CIRCUMCISION AND RISK FACTORS FOR PENILE CANCER

Year 2010, Volume: 4 Issue: 2, 85 - 88, 25.07.2010

Ahmet Gökçe

Abstract

Penile carcinoma is relatively uncommon in most Western countries. The diagnosis of penil cancer may be delayed because many patients disregard early asymptomatic lesions. Majority of the cases are squamous cell carcinoma (SCO). Although several risk factors commonly are recognized, the exact cause of penis cancer is not definitely known. Phimosis is one of the most mentioned cause in the pathogenesis of penile SCC. Studies have consistently reported neonatal or childhood circumcision to be associated with reduced risk, which corresponds geographically with reduced rates of penile SCC in populations practicing neonatal circumcision. The protective effect of childhood circumcision seems to be attributable to the elimination of inflammatory conditions related to poor genital hygiene, such as phimosis and balanitis. Accordingly, an intact foreskin has been shown not to be associated with increased penile SCC risk in the absence of phimosis. Poor genital hygiene in uncircumcised men, even in the absence of phimosis, may also lead to the retention of microorganisms and secretions, including smegma. Tobacco smoking, particularly current smoking, has been reported in a number of studies to be linked to increased risk of penile SCC. Ultraviolet radiation exposure, either therapeutic or recreational, may increase the risk of penile SCC. Human papillomavirus has been implicated as a causal agent in penile cancer, suggesting that this cancer may be a sexually transmitted disease. Chronic irritation or trauma and prolonged exposure to chemical compounds together with poor hygiene have been reported in association with penile SCC.

Keywords

Penile Neoplasms, Circumcision, Phimosis

PENİS KANSERİ İÇİN RİSK FAKTÖRLERİ VE SÜNNET

Abstract

Penis kanseri batı ülkelerinin çoğunda diğer ülkelere göre daha nadir görülür. Penis kanseri tanısı erken dönemde gözlenen ve semptoma yol açmayan lezyonların hastalar tarafından fazla önemsenmemesi ve dikakate alınmaması nedeniyle gecikebilir. Penis kanseri olgularının büyük çoğunluğu skuamöz hücreli kanserdir. Bazı risk faktörleri tanımlanmış olsa da penis kanserinin kesin sebebi tam olarak anlaşılabilmiş değildir. Fimozis penis kanserinin gelişiminde rol aldığı düşünülen konular içinde en fazla bahsi geçen durumlardan biridir. Yapılan bilimsel çalışmaların çoğundan elde edilen sonuçlar yenidoğan veya çocukluk çağında sünnet yapılması ile riskin azalması arasında anlamlı bir ilişki olduğunu göstermektedir. Yine yapılan çalışmaların çoğundaki sonuçlar, çocukluk çağında yapılan sünnetin koruyucu etkisinin fimozis ve balanitis gibi kötü genital hijyen ile ilgili inflamatuvar durumların ortadan kaldırılmasına bağlı olduğunu vurgulamaktadır. Sünnet olmamış kişilerde eğer genital bölge hijyeni kötü ise fimozis olmasa da bu bölgede mikroorganizmalar ve smegma birikimi meydana gelebilir. Birçok çalışmada sigara içiciliğinin de penil skuamöz hücreli kanser riskinde artış ile ilşkili olduğu sonucu elde edilmiştir. İster tedavi amaçlı olsun ister estetik amaçlı olsun ultraviyole radyasyona maruz kalmak da farklı derecelerde penil skuamöz hücreli kanser riskini artırabilir. Kronik irritasyon ve penil travma, kötü genital hijyenle eş zamanlı olarak uzun süreli olarak kimyasal bileşenlere maruz kalmak da penis kanserleri ile ilişkili durumlar olarak yapılan çalışmalarda bildirilmiştir.

