What's in this article?
- 1 What is penile cancer?
- 2 Penile cancer signs and symptoms
- 3 What Are the Risk Factors for Penile Cancer?
- 4 How is penile cancer staged?
- 5 Treatment option overview
- 5.1 Surgery
- 5.2 Radiation therapy
- 5.3 Chemotherapy
- 5.4 Biologic therapy
- 5.5 Radiosensitizers
- 5.6 Sentinel lymph node biopsy followed by surgery
- 5.7 Patients may want to think about taking part in a clinical trial.
- 5.8 Follow-up tests may be needed.
What is penile cancer?
Penile cancer develops in or on the penis. Cancer starts when cells begin to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to other areas in the body.
To understand penile cancer, it helps to know about the normal structure and function of the penis.
Risk factors for developing penis cancer include human papillomavirus (HPV) infection, not being circumcised, being age 60 or older, phimosis, poor hygiene, many sexual partners, and tobacco use. Signs and symptoms of penile cancerinclude sores, redness, irritation, discharge, bleeding, or a lump on the penis.
Penile cancer signs and symptoms
You should be aware of any abnormalities or signs of penile cancer, including:
- a growth or sore on the penis that doesn’t heal within four weeks
- bleeding from the penis or from under the foreskin
- a foul smelling discharge
- thickening of the skin of the penis or foreskin that makes it difficult to draw back the foreskin (phimosis)
- a change in the colour of the skin of the penis or foreskin
- a rash on the penis
If you experience these symptoms, it’s important that they’re checked by your GP as soon as possible. It’s unlikely they’ll be caused by cancer of the penis, but they need to be investigated.
Any delay in diagnosing penile cancer could reduce the chances of successful treatment.
Possible signs of penile cancer include sores, discharge, and bleeding.
These and other symptoms may be caused by penile cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:
- Redness, irritation, or a sore on the penis.
- A lump on the penis.
What Are the Risk Factors for Penile Cancer?
Men living in Asia, Africa, and South America have a higher risk of developing penile cancer. Approximately 10 to 20 per 100,000 men are diagnosed with the condition every year in these regions.
Men who are uncircumcised are also more likely to be diagnosed with penile cancer. This may be because uncircumcised men are at risk for other conditions that affect the penis, such as phimosis and smegma. Phimosis is a condition in which the foreskin becomes tight and difficult to retract. Men with phimosis have a high risk of developing smegma. Smegma is a substance that forms when dead skin cells, moisture, and oil collect underneath the foreskin. It may also develop when uncircumcised men fail to clean the area under the foreskin properly.
Men are also at an increased risk for penile cancer if they:
- are over age 60
- smoke cigarettes
- practice poor personal hygiene
- live in a region with poor sanitation and hygiene practices
- have multiple sexual partners
- have a sexually transmitted infection, such as the human papillomavirus (HPV)
How is penile cancer staged?
The stage of a cancer is a standard way for doctors to sum up how far the cancer has spread. Once penile cancer is diagnosed, your doctor will determine the stage of the cancer using the results of exams, biopsies, and any imaging tests you have had. (These were described in the section “How is penile cancer diagnosed?”) The stage of your cancer is a very important factor in planning your treatment and estimating your prognosis (outlook).
If you have penile cancer, ask your cancer care team to explain its stage in a way that you can understand. Knowing all you can about staging can help you take a more active role in making informed decisions about your treatment.
There are actually 2 types of staging for penile cancer:
- The clinical stage is your doctor’s best estimate of the extent of your disease, based on the results of the physical exam, a biopsy of the main tumor, and any imaging tests you have had.
- The surgical or pathologic stage is based on the same factors as the clinical stage, plus what is found during surgery to remove the main tumor or lymph node biopsies.
If you have surgery, the stage of your cancer might actually change afterward (for example, if cancer is found to have spread farther than was suspected). Pathologic staging is likely to be more accurate than clinical staging, because it gives your doctor a firsthand impression of the extent of your disease.
Treatment option overview
There are different types of treatment for patients with penile cancer.
Different types of treatments are available for patients with penile cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Three types of standard treatment are used:
Surgery is the most common treatment for all stages of penile cancer. A doctor may remove the cancer using one of the following operations:
- Mohs microsurgery: A procedure in which the tumor is cut from the skin in thin layers. During the surgery, the edges of the tumor and each layer of tumor removed are viewed through a microscope to check for cancer cells. Layers continue to be removed until no more cancer cells are seen. This type of surgery removes as little normal tissue as possible and is often used to remove cancer on the skin. It is also called Mohs surgery.
- Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor.
- Cryosurgery: A treatment that uses an instrument to freeze and destroy abnormal tissue. This type of treatment is also called cryotherapy.
- Circumcision: Surgery to remove part or the entire foreskin of the penis.
- Wide local excision: Surgery to remove only the cancer and some normal tissue around it.
- Amputation of the penis: Surgery to remove part or all of the penis. If part of the penis is removed, it is a partial penectomy. If all of the penis is removed, it is a total penectomy.
Lymph nodes in the groin may be taken out during surgery.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly onto the skin (topical chemotherapy) or into the spinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Topical chemotherapy may be used to treat stage 0 penile cancer.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied.
Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy. Topical biologic therapy may be used to treat stage 0 penile cancer.
Radiosensitizers are drugs that make tumor cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers helps kill more tumor cells.
Sentinel lymph node biopsy followed by surgery
Sentinel lymph node biopsy is the removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. It is the first lymph node the cancer is likely to spread to from the tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes. After the sentinel lymph node biopsy, the surgeon removes the cancer.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today’s standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI’s listing of clinical trials.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.