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Cancer Medicine :: Penile Cancer

Penile Cancer

Treatment Option

In recent years, much progress has been made in treating penile cancer. New medicines or ways to use medicines have been developed. Surgical methods involving microscopic techniques and lasers have been refined, and more is known about the best way to use radiation.

Making penile cancer treatment decisions

After the cancer is found and staged, your cancer care team will discuss treatment options with you. You should take time and think about all of your choices. In choosing a treatment plan, factors to consider include:

The type and stage of your cancer

Your overall physical health

Your personal preferences about treatments and their side effects

If time permits, it is often a good idea to seek a second opinion. A second opinion can provide more information and help you feel more confident about the treatment plan you have chosen. Some insurance companies even require a second opinion before they will agree to pay for certain treatments.

The main types of treatments that can be used to treat penile cancers are:

Surgery

Radiation therapy

Chemotherapy

Surgery is the main method of treatment for nearly all penile cancers, but sometimes radiation therapy may be used, either instead of or in addition to surgery. Chemotherapy may be given if the cancer has spread.

The goal of your cancer care team is to treat the cancer effectively while limiting the treatment's effects on the function and appearance of the penis. If the cancer can't be cured, the goal may be to remove or destroy as much of the cancer as possible and to prevent the tumor from growing, spreading, or returning for as long as possible. Sometimes treatment is aimed at relieving symptoms, such as pain or bleeding, even if you won't be cured.

Surgery for penile cancer

Surgery is the most common treatment for all stages of penile cancer. If the cancer is detected early, the tumor can often be treated without having to remove part of the penis. If the cancer is detected at a more advanced stage, part or all of the penis might have to be removed with the tumor. Your team will discuss with you the treatment options that give you the best chance of curing your cancer while preserving as much of the penis as possible.

Patients with cancers that have invaded deep within the penis (stage T2 or higher) usually need to have some nearby lymph nodes removed as well to check for cancer spread. Instead of removing all of the groin lymph nodes to look for cancer, some doctors prefer to do a sentinel lymph node biopsy, which is discussed later in this section.

Several different kinds of surgery are used to treat penile cancers.

Circumcision

This operation removes the foreskin and some nearby skin. This method can often cure cancers that are only in the foreskin.

Circumcision is also done to remove the foreskin before radiation therapy to the penis. Radiation can cause swelling and constriction of the foreskin, which could lead to other problems.

Simple excision

In this operation, the tumor is cut out with a surgical knife, along with some surrounding normal skin. If the tumor is small, the remaining skin can then be stitched back together. This is the same as an excisional biopsy.

In a wide local excision, the cancer is removed along with a large amount of normal tissue around it (called wide margins). Removing healthy tissue makes it less likely that any cancer cells are left behind. If not enough skin remains to cover the area, a skin graft may be taken from another part of the body and placed over the area.

Mohs surgery (microscopically-controlled surgery)

Using the Mohs technique, the surgeon removes a layer of the skin that the tumor may have invaded and then checks the sample under a microscope right away. If it contains cancer, another layer is removed and examined. This process is repeated until the skin samples are found to be free of cancer cells.

This process is slow, but it means that more normal tissue near the tumor can be saved. This creates a better appearance and function after surgery. This is a highly specialized technique that should be used only by doctors who have been trained in this specific type of surgery. It is used for pre-cancerous conditions and for some cancers that have not invaded deeply into the penis

Laser surgery

This approach uses a beam of laser light to vaporize cancer cells. It is useful for squamous cell carcinoma in situ (involving only the outer layer of the skin) and for very thin or shallow basal cell cancers.

Cryosurgery

This approach freezes the cancer cells with a probe cooled with liquid nitrogen. It is useful for some verrucous penile cancers and carcinoma in situ of the glans.

Partial or total penectomy

This operation removes part or all of the penis. It is the most common and most effective way to treat a penile cancer that has grown deeply inside the penis. The goal is to remove all of the cancer. To do this the surgeon needs to remove some of the normal looking penis as well. The surgeon will try to leave as much of the shaft as possible.

The operation is called a partial penectomy if only the end of the penis is removed (and some shaft remains).

If not enough of the shaft can be saved for the man to urinate standing upright without dribbling, a total penectomy will be done. This operation removes the entire penis, including the roots that extend into the pelvis. The surgeon creates a new opening for urine to drain from the perineum, which is the area between the scrotum (sac for the testicles) and the anus. This is known as a perineal urethrostomy. Urination can still be controlled because the sphincter (the "on-off" valve) in the urethra is left behind, but the man will have to sit down to urinate.