Dr. Ahmet GÖKÇE,
Dr. Mevlana Derya BALBAY

Keywords

Penil tümörler; Sünnet; Fimozis, Penil tümörler, Sünnet, Fimozis

References

• 1. Riveros M and Lebron RF. Geographical pathology of cancer of the penis. Cancer 1963;16:798-811
• 2. Madsen BS, van den Brule AJ, Jensen HL, Wohlfahrt J and Frisch M. Risk factors for squamous cell carcinoma of the penis--pop-ulation-based case-control study in Denmark. Cancer Epidemiol Biomarkers Prev 2008;17:2683-91
• 3. Mosconi AM, Roila F, Gatta G and Theodore C. Cancer of the penis. Crit Rev Oncol He-matol 2005;53:165-77
• 4. Maiche AG. Epidemiological aspects of cancer of the penis in Finland. Eur J Cancer Prev 1992;1:153-8
• 5. Dating JR, Madeleine MM, Johnson LG, Schwartz SM, Shera KA, Wurscher MA, Carter JJ, Porter PL, Galloway DA, McDougall JK et al. Penile cancer: importance of circumcision, human papillomavirus and smoking in in situ and invasive disease. Int J Cancer 2005;116:606-16
• 6. Narayana AS, Olney LE, Loening SA, Weimar GW and Culp DA. Carcinoma of the penis: analysis of 219 cases. Cancer 1982;49:2185-91
• 7. Carver BS, Mata JA, Venable DD and Eastham JA. Squamous cell carcinoma of the penis: a retrospective review of forty-five patients in northwest Louisiana. South Med J 2002;95:822-5
• 8. Burgers JK, Badalament RA and Drago JR. Penile cancer. Clinical presentation, diagnosis, and staging. Urol Clin North Am 1992;19:247-56
• 9. Dillner J, von Krogh G, Horenblas S and Meijer CJ. Etiology of squamous cell carcinoma of the penis. Scand J Urol Nephrol Suppl 2000;189-93
• 10. Kamat MR, Kulkarni JN and Tongaonkar HB. Carcinoma of the penis: the Indian experience. J Surg Oncol 1993;52:50-5
• 11. Cubilla AL, Barreto J, Caballero C, Ayala G and Riveros M. Pathologic features of epidermoid carcinoma of the penis. A prospective study of 66 cases. Am J Surg Pathol 1993;17:753-63
• 12. Persky L. Epidemiology of cancer of the penis. Recent Results Cancer Res 1977;97-109
• 13. Jensen MO. Cancer of the penis in Denmark 1942 to 1962 (511 cases). Dan Med Bull 1977;24:66-72
• 14. Boon ME, Susanti I, Tasche MJ and Kok LP. Human papillomavirus (HPV)-associated male and female genital carcinomas in a Hindu population. The male as vector and victim. Cancer 1989;64:559-65
• 15. Grossman HB. Premalignant and early carcinomas of the penis and scrotum. Urol Clin North Am 1992;19:221-6
• 16. Onuigbo WL Carcinoma of skin of penis. Br J Urol 1985;57:465-6
• 17. Wiswell TE. Circumcision--an update. Curr Probl Pediatr 1992;22:424-31
• 18. Shabad AL. Some Aspects of Etiology and Prevention of Penile Cancer. J Urol 1964;92:696-702
• 19. Longombe AO and Lusi KM. Penile cancer in rural Zaire. Trop Geogr Med 1994;46:366-7
• 20. Tsen HF, Morgenstern H, MackT and Peters RK. Risk factors for penile cancer: results of a population-based case-control study in Los Angeles County (United States). Cancer Causes Control 2001;12:267-77
• 21. Maden C, Sherman KJ, Beckmann AM, Hislop TG, Teh CZ, Ashley RL and Daling JR. History of circumcision, medical conditions, and sexual activity and risk of penile cancer. J Natl Cancer Inst 1993;85:19-24
• 22. Schoen EJ, Oehrli M, Colby C and Machin G. The highly protective effect of newborn circumcision against invasive penile cancer. Pediatrics. 2000;105:E36
• 23. Licklider S. Jewish penile carcinoma. J Urol 1961;86:98
• 24. Misra S, Chaturvedi A and Misra NC. Penile carcinoma: a challenge for the developing world. Lancet Oncol 2004;5:240-7
• 25. Novara G, Galfano A, De Marco V, Artibani W and Ficarra V. Prognostic factors in squamous cell carcinoma of the penis. Nat Clin PractUrol 2007;4:140-6
• 26. Hellberg D, Valentin J, Eklund T and Nilsson S. Penile cancer: is there an epidemiological role for smoking and sexual behaviour? Br Med J (Clin Res Ed) 1987;295:1306-8
• 27. Pec J, Jr., Pec J, Sr., Plank L, Plank J, La-zarova Z and Kliment J. Squamous cell carcinoma of the penis. Analysis of 24 cases. Int Urol Nephrol 1992;24:193-200
• 28. Soria JC, Fizazi K, Piron D, Kramar A, Ger-baulet A, Haie-Meder C, Perrin JL, Court B, Wibault P and Theodore C. Squamous cell carcinoma of the penis: multivariate analysis of prognostic factors and natural history in monocentric study with a conservative policy. Ann Oncol 1997;8:1089-98
• 29. Kakinuma H, Miyakawa K, Baba S, Suzuki H, Kawada N and Takimoto Y. Penile cancer associated with an artificial penile nodule. Acta Derm Venereol 1994;74:412-3
• 30. Plaut A and Kohn-Speyer AC. The Carcinogenic Action of Smegma. Science 1947;105:391-2
• 31. Dennis EJ, Heins HC, Latham E, McIver FA and Pratt-Thomas HR. The carcinogenic effect of human smegma: an experimental study. I. Preliminary report. Cancer 1956;9:671-80
