Scrotal Carcinoma

 

Scrotal Carcinoma

 

Scrotal carcinoma refers to cancer in the scrotum. A scrotum is a sac like structure, which holds the testes in males. The most common type of primary scrotal cancer is squamous cell carcinoma (see article on Skin Cancer). The squamous cells of the skin of the scrotum are the main site of origin of this form of cancer. However sometimes adenocarcinoma (Paget’s disease) can also occur.

 

Squamous cell carcinoma of the scrotum is also called Chimney sweeps’ cancer or Soot wart since this form of cancer was initially found in Chimney sweeps. This disease stands out from the rest since it was the first form of occupational cancer reported. It was identified by Percival Pott in 1775. The cancer was caused by an active ingredient of coal soot, which is a carcinogen.

Epidemiology

Squamous cell carcinoma of the scrotum is a rare malignancy in the United States. The mean age of patients is 62 years.

The frequency of the disease has decreased in the last 50 years.

The overall incidence rate for scrotal cancer varied around 1.5 per 1,000,000 person-years.

The testicles are in the scrotum; testicular cancer is a completely separate disease (see article on testicular carcinoma).

Etiology or Risk factors

  • Occupational exposure: Previously, it commonly resulted from exposure to environmental carcinogens. Workers in the chimney sweep, paraffin, shale oil, cotton spinning, machine operation, petroleum wax pressing, screw-making, and automatic lathe operating industries or are more likely to develop scrotal cancer. At the current time, car mechanics are at potential risk for coming in contact with used engine oil that contains elevated polycyclic aromatic hydrocarbons and are the only workers shown to be at increased risk according to recent studies.
  • Currently most cases result from poor personal hygiene and chronic irritation and inflammation.
  • PUVA treatment (a psoralen plus long-wave ultraviolet radiation or UVA treatment) for psoriasis and eczema, coal tar and arsenic-based treatments for treatment of psoriasis and exposure to radiation for therapeutic purpose
  • Human Papilloma Virus (HPV) infection

At present frequency of scrotal cancer due to occupational exposure has decreased drastically due to improved working environment and infrastructure.

Clinical features

  • A slow growing single skin lesion which is often ulcerated
  • In half of the patients who present palpable inguinal lymphadenopathy cancer has spread from the scrotum to their inguinal nodes

Symptoms

  • Lump or sore on the skin of the scrotum, that may be painful or painless
  • Unusually large scrotum

Diagnosis

  • Physical exam
  • Ultrasound imaging of the scrotum: This procedure with sound waves gives an image of the internal regions of the scrotum on a computer screen.
  • Biopsy: Cells or tissues removed from the affected tissue by surgery are examined under a microscope in the laboratory to check for signs of cancer. Sentinel node biopsy and superficial inguinal node biopsy are done to analyze the extent to which cancer has spread.

Staging

Ray Whitmore classification (1977) was modified by Lowe in 1992. According to Lowe, scrotal carcinoma can have the following stages:

  • A1: Restricted in scrotum
  • A2: Spreads locally to adjacent structures, including testis, spermatic cord, penis, pubic bone or perineum
  • B: Spreads to inguinal lymph nodes
  • C: Spreads to pelvic lymph nodes
  • D: Spreads to distant organs

Treatment

Surgery: Surgery is the mainstay treatment for scrotal cancer. A wide excision at the site of cancer is done and the cancerous tissue is removed along with some additional nearby tissues and nearby lymph glands in most cases. Biopsy results suggest whether cancer has spread beyond the scrotum. If biopsy results are positive then radical ilioinguinal lymphadenectomy is performed to remove the lymph nodes in which the cancer has spread.

Prognosis

In a study conducted in Netherlands, it was found that the 5-year relative survival rate for scrotal cancer patients is 82 %. Among them 77 % patients had squamous cell carcinoma and 95% patients had basal cell carcinoma. Data for this study was collected for a period of 17 years (1989-2006). Therefore, Chimney sweeps disease, which is squamous cell carcinoma of the scrotum, has a good survival rate. However, almost all patients die whose iliac nodes are invaded by the cancer cells.

References

  1. Azike JE. (2009) A review of the history, epidemiology and treatment of squamous cell carcinoma of the scrotum. Rare Tumors.;1(1):e17.
  2. Chamorro JC, García SG, de Blas Gómez V. (2011) Scrotal carcinoma. Arch Esp Urol. Jul;64(6):541-3.
  3. Verhoeven RH, Louwman WJ, Koldewijn EL, Demeyere TB, Coebergh JW. (2010) Scrotal cancer: incidence, survival and second primary tumors in the Netherlands since 1989. Br J Cancer.;103(9):1462-6.
  4. Saunders S, Martin J, Harmse D. (2009) Scrotal carcinoma: a reminder of a disappearing occupational disease. BMJ Case Rep. 2009;2009. pii: bcr06.2008.0132.
  5. Azike JE, Chukwujama NO, Oguike TC. (2009) Squamous cell carcinoma of the scrotum in a Nigerian: case report. Rare Tumors. 22;1(1):e2.
  6. This article was originally published on September 3, 2012 and last revision and update was 9/4/2015.