[Cancer of the penis. 1989]

Cancer of the penis is the rarest male genital tract tumour, accounting for only 1% of all cancers in men. It is highly lymphophilic. Complex diagnostic problems are posed by both the primary tumour and lymph nodes. The prognosis depends on the degree of lymphatic spread. This cancer occurs in uncircumcised men with poor personal hygiene. The diagnosis is based on biopsy of all persistent lesions on the glans. In every case, treatment requires complete removal of the prepuce. Small noninvasive cancers can be treated by application of radioactive iridium wire. Inguinal lymph node biopsy is performed on a palpable node. Small cancers with lymph node involvement requires extensive inguinal lymph node dissection. Adjuvant irradiation is only indicated when the tumour has extended beyond the lymph node capsule. Cancer invading the corpora cavernosa has a poor prognosis (T3). It justifies large amputation of the penis with perineal urethrostomy and extensive lymph node dissection in the presence of positive nodes. Advanced cancers with unresectable lymph nodes (inguinal and iliac) and/or metastases (pulmonary) require combination chemotherapy with MTX-cisplatin-bleomycin.