For advanced tumors, sometimes the penis is removed along with the scrotum (and testicles). This operation is called emasculation. Since this operation removes the main natural source of the male hormone testosterone, men who have this procedure must take a man-made version of this hormone for the rest of their life.

Any of these operations can affect a man's self image, as well as his ability to have sexual intercourse. 

Surgery to remove lymph nodes

Patients with cancers that have invaded deep within the penis (stage T2 or higher) usually need to have some nearby lymph nodes removed to check for cancer spread.

Sentinel lymph node biopsy: This operation can sometimes help the surgeon see if the groin lymph nodes contain cancer without having to remove all of them. It is most often done when lymph nodes are not enlarged but there is a chance that the cancer may have reached them.

The surgeon finds the first lymph node that drains the tumor (called the sentinel node) and removes it. If the cancer has spread outside of the penis, this lymph node is the one most likely to contain cancer cells. If the sentinel node contains cancer, a more extensive operation, known as a lymph node dissection or inguinal lymphadenectomy, is done (see below). If the sentinel node does not have cancer cells, the surgeon doesn't have to remove any more lymph nodes.

To find the right lymph node, a radioactive tracer is injected into the region around the tumor the day before surgery. A radiation detection device is used to determine whether the lymphatic channels around the cancer drain into the left groin or right groin. This tells the doctor which side is likely to have cancer if it has spread. On the day of surgery, a blue dye is injected into the region of the tumor.

The lymphatic vessels will carry the dye and radioactive material to the sentinel node. The surgeon finds this node during the operation either visually (by the blue dye) or with a Geiger counter (radiation detector) and removes it.

Using this approach, fewer patients need to have as many lymph nodes removed. The more lymph nodes that are removed, the higher the risk of side effects such as lymphedema (swelling in the groin and legs caused by the buildup of fluid) and problems with wound healing.

Not all doctors agree on how useful this type of operation is for penile cancer. Early studies showed that a sentinel lymph node procedure was helpful in finding those men with lymph node spread from their cancer, but later studies did not show that it was very accurate, and some men with lymph node spread could be missed if the sentinel lymph node procedure was used.

Also, if your doctor is considering a sentinel lymph node biopsy, it might be useful to determine how many sentinel node biopsies he/she has done. Experience is very important to the success of this procedure. Discuss the procedure with your doctor.

Inguinal lymphadenectomy (groin lymph node dissection): Many men with penile cancer have swollen groin lymph nodes when they are first diagnosed. These lymph nodes only need to be removed if they contain cancer cells. About half of the time, the swelling is from infection or inflammation -- not from cancer. If the lymph nodes are swollen, doctors routinely give a course of antibiotics and wait 4 to 6 weeks after the main penile tumor is removed. If the swelling doesn't go away with time, then a second operation, called an inguinal lymphadenectomy, is done to remove the lymph nodes.

This operation may also be done if cancer is found during a sentinel lymph node biopsy. In this procedure, the surgeon makes a 4-inch incision in your groin and carefully removes the tissues containing lymph nodes. This must be done with care because important muscles, nerves, and blood vessels run through this area. The nodes are then sent to a lab, where a pathologist looks at them under a microscope to see if they have cancer.

Side effects of lymph node surgery: The groin lymph nodes are part of the system that normally helps excess fluid drain out of the legs and back into the bloodstream. Removing many lymph nodes in an area can lead to abnormal swelling from problems with fluid drainage. This condition is called lymphedema. In the past, this was a common problem after treatment for penile cancer because the lymph nodes from groin areas on both sides were removed to check for cancer spread. Up to half of the patients who had this surgery developed severe lymphedema in both legs. Now fewer lymph nodes are usually removed, which lowers the chance that lymphedema will occur. Still, lymphedema can occur even when only one lymph node or the lymph nodes from only one groin area are removed.

Other side effects can occur after lymph node surgery, and can include problems with wound healing, infection, and skin breakdown (necrosis). These are not common.

Radiation therapy for penile cancer

Radiation therapy uses high-energy rays or particles to destroy cancer cells. It can be used to treat some early stage penile cancers instead of surgery. In cases where cancer has reached several lymph nodes, radiation may be used along with surgery to remove lymph nodes to try to reduce the risk the cancer will come back. Radiation may also be used for advanced cancers to try to slow the growth of the cancer or to relieve symptoms caused by the cancer.

