Late Effects of Penile Cancer

Penile cancer therapy should encompass treatment of the primary cancer and lymph nodes, whilst optimising cosmetic appearance and function. Late effects of treatment include urinary changes, sexual dysfunction, genital and lower limb lymphoedema. Urinary symptoms can occur due to recurrence of pathologies that predisposed patients to developing penile cancer in the first place such as lichen sclerosis, external factors from genital lymphoedema causing penile burying, or secondary to scarring due to the surgery itself including meatal stenosis. Sexual function encompasses both physical and psychological components and is dependent on the procedure performed, with more radical approaches leading to lower patient satisfaction rates. Patients can also experience body and self-image challenges because of treatment that need to be considered in their holistic management. Lymphoedema occurs due to the disruption of lymphatics when nodal sampling or nodal dissection occurs. The accumulation of lymph fluid contributes to loss of elasticity and hyperplasia of connective tissue and ultimately fibrosis. This result clinically, in hyperkeratosis, dermal thickening, hyperpigmentation, increased skin folds, warty overgrowths and occasionally malignant transformation.