title: Ten-year surgical experiences with penile cancer at a tertiary care hospital in northwestern Tanzania: a retrospective study of 236 patients.
abstract: BACKGROUND
  Penile cancer is an uncommon malignancy in developed countries, but the incidence is as high as 10% to 20% of all male cancers in some developing countries. There is a paucity of published data on this subject in our setting. This study describes the clinicopathological presentation and treatment outcome of this condition in our environment, and highlights challenges associated with the care of these patients and proffers solutions for improved outcome.
  
  
  METHODS
  This was a retrospective study of histologically confirmed cases of penile cancer seen at Bugando Medical Centre between January 2004 and December 2013.
  
  
  RESULTS
  There were 236 penile cancer patients representing 2.2% of all male malignancies during the study period. The median age was 47 years with a modal age group of 41 to 50 years. Of the 236 patients, 147 (62.3%) had severe phimosis. The majority of patients (89.8%) were uncircumcised. A history of human papilloma virus (HPV) was reported in 12 (5.1%) cases. One hundred eighty-two (77.1%) patients reported history of cigarette smoking. Seven (6.7%) patients were human immunodeficiency virus (HIV) positive. The majority of the patients (68.6%) presented with Jackson's stages III and IV. Squamous cell carcinoma was the most common histopathological type (99.2%). Lymph node metastasis was recorded in 65.3% of cases, and it was significantly associated with the tumor size, histopathological subtype, histopathological grade, lympho-vascular invasion, positive resection margins, and urethral involvement (P < 0.001). Distant metastasis accounted for 4.2% of cases. The majority of patients (63.1%) underwent partial penectomy. Chemotherapy and radiotherapy were given in 14 (5.9%) and 12 (5.1%) patients, respectively. Complication and mortality rates were 22.0% and 4.2%, respectively. HIV positivity, histopathological stage and grade of the tumor, and presence of metastases at the time of diagnosis were the main predictors of death (P < 0.001). The median length of hospitalization was 14 days. Local recurrence was reported in 12 (5.3%) patients. Data on long-term survivals were not available as the majority of patients were lost to follow-up.
  
  
  CONCLUSIONS
  Penile cancer is not rare in our environment. The majority of patients present late with advanced stage of the disease. Early detection of primary cancer at an early stage may improve the prognosis.
authors.affiliation: Department of Surgery, Bugando Medical Centre, P.O. Box 1370, Mwanza, Tanzania. drphillipoleo@yahoo.com.
authors.forename: Phillipo L
authors.initials: PL
authors.lastname: Chalya
authors.affiliation: Department of Pathology, Catholic University of Health and Allied Science-Bugando, P.O. Box 1464, Mwanza, Tanzania. prambau@bugando.ac.tz.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Rambau
authors.affiliation: Department of Oncology, Bugando Medical Centre, P.O. Box 1370, Mwanza, Tanzania. nmasalu4@gmail.com.
authors.forename: Nestory
authors.initials: N
authors.lastname: Masalu
authors.affiliation: Department of Urology, Bugando Medical Centre, P.O. Box 1370, Mwanza, Tanzania. samsimbila50@gmail.com.
authors.forename: Samson
authors.initials: S
authors.lastname: Simbila
mesh_terms: D000328:Adult; D018288:Carcinoma, Small Cell / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D010412:Penile Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D015996:Survival Rate; D013636:Tanzania; D063128:Tertiary Health Care; D013997:Time Factors