For uncircumcised men who are going to get radiation to the penis, circumcision is done first to remove the foreskin. This is because radiation can cause swelling and constriction of the foreskin, which could lead to other problems.

There are 2 main ways to get radiation therapy.

External beam radiation therapy

The most common way to get radiation therapy is from carefully focused beams of radiation aimed at the tumor from a machine outside the body. The treatment is much like getting an x-ray, but the radiation is more intense. The procedure itself is painless. Each treatment lasts only a few minutes, but the setup time -- getting you into place for treatment -- usually takes longer. Treatments are usually given 5 days a week for a period of 6 weeks or so.

Brachytherapy

For brachytherapy, a radioactive source is placed into or right next to the penile tumor. The radiation travels only a short distance, so nearby healthy tissues don't get much radiation. This type of treatment is done while you are in the hospital. There are 2 ways to get brachytherapy for penile cancer.

In one method, known as interstitial radiation, hollow needles are first placed into the penis in the operating room. Then tiny pellets of radioactive materials are put into the needles to treat the tumor. The pellets are kept in place for several days while they release their radiation. After the treatment is over, the needles are removed.

Another type of brachytherapy puts the radiation source close to (but not into) the tumor. This is called plesiobrachytherapy. In this method, a plastic cylinder is placed around the penis and then another cylinder with a radiation source is placed on top of the first cylinder. Another way to do this is to make a sponge-like mold of the penis and put the radioactive material into hollowed-out spaces in the mold. Treatment is usually done for several days in a row.

Possible side effects of radiation therapy

The main drawback of radiation therapy is that it can destroy or damage nearby healthy tissue along with the cancer cells. Many men have side effects such as swelling, redness, and sensitivity. The skin in the treated area may have patches that are oozing and tender. For some, the skin may even peel. For a while, you may feel a burning sensation when you urinate.

Patients treated with brachytherapy will find their side effects tend to be worse 1 to 2 weeks after the treatment is finished. If external beam radiation is used, the side effects tend to occur during treatment and then improve after radiation is stopped. Most symptoms go away in 1 to 2 months. Over time, men treated with radiation may notice the skin of the penis has become darker or less elastic. Tiny web-like blood vessels (called telangiectasia) may be visible. Some more serious side effects can include:

Some of the skin or tissue at the end of the penis can die (called necrosis).

The urethra can become narrow from scar tissue (called stenosis), leading to problems passing urine.

An abnormal opening (fistula) can form between the urethra and skin.

In many cases, the function and appearance of the penis gradually return to normal in the months and years after radiation therapy. In cases where the tumor has not grown beyond the glans, radiation is directed only at the tip of the penis, so the ability to achieve erections should not be affected.

Possible side effects of radiation to the pelvic area and groin lymph nodes include tiredness, nausea, or diarrhea.

Chemotherapy for penile cancer

Chemotherapy (often called chemo) is the use of drugs to treat cancer. Two types of chemotherapy that may be used in treating penile cancer are topical chemotherapy and systemic chemotherapy.

Topical chemotherapy

Topical chemotherapy means that an anti-cancer medicine is placed directly onto the skin instead of being taken as a pill or injected into a vein. The drug most often used in topical treatment of penile cancer is 5-fluorouracil (5-FU), which is applied daily for several weeks.

When applied directly onto the skin in the form of a cream, 5-FU reaches cancer cells near the skin surface but cannot reach cancer cells that have invaded deeply into the skin or spread to other organs. For this reason, treatment with 5-FU generally is used only for pre-cancerous conditions or carcinoma in situ (Tis, stage 0).

Because the drug does not spread throughout the body, the side effects that often occur with systemic chemotherapy do not occur with topical chemotherapy. Treatment with 5-FU cream causes the treated skin to become red and very sensitive for a few weeks. Using other topical medicines or creams can help relieve this.

Systemic chemotherapy

Systemic chemo uses anti-cancer drugs that are injected into a vein or given by mouth. These drugs enter the bloodstream to reach cancer cells in all areas of the body. This treatment is useful for cancers that have spread to lymph nodes or distant organs. Chemo can also be used to shrink cancers before surgery to make them easier to remove. It is also being studied to see if giving it after surgery will keep the cancer from coming back and improve survival.

