Penile cancer, almost always squamous cell carcinoma, is rare in individuals who maintain good penile hygiene and is essentially unknown in males circumcised in infancy. On the other hand, in some groups in which these protective factors are not present, particularly in Far Eastern countries, carcinoma of the penis is a relatively common form of cancer. It is frequently associated with venereal disease or with phimosis, which may obscure the diagnosis.

Clinical carcinoma of the penis may be preceded by leukoplakia of the glans or by epidermoid carcinoma in situ. The early malignant lesion may present as an innocent-appearing smooth papule or thickening of the epithelium or as a small warty growth. More advanced stages may be papillary and verrucoid (better prognosis) or ulcerating (poorer prognosis).

Simple biopsy should be performed to establish a histologic diagnosis of any persistent lesion of the glans, corona, or prepuce. Adequate surgical removal is the treatment of choice.

Testis

There are no known etiologic factors that are helpful in the diagnosis and management of cancer of the testis, except for the increased likelihood of a malignant tumor developing in an undescended testis, particularly when it is intra-abdominal.

The majority of testicular tumors are malignant, although there is a wide variation in clinical features and prognosis, ranging from the relatively favorable teratoma and radiosensitive seminoma to the less favorable teratocarcinoma and embryonal cell carcinoma and the highly malignant choriocarcinoma. Most tumors of the testis occur in patients between the ages of 20 and 45 years. At any age, however, a solid testicular swelling that is not clearly explained by infection must l>e assumed to be neoplastic until proved otherwise.

Since almost all testicular tumors are malignant and cure rates are related to early diagnosis and treatment, there should be no hesitation in proceeding with surgical exploration in the presence of findings that suggest the possibility of a neoplasm.

History

1. Painless swelling of the testicle, often associated with coincidental history of trauma.

2. Dragging sensation or "heaviness" in the scrotum.

3. Testicular tumors may masquerade as epididymitis, even with acute onset. This is far too often accepted as the provisional diagnosis and vital time lost before recognition of the malignant nature of the lesion.

4. Flank and/or chest pain and cough may be among first manifestations of aggressively metastasizing testicular tumors.

5. Swelling of the breasts may be the first complaint in patients with tumors that secrete chorionic gonadotrophins.

Physical Findings

1. Smooth firm enlargement, often generalized, although may present as a localized area or a nodule within an otherwise normal testis.

2. Areas of cystic softening may be encountered within some tumors.

3. Testicle tends to be less tender than usual.

4. Gynecomastia may be an early, even the presenting, finding in embryonal cell carcinoma or choriocarcinoma.

Intravenous pyelography, x-ray films of the chest, and determination of chorionic gonadotrophins may be helpful in establishing the nature and extent of disease preoperatively.

All of these procedures may give negative results in early and favorable tumors. In the presence of a strong suspicion of testicular tumor on history, physical examination, and at the time of surgical exposure of the testis, the recommended procedure is orchiectomy and pathologic examination of the entire testis. Needle aspiration or open biopsy are to be avoided to prevent dissemination of tumor.