By Stephen Ssenkaaba

MATAYO Orono of Tecel village in Dokolo district is in agony and worried for his life. The 40-year-old father of six was recently admitted at Dokolo Health Centre IV with a damaged penis.

“It started by itching in 2008, before developing a wound,” Orono says. “When I tried to treat it using local herbs, it swelled,” he adds.

After a medical check-up, Orono was diagnosed with penile cancer.
Patrick Okino reports that Dr Moses Okello, the in-charge of Dokolo health unit, said the case was the first of its kind to be registered at the centre.

Penile cancer is slowly becoming a health concern. Although rare in the Western world, this disease is common in developing countries.

In Uganda, penile cancer is one of the most common cancers in males, but more recent data indicate declining incidence of the disease.

Dr. Rosemary Nassanga, a consultant urologist at Mulago Hospital, says the hospital receives one penile cancer patient every two weeks.

A urologist is a physician with specialised knowledge and skills regarding problems of the male and female urinary tract and the male reproductive organs.

What is penile cancer?
Penile cancer is a disease which causes cancerous cells to grow on the penis.

“It may start as a small swelling with white patches on the head of the penis,” says Dr. Nassanga. If left untreated, the cancer spreads from the penis to the lymph nodes in the groin and eventually to other parts of the body.

The cause of penile cancer is unknown, but Dr. Nassanga says it is linked to poor genital hygiene among uncircumcised men.

“Men who do not clean their foreskins stand a higher risk of getting the disease, resulting from an accumulation of whitish substance (smegma) which forms under the foreskin.

When it accumulates, this substance irritates the soft skin under the foreskin and could, with time, lead to cancer of the penis,” she says.

Symptoms
The disease presents various symptoms. The most common include a tender spot, wart-like lump or open sore on the penis, unusual liquid discharges from the penis as well as pain or bleeding in the genital area.

“In some cases, the patient may present with swelling of the lymph nodes around the groin area (ensanjabavu),” says Dr. Nassanga.

If unattended to, the cancerous tumour may grow into a wound which may eat away the penis right up to the pubic bone. It may eventually lead to the shrinking of the penis and in some cases completely eat it away.

In other instances, the disease may cause hardening and swelling of the penis. In advanced stages, the penis gives off a foul smell. If not given quick medical attention, the cancer may spread to other parts of the body — the lungs and bones.

In Uganda, she says, patients seek medical help late, which makes it difficult for doctors to help. She attributes this to the fear of stigmatisation by patients.

“Men are not forthcoming about penile cancer. They shy away from reporting this sickness fearing that people might call it a sexually transmitted disease (STD),” she says.

Although it is not an STD, Nassanga says, the disease is linked with sexually transmitted diseases.

“With the advent of AIDS, we seem to see an increasing number of penile cancer cases. The Human Papilloma Virus may also have a role to play in the development of penile cancer as it provides a conducive environment for growth of the cancerous swelling.” She says the condition may be worsened by smoking.

“Chemicals from the smoke fumes accumulate under the foreskin and when they mix with smegma, this results into irritation of the soft skin of the foreskin to cause penile cancer.

Nassanga explains that sometimes penile cancer affects the lymph nodes, causing lots of pain. The lymph nodes may swell and burst, leading to their infection and bleeding.

Treatment
According to Dr. Nassanga, excision is the mainstay of treatment for the disease. This involves cutting off the cancerous growth to prevent the cells from spreading to surrounding areas and the rest of the body,” she says.

If the cancerous growth is on the foreskin, we apply medical circumcision,” she says.

But if it is advanced, irrespective of where it is, we apply partial amputation of the penis. This is done in an area 2cm away from the tumour.

If the growth has eaten deep into the pubic area and is threatening to attack the pubic bone, the penis can be removed.

This means the patient would have to pass urine while squatting. This usually happens when a patient reports the case when it is too late.

Dr. Nassanga explains that while surgery is most ideal, there are other medical interventions. The patient can be subjected to radiotherapy.

This helps to prevent the spread of cancerous cells to other parts of the body.

Prevention
Prof. Henry Wabinga, a pathologist at Makerere University Medical School in Mulago, advises people to look out for the risk factors.
“It is advisable to maintain proper genital hygiene,” he says.

Dr. Nassanga says circumcision also helps as this ensures cleanliness of the soft skin and eliminates any chances of its irritation.

For those who are not circumcised, keep the foreskin clean by bathing frequently (at least once everyday). “It is also advisable for people to stop smoking as this contributes to the growth of the condition,” she says.