Doctors give chemo in cycles, with each period of treatment followed by a rest period to give the body time to recover. Chemo cycles generally last about 3 to 4 weeks. Some of the drugs most commonly used to treat penile cancer include:

Cisplatin

Fluorouracil (5-FU)

Methotrexate (MTX)

Bleomycin

Paclitaxel (Taxol®)

Ifosfamide (Ifex®, ifos)

Often, these drugs are used together to treat penile cancer that has spread to lymph nodes or other organs. The most commonly used combinations include:

BMP: bleomycin, methotrexate, and cisplatin ("platinum")

TIP: paclitaxel (Taxol), ifosfamide, and cisplatin ("platinum")

Possible side effects: Chemotherapy drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles, divide quickly, too. These cells are also likely to be affected by chemotherapy, which can lead to some side effects.

The side effects of chemotherapy depend on the type and dose of drugs you take and how long they are used. Common side effects can include:

Hair loss

Mouth sores

Loss of appetite

Nausea and vomiting

Low blood counts

Chemo drugs can affect the blood forming cells of the bone marrow. This can lead to:

Increased chance of infections (due to low white blood cell counts)

Easy bruising or bleeding (due to low blood platelet counts)

Fatigue (due to low red blood cell counts)

These side effects are usually short-term and go away after treatment is finished. There are often ways to lessen these side effects. For example, there are drugs that can be given to help prevent or reduce nausea and vomiting. Be sure to ask your doctor or nurse about medicines to help reduce side effects, and let him or her know when you do have side effects so they can be managed effectively.

Some of the drugs used to treat penile cancer can have specific side effects.

Cisplatin can cause nerve damage (neuropathy) and kidney damage (nephropathy). The nerve damage can cause problems with numbness and tingling in the hands and feet. Doctors give a lot of intravenous (IV) fluid with cisplatin to help prevent the kidney damage.

5-fluorouracil (5-FU) can cause sores in the mouth (mucositis) that can make it hard to eat. This drug can also cause diarrhea.

Vincristine and paclitaxel can also cause nerve damage.

A rare side effect of bleomycin is lung damage, which can lead to problems breathing. The risk of this is higher in patients who smoke.

Ifosfamide can damage the lining of the bladder (called hemorrhagic cystitis). A drug called mesna is often given with ifosfamide to prevent this problem.

Immune therapy for penile cancer

Imiquimod is a drug that boosts the body's immune system. It is available as a cream that is placed directly on the skin. It is sometimes used to treat carcinoma in situ of the penis.

Treatment options for penile cancer by stage

The type of treatment your cancer care team will recommend depends on how far the cancer has spread. This section summarizes the choices available according to the stage of your cancer.

Stage 0:Stage 0 includes 2 types of tumors: carcinoma in situ and verrucous carcinoma. They are treated differently.

Patients with carcinoma in situ that only involves the foreskin can often be treated with circumcision. If the tumor developed in the glans and does not affect other tissues, it may be possible to treat it with topical chemotherapy (such as 5-FU cream) or immunotherapy (imiquimod), or Mohs (microscopically directed) surgery. Laser treatment, cryotherapy, and radiation therapy are also possible options. Penectomy is not often needed.

Verrucous carcinoma can often be treated with laser therapy, cryotherapy, or Mohs surgery. Only rarely will penectomy be needed. Radiation is not used for this type of tumor, because it can make it more likely to spread.

Stage I:These tumors have grown below the skin of the penis but have not invaded deeper layers. Options for treatment may include circumcision (for tumors confined to the foreskin), surgical removal of part of the penis (partial penectomy), radiation therapy, and Mohs surgery. The use of laser surgery for superficial penile cancer is being studied.

Stage II:Stage II penile cancer includes tumors that have grown into the tissues of the penis (such as the corpus spongiosum or cavernosum) or the urethra, but have not spread to nearby lymph nodes. These cancers are usually treated with a partial or total penectomy, with or without radiation therapy. A less common approach is to use radiation therapy as the first treatment with surgery remaining as an option if the cancer is not completely destroyed by the radiation. Radiation may also be used as the main treatment in men who cannot get surgery due to severe medical problems.

Many doctors recommend checking groin lymph nodes, even if they are not enlarged. This may be done with a sentinel lymph node biopsy or with a more extensive lymph node dissection. If the lymph nodes show cancer spread, then the cancer is not really a stage II. It is a stage III or IV.

Stage III:Stage III penile cancers include T1, T2, and T3 tumors that have spread to nearby lymph nodes (N1 or N2). Stage III includes tumors that have grown into the corpus spongiosum, corpus cavarnosum, or urethra, but not tumors that have grown into nearby structures like the bladder or prostate.

