional symptoms such as fatigue, weight loss, and palpable inguinal lymph nodes may be evident in advanced instances of penile cancer. Because of a lack of awareness, socioeconomic level, or fear of treatment alternatives, most men with penile illness present with late stages of penile cancer.
Why Is Penectomy Done in Penile Cancer?
Penile cancer has a high death rate and a significant recurrence risk if adequate excision is not performed. Early interventions are therefore preferred since repair is reasonably feasible and has a good prognosis. However, the more advanced cancer, the greater the likelihood of recurrence; hence, removal of the penis or penectomy may become necessary to extend the individual's life expectancy.
What Are the Preoperative Examinations Before Penectomy?
Penectomy is a primary surgical treatment requiring careful planning before and after the procedure. Initial diagnostics include blood testing and echocardiography (ECG) to evaluate the patient's cardiac function. In addition, chest X-rays and bowel preparations are performed. Ultrasound, computed tomography (CT scan), and magnetic resonance imaging (MRI) scans are three of the most popular diagnostic techniques used in cases of penile cancer. Ultrasounds are often helpful for detecting enlarged or non-palpable nodes in preparation for treatments. However, all these methods are insufficient for detecting metastases in the nodes they see. Gallium citrate scanning, sentinel node mapping (with some positive potential), medial inguinal lymph node biopsy, and dynamic sentinel node mapping are diagnostic and preoperative testing approaches.
How Is Penectomy Performed?
Many surgeons believe that cases with a high likelihood of nodal involvement and tumor statuses of T2, T3, T4, and grades 2 and 3 are appropriate candidates for preventive node dissection. Depending on the conditions, a local, partial, or total dissection of the penis may be the simple surgical approach. In this case, doctors recommend an aggressive strategy for treating cancer to increase survival rates, establish long-term palliation, and prevent recurrences. Local circumcision can treat small tumors smaller than 1.5 cm in size. Those more significant than this necessitate partial or total amputation. In rare circumstances, local wedge resection is also explored.
Small lesion removal necessitates thorough excision of the lesion with a reasonable margin of normal tissue removed. A two-centimeter margin of normal tissue is excised around the malignant tumor. The use of section frozen is beneficial in eliminating the lesion. If the surgical resection is substantial, two further operations can be performed at this time. Urethral reconstruction and perineal urethrostomy are two examples.
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The Mohs Micrographic Surgical Method: It is an effective therapy with no local invasion. It preserves normal tissues while removing tumorous ones. Laser operations and treatments can help with superficial lesions. However, the primary tumor is first removed, followed by resectioning metastatic inguinal lymph nodes. Retaining these lymph nodes increases the risk of pelvic lymph node metastases, leading to further morbidity.
What Are the Complications That Can Arise Due to Penectomy?
As the penile tissue has high vascularity, there is a risk of the following complications:
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Hemorrhage.
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Copious bleeding.
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Tumor diffusion into deeper lymph nodes.
The majority of the problems are found in general surgical operations. Nevertheless, the surgery is performed with excellent understanding and appropriate access to the operative site due to the intricate neural and vascular supply.
What Is the Post Operative Care After Penectomy?
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Pain Medications - Non-steroidal anti-inflammatory drugs (NSAIDs), notably COX 2 selective inhibitors, are the most chosen drugs among doctors for pain treatment in penile cancer patients. However, the doctor can also administer other pain medications, such as Paracetamol and its combinations with Codeine and Dihydrocodeine, opioids in various dosage forms, and multiple epidurals.
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Debridement of the Wound - Debridement of the wound and prevention of wound infection may be necessary from time to time.
Conclusion:
Penile carcinoma is a rare cancer that is often treated with penile preservation surgery. Both partial and total, penectomy is still possible for advanced and more proximal penile cancers. Patients undergoing surgical treatment may have severe functional and psychological morbidity. Recent findings and guidelines are changing the surgical treatment of penile malignancies. Safe surgical margin criteria have been decreased from 2 cm to 3-5 mm, allowing surgeons to do penile preserving procedures in order to optimize patient functionality. Although it is a very infrequent treatment, it is nonetheless a significant source of morbidity and mortality in patients and must be completed with the necessary care and attention.
