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Psychopathophysiology Penile cancer is rare, occurring in less than 1% of cancers among men in the United States. (ACS, 2009) Several factors for penile cancer have been identified, including lack of circumcision, poor genital hygiene, phimosis, HPV, smoking, UV light treatment of psoriasis on the penis, increasing age (two thirds of cases occur in men older than 65 years of age), lichen sclerosus and balanitis xerotica obliterans. (Smeltzer et. Al., 2010). The patient was an alcoholic and a smoker (36 pack years). Being a jeepney driver and having to sit in very long periods subjects the perineal area, including the penile area, to chronic irritation though pressure and heat. This lifestyle makes the patient become more stressed causing him to have a weaker immune response in eliminating carcinogens. Prolonged exposure to this environmental and internal risk factors resulted in the alteration of the DNA structure in the cells. The first step of carcinogenesis, initiation, is often associated with prolonged exposure to the risk factors resulting in the activation of the proto-oncogenes thus turning them into oncogenes. Oncogenes play a major role in the process of cancer cell formation. Oncogenes such as erb B, hst, int-2 and PRAD-1 have been known to contribute in formation of most squamous cell carcinomas. In initiation, the suppressor genes also lose their effect that is to suppress the protooncogene activation. Initiated cells undergo promotion, the second stage of carcinogenesis by which the cells are repetitively exposed to different carcinogens. If initiation and promotion is successful, the cell will now undergo progression, the third stage of carcinogenesis. In progression, cell malignancy begins to develop. Cells will have shorter periods of G0 or reproductive resting states by then cells reproduce in a much faster rate. The cells also lose their density-dependent contact inhibition property. This property of normal cells is needed so that cells recognize their neighbouring cells and signals them to stop reproduction. This cell property governs the normal anatomical and physiological structure development of life-forms. Cancer cells lose this property thus allowing them to reproduce despite space constraints in the tissues. All these new properties of the cancer cells allow them to grow in a faster rate and form tumors. To even more speed up tumor formation, cancer cells secrete tumor angiogenesis factors (TAF) which diffuses to near vasculatures. This would then allow

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small neoplasms to make new blood vessels to it for better blood supply and nourishment. This process of neovascularization and high reproduction rate leads to a much faster tumor formation. The formed tumor presses around the skin and the deep tissues surrounding it causing pain, swelling and tenderness in the shaft of the penis. The cancer cell will then invade deeper tissues and vasculatures. Together with this and the formation of the tumor, skin integrity is impaired causing the patient to slightly bleed in his penis due to vascular breakage. Normal cells are binded to each other by a protein called fibronectin. This prevents normal cells to break or separate from its desirable position. Cancer cells on the other hand lack fibronectin in their extracellular matrix thus making them to easily break down. At the time the cancer cell reached the lymphatic vessels, the flow of lymph causes the cancer cell to separate. The cancer cells travels through the lymphatic system and reaches both sides of the superficial inguinal and pelvic lymph nodes. There the cancer cells would continue to proliferate and grow on the nodes causing it to swell due to compression and accommodation. Surgery is the most common treatment method used in all forms of the disease. (Smeltzer et. Al., 2010) To prevent furthermore damage to surrounding tissues or organs, total penectomy and bilateral ilio-inguinal and pelvic lymphadenectomy was performed. Penectomy was done so because the penis would no longer be of use because of the damage and it would possibly be a cause of infection due its lesions. The procedure would result to the loss of a sensitive part of male human being which caused him to feel situational low self-esteem and slight shame because of his altered body image. Due to loss of closure of the urethra by total penectomy, perineal urethrostomy was done in order to provide new access for urine to go out of the body. To prevent metastasis, the last and the most dangerous stage of cancer, lymphadenectomy was done to stop the flow of the cancer cells throughout the other vital organs and to relieve patient from the discomfort of the swollen lymph nodes

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