Stage III cancers are treated with a partial or total penectomy. In a few cases, chemotherapy (chemo) or chemo plus radiation may be used first to shrink the tumor so that it can be more easily removed with surgery.

These cancers require an inguinal lymphadenectomy to remove lymph nodes in the groin. Radiation therapy to the groin may be used as well, either after surgery or instead of surgery in selected cases.

These tumors can be hard to treat, so men may want to consider taking part in clinical trials of new treatments.

Stage IV:Stage IV penile cancer includes cancers that have spread to nearby tissues, like the prostate, bladder, scrotum, or abdominal wall (T4). Treatment may include surgery to remove the main tumor, such as penectomy. If the tumor is in the scrotum or parts of the abdominal wall, it may also be necessary to remove the testicles and/or the scrotum. A new opening can be made in the abdomen or the perineum to allow urination. If the tumor has grown into the prostate or bladder, these may need to be removed, as well. Chemo (sometimes with radiation) may be given before surgery to try to shrink the tumor and make it easier to remove. The inguinal (groin) lymph nodes on both sides will be removed as well. This area may also be treated with radiation after surgery (unless it was given before surgery).

Stage IV also includes smaller cancers with more extensive lymph node spread (N3), such as cancer spread in groin lymph nodes that has grown through the lymph nodes’ outer covering and into surrounding tissue or cancer spread to lymph nodes inside the pelvis. This stage is treated with surgery to remove the main tumor in the penis, such as penectomy. The lymph nodes in both groins are also removed. The lymph nodes inside the pelvis will also be removed if they are thought to contain cancer spread (if they are enlarged, for example). After the lymph nodes are removed, those areas are often treated with radiation to try to kill any cancer cells that may be have left behind (but are too small to see).

Penile cancer that has spread to distant organs and tissues is also considered stage IV. This is usually not considered curable by current methods. Treatment is designed to try to keep the cancer in check and to prevent or relieve symptoms to the best extent possible. Choices to treat the penile tumor usually include wide local excision, penectomy, or radiation therapy. Surgery or radiation therapy may also be considered to treat nearby lymph nodes. Radiation may also be used to treat areas of cancer spread in the bones or in the brain or spinal cord.

Chemo may be used to treat cancer that has spread to other areas, like the lungs or liver. Studies are under way to determine the value of chemotherapy combined with surgery or radiation therapy.

Stage IV cancers are hard to treat, so men may want to think about taking part in clinical trials of new treatments.

What happens after treatment for penile cancer?

For many people with penile cancer, treatment may remove or destroy the cancer. Completing treatment can be both stressful and exciting. You may be relieved to finish treatment, but find it hard not to worry about cancer coming back. (When cancer comes back after treatment, it is called recurrence.) This is a very common concern in people who have had cancer.

It may take a while before your fears lessen. But it may help to know that many cancer survivors have learned to live with this uncertainty and are living full lives. 

For other people, the cancer may never go away completely. These people may get regular treatments with chemotherapy, radiation therapy, or other therapies to try to help keep the cancer in check. Learning to live with cancer that does not go away can be difficult and very stressful. It has its own type of uncertainty. 

Follow-up care

When treatment ends, your doctors will still want to watch you closely. It is very important to go to all of your follow-up appointments. During these visits, your doctors will ask questions about any problems you may have and may do exams and lab tests or x-rays and scans to look for signs of cancer or treatment side effects. Almost any cancer treatment can have side effects. Some may last for a few weeks to months, but others can last the rest of your life. This is the time for you to talk to your cancer care team about any changes or problems you notice and any questions or concerns you have.

After your cancer treatment is finished, you will probably need to still see your cancer doctor for many years. So, ask what kind of follow-up schedule you can expect.

It is important to keep your health insurance. Tests and doctor visits cost a lot, and even though no one wants to think of their cancer coming back, this could happen.

If treatment for penile cancer stops working

If cancer keeps growing or comes back after one kind of treatment, it is possible that another treatment plan might still cure the cancer, or at least shrink it enough to help you live longer and feel better. But when a person has tried many different treatments and the cancer has not gotten any better, the cancer tends to become resistant to all treatment. If this happens, it's important to weigh the possible limited benefits of a new treatment against the possible downsides. Everyone has their own way of looking at this.

This is likely to be the hardest part of your battle with cancer -- when you have been through many medical treatments and nothing's working anymore. Your doctor may offer you new options, but at some point you may need to consider that treatment is not likely to improve your health or change your outcome or survival.

