Advancement in the use of radiation therapy includes using three-dimensional conformal radiation therapy (3D-CRT) to create a three-dimensional image of tumor so providers can determine the dose of radiation per patient while limiting radiation exposure to normal tissues. Techniques such as multi-field optimization (MFP) allows for more precise distribution of proton beams. Treatment Plan
The first line of treatment for most people is surgery or resection of the tumor(s). The surgery involves removing the primary tumor and any tissue that may be infected with cancer cells. Resection of the tumor tends to be more favorable in cancers that have not yet metastisized. In the case that the tumor cannot be removed, the cancer can be treated with a combination of radiation and chemotherapy instead. In the majority of people, the surgery cannot remove all traces of the cancer and chemotherapy/radiation will be required as further treatment to eradicate any remaining cancer. Chemotherapy is given in the US as a medication regimen abbreviated VAC, consisting of Vincristine, Actinomycin D, and Cyclophosphamide. The chemotherapy works to kill all the remaining cancer cells and to stop future growth of any possible cancerous cells. Safety concerns regarding the long term effects of chemotherapy remains a concern. Side effects of the VAC regimen include nausea, vomiting, liver damage, and immune system suppression. The length and dosing of the chemotherapy is oftentimes on a case by case basis based off the persons stage of cancer, site of tumor and age.
According to Vilanora and Raventos, in 1954, a fourth group called pseudodiphallia is added.The current widely accepted classification, introduced by Aleem in 1972, classifies double penis into two groups: true diphallia and bifid phallus. True diphallia is caused by cleavage of pubic tubercle; bifid phallus is caused by separation of pubic tubercle. Each of these two groups is further subdivided into partial or complete. True diphallia is where each phallus has two corpora cavernosa and a single corpus spongiosum containing a urethra. True diphallia can be either complete with both penises similar in size, or partial when one of the phallia is smaller in size or immature, though structurally same as the larger phallus. In bifid phallus, each phallus has only one corpus cavernosum and one corpus spongiosum containing a urethra. Separation of penises down to the base of the penile shaft is complete bifid, whereas to glans is partial bifid. For complete bifid phallus associated with anomalies, the anterior urethra is absent from each penis and the prostatic urethra is situated in the skin between the two penises. In partial bifid phallus, the duplication of urethra, corpora cavernous and corpus spongiosum in one penis is incomplete, and there is only a corpus cavernosum and a spongiosum surrounding the functioning urethra in the other penis. Notable clinical cases
Diphallia is usually accompanied by systemic anomalies; their extent varies, ranging from no associated anomaly to multiple anomalies including urogenital, gastrointestinal and musculoskeletal systems. Penile duplication also varies from a single penis with double glans to complete double penises.