- Giulia Granchi
- From BBC News Brazil to Sao Paulo
About eight years ago, Carlos noticed that small warts had appeared on the tip of his penis. Without imagining that it could be cancer, the symptoms that appeared a few days later scared the paulistano, then 64 years old.
Before long, the lesions swelled and began to cause severe pain and burning and interfere with his work as a truck driver. With the constant discomfort, sleeping for hours at a stretch or concentrating on usual routine activities became impossible.
He made an appointment with a doctor he found at a popular private health care network. The biopsy performed by the professional indicated that Carlos suffered from squamous papilloma, a tumor that has been linked to HPV (human papilloma virus) infection.
The prescribed treatment consisted of antibiotics and an ointment made in a compounding pharmacy. It was not enough. Between a new biopsy, the change of medication and the cauterization of the wounds, the years passed. “Nothing helped solve the problem once and for all, so I decided to look for another hospital,” Carlos recalls.
By indication, he arrived in Santa Casa de São Paulo at the beginning of 2021, where he was diagnosed with penile cancer by the urology team. “It was a feeling of frustration. I looked for a private doctor, I did what I could, but it still wasn’t enough,” he says.
A few months later, in July, when he already had advanced penile cancer, he had to amputate part of the organ. “I was sad to lose an important part of me, but I understood that there was no other way. I felt relieved to end the pain,” says Carlos.
He is now waiting to see if he will need chemotherapy or radiotherapy and, at the moment, he is unable to work. “I’ve always had a big truck, but had to swap it out for a smaller one, and my companion works alone, hauling 1,600 kilos a day.”
Brazil records an annual average of almost 500 total or partial amputations of the penis due to lack of correct treatment or late diagnosis.
Every wound on the penis must be checked by a specialist
Penile cancer can manifest as sores of different appearances. Therefore, the recommendation is that any injury to the penis should be evaluated by a specialist. “It can be flat, verrucous, ulcerated… There is no definitive pattern and each change must be considered as an alert”, explains Alfredo Canalini, urologist and president of the SBU (Brazilian Society of Urology).
Bleeding, hardened and red skin, intense itching and difficulty exposing the glans during the extraction of the foreskin are also symptoms that should not be overlooked.
The diagnosis that confirms penile cancer is made by biopsy of a fragment of the lesion.
The incidence of the disease increases with age and is more common in people between the ages of 50 and 70.
In 2021, due to the difficulty of access aggravated by the pandemic, there was a decrease of around 20% in cases reported by the Ministry of Health, compared to the average of previous years.
In most northeastern capitals, the rates are even more alarming than that, with 41% fewer cases diagnosed in Fortaleza, 48% in São Luís and 78% in Maceió. Despite the possibly lower notification, according to information from the Inca (National Cancer Institute), the Northeast and the North are the regions with the most cases of the disease, taking into account the relative numbers by population density local male.
Risk factors and prevention
A study which analyzed Brazilian cases of the disease, published in the scientific journal Journal of Cancer Research and Clinical Oncology in 2020, warns that penile cancer is associated with the low and middle income population. “For lack of knowledge and prejudice, man ends up neglecting his own health,” explains the doctor.
To reduce the risk of penile cancer, the document recommends neonatal circumcision, smoking bans, vaccination against HPV (a virus that can cause cervical cancer in women), use of condoms to prevent STIs (sexually transmitted infections) and education campaigns that teach men how to properly clean their penises.
“The lack of hygiene increases the risk because the dirt accumulated in the skin can cause irritation and modify the cytology (cellular biology). Successively mistreated skin makes the organism react, and thus a tumor can occur”, explains Canalini.
The doctor teaches that the man must remove the skin from the foreskin, exteriorize the glans and wash the area well with soap and water, then dry and then put the skin back on.
If not treated properly, penile cancer can lead to amputation.
Brazil has registered 7,213 total or partial amputations of the penis due to lack of correct treatment or late diagnosis in the past 14 years, according to Ministry of Health data released by SBU (Brazilian Society of urology), an average of 515 per year.
The aggressiveness of penile cancer can vary depending on the type of tumor and when the disease is discovered defines the treatment that will be done and the patient’s chances of recovery. “When there is early detection, the disease is still at an early stage, less mutilating treatments can be used,” says Canalini.
For those who need to be amputated, the shock is usually significant. “This is an extremely traumatic situation in any age group, and every patient should have
Psychological support. In these cases, we can use the urethral canal for penile reconstruction surgery.”
Unlike cervical cancer in women, which is similar to penile cancer because it can also have the HPV virus as a precursor, the problem in men can be more easily observed, without necessarily being detected only by a healthcare professional. “That’s why we need to encourage men of all ages to self-examine their foreskin and glans,” warns the expert.
When it comes to the ability to have children, not everyone with penile cancer has their fertility affected. Factors such as the size of the amputation and the treatments used (whether it involves chemotherapy and radiotherapy, for example), can reduce the risks. Ideally, fertility preservation should be discussed at the start of treatment, so that if the patient so wishes and their body offers the possibility, they have the possibility of storing sperm for future use.
Have you watched our new videos on Youtube? Subscribe to our channel!