Just about every man's worst nightmare.

• A lesion (lump) on the penis, which may look like a wart or spot; occasionally the lesion may be painful.
• A painless sore on the penis.
• Pain and bleeding may occur with advanced disease. 

Penile cancer is very rare — there's just one case for every 100,000 men each year — but uncircumcised men over 60 are at greater risk.

The exact cause of penile cancer is unknown. However, build-up of smegma (a smelly, cheese-like substance) under the foreskin is believed to be a factor because it can lead to chronic (i.e. long-term) inflammation. The disease is almost unknown among men who were circumcised shortly after birth.

You should see your doctor immediately if you find a lump on your penis. Your GP will perform a physical examination that can rule out any other conditions. He or she can refer you on to a hospital specialist for more detailed assessment. 

The treatment depends on the size and location of the tumor.

The first step is usually removal of the lump combined with circumcision. If the lump is too large to be removed without causing disfigurement then the surgeon will take only a small portion for analysis (biopsy). If penile cancer is confirmed then other options are possible:

• If the tumor was completely removed during the initial operation, then the condition can often be managed by a series of regular check-ups.
• If some cancer cells have been left behind then it may be appropriate to give X-ray treatment (radiotherapy) to the penis to avoid the need for further surgery.
• In advanced cases, then some or all of the penis may need to be removed (partial or total penectomy).
• If the disease has spread to involve the rest of the body then chemotherapy may be required. You will need to go into hospital for the first few doses of the chemotherapy drug to check for adverse side-effects.

If you are uncircumcised, you should clean behind your foreskin regularly. 

The outcome can be good if you are diagnosed and treated early. However, cancer of the penis often spreads to other parts of the body in the early stages of the disease. If the disease has not reached the lymph glands then between 65% and 90% of men survive for five years or more.

If a partial or total penectomy is performed then a new exit point for the urethra (water pipe) will have been fashioned at the time of surgery (this procedure is known as a urethrostomy). Sexual functioning can be maintained even when a large part of the penis has been removed, although your erection will be impaired. You will need time to get used to the appearance of the penis. It is likely to be distressing at first and counselling may be helpful. Joining a support group of other men affected may also help.