The rare condition of penile cancer

An old man was referred from a peripheral health facility to Muhimbili National Hospital (MNH). That was two years ago when I was serving as an intern doctor at the national referral hospital.

The chap, who was in his 60s, was complaining of a nagging sore on his penis. It had been bleeding from under the foreskin, with a foul smell and changes in colour.

He was in great dismay because of what he was experiencing. But what scared him most was his foreskin. It was becoming thicker and thicker and difficult to retract—at that time; it looked like everything fared badly for him.

After taking his history and performing physical examination, I elicited all signs and symptoms--all pointing to the fact that he was suffering from penile cancer (cancer of the penis)-a condition believed to be rare in Tanzania.

Penile cancer occurs in almost the same way as the old man was describing his symptoms—and on physical examination, all signs were typical of the malignancy.

It is not known what actually causes this cancer; however, there are known risk factors such as, tobacco smoking, infection by Human Papilloma Virus (HPV) and the cancer has been found to be common in males who remain uncircumcised from childhood to adulthood.

Back to the old man’s story, and here comes a situation where part of penis had to be surgically removed. Medical tests were now completed and the results were out; and the stage of his cancer was known.

A section of his penis—the glans and part of the shaft (the tubular part of the penis) had been attacked by the malignancy.

My role as a junior doctor was now to give him as much counseling as possible—especially on the cosmetic and health aspects of carrying out the surgical procedure on his penis.

The procedure entailed cutting off the end part of his penis but the shaft was going to be left intact.

I tried to talk to him humbly and compassionately, as I explained in details about his health condition and the possible treatment options.

Of course, as I spoke to him, the issue of cutting off a section of his penis worried him. He appeared distressed. He then posed a question which to me; sounded very logical.

“Je, nitaweza kushiriki tena tendo la ndoa,” (Will I be able to enjoy –sex after all this?),” he asked, in Kiswahili:

In order not to leave him shocked, I first told him, patiently, that he would need to sit during a short call. Then, I gave him the bad news, making it clear to him that he could never again have sexual intercourse. But I insisted to him that he could still remain fertile.

Of course, I had to be so persuasive; but he was keen—he kept on posing questions. He was right to ask; because what was going to be removed was his an organ that gives his pleasure and it’s a reproductive organ.

Someone would wonder, why this mzee, despite being in his 60s, was still so worried about it his sexual organ!

An to make matters worse, the man flatly refused to undergo the procedure. He asked us to give him time to think about it. He then posed another question: “hivi hamna dawa ya kukausha tu” (is there no medicine to dry out this cancer?”

Well, there was no pleasing answer for him. He spent days in the ward without giving consent for surgery. But, as you know, the cancer doesn’t stop and you can imagine what his decision was when matters got worse!

Story aside, there is this aspect of data. In the United Kingdom, around 550 men are diagnosed with cancer of the penis each year. It most commonly affects men aged 60 years and above. It as well occurs at any age including childhood, but it mostly affects the elderly. It is said that in Africa it affects more people below the age of 60 years.

That data actually means that the western world has a low prevalence; possibly because those countries have invested heavily in fighting the cancer.

In a study done in 2013 at Bugando Medical Centre in Mwanza Region, 236, patients representing 2.2 per cent of all male cancers during the study period, the median age of the patients was 47years.

In that study, 89.8 per cent of patients were uncircumcised and in 5.1 per cent of them, a history of Human Papilloma Virus (HPV) was reported.

In 77.1 per cent of them, there was a history of cigarette smoking. Majority of the patients underwent surgery to remove part of the penis—partial penectomy—that was 63.1 per cent.

About 22.9 per cent of the patients reported a history of having multiple sexual partners, and because of all this data, the researchers concluded that penile cancer was not rare disease here in Tanzania.

According to the researchers, majority of patients usually report late at health facilities, when their disease has advanced and this makes early detection impossible. This study was an eye-opener.

In my opinion, this disease is not yet well studied here in Tanzania. It may have become a stick-in-the mud for those who believe the disease is still rare in the country.

Can it be prevented?

You can just reduce the chances of getting it. What you need to do is stop smoking cigarettes from now on, maintain good penis hygiene, being circumcised at childhood. Mind you it is said that delayed circumcision offers only slight protection against subsequent development of penile carcinoma.

The author is a medical doctor, public health activist and researcher based in Dar es Salaam.