If you want to continue to get treatment for as long as you can, you need to think about the odds of treatment having any benefit and how this compares to the possible risks and side effects. In many cases, your doctor can estimate how likely it is the cancer will respond to treatment you are considering. For instance, the doctor may say that more chemo or radiation might have about a 1% chance of working. Some people are still tempted to try this. But it is important to think about and understand your reasons for choosing this plan.

No matter what you decide to do, you need to feel as good as you can. Make sure you are asking for and getting treatment for any symptoms you might have, such as nausea or pain. This type of treatment is called palliative care.

Palliative care helps relieve symptoms, but is not expected to cure the disease. It can be given along with cancer treatment, or can even be cancer treatment. The difference is its purpose - the main purpose of palliative care is to improve the quality of your life, or help you feel as good as you can for as long as you can. Sometimes this means using drugs to help with symptoms like pain or nausea. Sometimes, though, the treatments used to control your symptoms are the same as those used to treat cancer. For instance, radiation might be used to help relieve bone pain caused by cancer that has spread to the bones. Or chemo might be used to help shrink a tumor and keep it from blocking the bowels. But this is not the same as treatment to try to cure the cancer.

At some point, you may benefit from hospice care. This is special care that treats the person rather than the disease; it focuses on quality rather than length of life. Most of the time, it is given at home. Your cancer may be causing problems that need to be managed, and hospice focuses on your comfort. You should know that while getting hospice care often means the end of treatments such as chemo and radiation, it doesn't mean you can't have treatment for the problems caused by your cancer or other health conditions. In hospice the focus of your care is on living life as fully as possible and feeling as well as you can at this difficult time. You can learn more about hospice in our document called Hospice Care.

Staying hopeful is important, too. Your hope for a cure may not be as bright, but there is still hope for good times with family and friends -- times that are filled with happiness and meaning. Pausing at this time in your cancer treatment gives you a chance to refocus on the most important things in your life. Now is the time to do some things you've always wanted to do and to stop doing the things you no longer want to do. Though the cancer may be beyond your control, there are still choices you can make.

What`s new in penile cancer research and treatment?

Since penile cancer is an uncommon disease in this country, it is hard to study. For example, it is hard to get large numbers of men to enroll in clinical trials to test newer forms of treatment, simply because there are fewer men with this type of cancer.

In some cases, laser therapy can cure or control the disease in its early stages and preserve the appearance and function of the penis. Research is being done to identify the best type of laser to use in these early tumors.

Scientists are working to discover the best ways to use radiation. This may mean combining radiation with chemotherapy to avoid surgical removal of the penis, whenever possible.

Doctors are also studying newer uses of chemotherapy for penile cancer, such as giving it before surgery to try to shrink the tumor. This might make surgery more effective, or might even allow the doctor to do a less invasive type of surgery. A recent study gave men with penile cancer with spread to lymph nodes the chemo drugs paclitaxel (Taxol), ifosfamide, and cisplatin before surgery with good results. Half of the men treated had their cancers shrink, and in a few of them the cancer went away completely. It is hoped that treatment like this will help men with advanced penile cancer live longer.

Doctors have looked at using different drugs to treat penile cancer, such as irinotecan (Camptosar®) and interferon.

Scientists are learning much more about how certain genes called oncogenes and tumor suppressor genes control cell growth and how changes in these genes cause normal cells to become cancerous. The ultimate goal of this research is gene therapy -- replacing the damaged genes in cancer cells with normal genes to stop the abnormal behavior of these cells.

Learning more about these abnormal genes in penile cancer can also help guide use of targeted therapies. Targeted therapy is a term used for drugs that target certain cell changes and signals that are needed for a cancer to develop and keep growing. Targeted cancer therapies do not damage bone marrow or blood cells like most standard chemo drugs do. They can be used alone or along with other drugs and cancer treatments. Targeted therapy is still relatively new compared with other forms of cancer treatment, like surgery, radiation, or regular chemo.

These treatments have been helpful in treating some kinds of cancer, but not as much is known about the value of these new drugs in penile cancer, because penile cancer is so rare. There have been a few cases of advanced penile cancer in which doctors chose targeted therapies that are effective against cancers with cells similar to those of penile cancer. Preliminary results suggest some value, but more research is needed.

Vaccines that protect against infection with types of HPV linked to certain cancers have been developed. One of these, Gardasil, is now approved for use in young men to help prevent genital warts and anal cancer. While it has not yet been studied, the hope is that the vaccine may eventually help prevent other cancers linked to HPV in men, including penile cancers.

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