• 32. Heins HC, Jr., Dennis EJ and Pratthomas HR. The possible role of smegma in carcinoma of the cervix. Am J Obstet Gynecol 1958;76:726-33;33-5
• 33. Reddy DG and Baruah IK. Carcinogenic action of human smegma. Arch Pathol 1963;75:414-20
• 34. Micali G, Innocenzi D, Nasca MR, Musumeci I ML, Ferrau F and Greco M. Squamous cell 1 carcinoma of the penis. J Am Acad Dermatol I 1996;35:432-51
• 35. Harish K and Ravi R. The role of tobacco in I penile carcinoma. Br J Urol 1995;75:375-7 I
• 36. Brinton LA, Li JY, Rong SD, Huang S, Xiao I BS, Shi BG, Zhu ZJ, Schiffman MH and I Dawsey S. Risk factors for penile cancer: I results from a case-control study in China. I Int J Cancer 1991;47:504-9
• 37. Stern RS, Bagheri S and Nichols K. The persistent risk of genital tumors among I men treated with psoralen plus ultraviolet A (PUVA) for psoriasis. J Am Acad Dermatol I 2002;47:33-9
• 38. Henseler T, Christophers E, Honigsmann H and Wolff K. Skin tumors in the European PUVA Study. Eight-year follow-up of 1,643 patients treated with PUVA for psoriasis. J
• 39. Stern RS. Genital tumors among men with psoriasis exposed to psoralens and ultraviolet A radiation (PUVA) and ultraviolet B radiation. The Photochemotherapy Follow-up Study. N Engl J Med 1990;322:1093-7
• 40. McCance DJ, Kalache A, Ashdown K, Andrade L, Menezes F, Smith P and Doll R. Human papillomavirus types 16 and 18 in carcinomas of the penis from Brazil. Int J Cancer 1986;37:55-9
• 41. Villa LL and Lopes A. Human papillomavirus DNA sequences in penile carcinomas in Brazil. Int J Cancer 1986;37:853-5
• 42. Shah KV. Biology of genital tract human papillomaviruses. Urol Clin North Am. 1992;19:63-9
• 43. Loning T, Riviere A, Henke RP, von Preyss S and Dorner A. Penile/anal condylomas and squamous cell cancer. A HPV DNA hybridization study. Virchows Arch A Pathol Anat Histopathol 1988;413:491-8
• 44. Favre M, Kremsdorf D, Jablonska S, Obalek S, Pehau-Arnaudet G, Croissant O and Orth G. Two new human papillomavirus types (HPV54 and 55) characterized from genital tumours illustrate the plurality of genital HPVs. Int J Cancer 1990;45:40-6
• 45. Iwasawa A, Kumamoto Y and Fujinaga K. Detection of human papillomavirus deoxyribonucleic acid in penile carcinoma by poly- merase chain reaction and in situ hybridization. J Urol 1993;149:59-63
• 46. Pfister H and Fuchs PG. Relation of papillomaviruses to anogenital cancer. Dermatol Clin 1991;9:267-76
• 47. Oriel JD. Natural history of genital warts. 1971. Sex Transm Infect. 2000;76 Suppl 1;S21
• 48. Werness BA, Levine AJ and Howley PM. Association of human papillomavirus types 16 and 18 E6 proteins with p53. Science 1990;248:76-9
• 49. zur Hausen H. Papillomaviruses in the causation of human cancers - a brief historical account. Virology 2009;384:260-5
• 50. Barrasso R, De Brux J, Croissant O and Orth G. High prevalence of papillomavirus-associated penile intraepithelial neoplasia in sexual partners of women with cervical intraepithelial neoplasia. N Engl J Med 1987;317:916-23
• 51. zur Hausen H. The role of papillomaviruses in anogenital cancer. Scand J Infect Dis Suppl 1990;69:107-11
• 52. Hellberg D and Nilsson S. Genital cancer among wives of men with penile cancer. A study between 1958 and 1982. Br J Obstet Gynaecol 1989;96:221-5
• 53. Previte SR, Karian S, Cho SI and Austen G, Jr. Penile carcinoma in renal transplant re-cipient. Urology 1979;13:298-9
• 54. Poblet E, Alfaro L, Fernander-Segoviano P, Jimenez-Reyes J and Salido EC. Human papillomavirus-associated penile squamous cell carcinoma in HIV-positive patients. Am J Surg Pathol 1999;23:1119-23
• 55. Parkin DM, Wabinga H, Nambooze S and Wabwire-Mangen F. AIDS-related cancers in Africa: maturation of the epidemic in Uganda. AIDS 1999;13:2563-70
• 56. Piepkorn M, Kumasaka B, Krieger JN and Burmer GC. Development of human papillomavirus-associated Buschke-Lowenstein penile carcinoma during cyclosporine therapy for generalized pustular psoriasis. J Am Acad Dermatol 1993;29:321-5
• 57. Rogus BJ. Squamous cell carcinoma in a young circumcised man. J Urol 1987;138:861-2
• 58. Sasson IM, Haley NJ, Hoffmann D, Wynder EL, Hellberg D and Nilsson S. Cigarette smoking and neoplasia of the uterine cervix: smoke constituents in cervical mucus. N Engl J Med 1985;312:315-6
• 59. Cruickshank AH, McConnell EM and Miller DG. Malignancy in Scars, Chronic Ulcers, and Sinuses. J Clin Pathol 1963;16:573-80
• 60. Novick M, Gard DA, Hardy SB and Spira M. Burn scar carcinoma: a review and analysis of 46 cases. J Trauma 1977;17:809-17