The disease that will take your manhood

Joseph Nzeyimana (not real name) had his penis cut off after he was diagnosed with penile cancer. But even this couldn’t help him survive the deadly disease: he died three months after the fateful operation. Nzeyimana was 49 at the time of his death. How it started When Nzeyimana noticed small sores on his penis about two years ago, he did not imagine that they would develop into a disease that would later cost him his life. Thinking that it was just a temporary setback, he decided to ignore them, hoping that they would eventually disappear. They did not. Instead, his penis kept on swelling and later developed a big wound. According to Nzeyimana’s widow, a resident of Bumbogo Sector in Gasabo District, her husband experienced unspeakable pain on his penis before he decided to seek medical attention at the University Central Hospital of Kigali (CHUK). “At CHUK we were referred to Kibagabaga Hospital from where he was diagnosed with penile cancer,” she says. The first thing the doctors did was to give Nzeyimana palliative care to ease the side effects of the deadly disease. For the uninitiated, palliative care includes supporting the patient with his or her physical, emotional, and social needs. But after sometime, doctors decided that Nzeyimana’s penis be removed because the cancer was already in advanced stages. Cutting off his penis, they argued, was the only way Nzeyimana could get a chance to live longer. “The doctors briefed me and I agreed without hesitation because I knew that was the only way my husband could be relieved of the pain and, maybe even, live longer,” she says. However, unfortunately, not even the operation could save her husband – it was too late. She regrets the fact that her husband didn’t seek medical attention in time, which greatly reduced his chances of survival. According to Dr Christian Ntizimira, a palliative care expert at Kibagabaga Hospital, the hospital receives at least two penile cancer patients every month. “But unfortunately most of them come here when the cancer is in advanced stages so they die after between three to six months,” he says. Dr Ntizimira says that most patients are reluctant to seek medical advice because at first they think it’s a Sexually Transmitted Disease. He advices patients to seek medical attention as soon as they get the following symptoms: swollen lymph nodes in the groin, growth or ulcer on the penis, changes in the colour of the penis, skin thickening, persistent discharge with a foul odour beneath the foreskin and blood oozing from the tip of the penis among others. Penectomy The surgical removal of part or all of the penis is the most common and effective procedure to treat penile cancer that has grown into the inside of the penis. A partial penectomy is usually performed when the cancerous tissue and 2cm margin of healthy tissue can be removed while leaving enough length of the penis for the patient to urinate naturally. When this is not possible, a total penectomy is performed, which is the removal of the entire penis. The surgeon will tunnel the urinary tract underneath the scrotum, requiring the patient to urinate in a sitting position. Causes of penile cancer The exact cause of most penile cancers is not known. However, scientists have found that the disease is associated with a number of other conditions. A great deal of research is now under way to learn more about how these risk factors cause cells of the penis to become cancerous. For example, research has shown that normal cells regulate themselves by making substances called tumor suppressor gene products to keep them from growing too fast and becoming cancers. Two proteins (E6 and E7) made by high-risk types of human papilloma virus (HPV) can block the function of tumor suppressor gene products in cells, which may make them more likely to become cancerous. Smoking produces cancer-causing chemicals that spread throughout the body and can damage the DNA of cells of the penis. (DNA is the chemical in each of our cells that makes up our genes – the instructions for how our cells grow and divide.) DNA damage affecting genes that regulate cell growth can contribute to the development of cancer.