Penile Cancer

What is cancer of the penis?

Cancer of the penis, a rare kind of cancer in the United States, is a disease in which cancer (malignant) cells are found on the skin and in the tissues of the penis.

Men who are not circumcised at birth may have a higher risk for getting cancer of the penis. A circumcision is an operation in which the doctor takes away part or all of the foreskin from the penis. The foreskin is the skin that covers the tip of the penis. A circumcision is done on many baby boys before they go home from the hospital.

A doctor should be seen if there are any of the following problems: growths or sores on the penis, any unusual liquid coming from the penis (abnormal discharge), or bleeding.

If there are symptoms of cancer, the doctor will examine the penis and feel for any lumps. If the penis doesn’t look normal or if the doctor feels any lumps, a small sample of tissue (called a biopsy) will be cut from the penis and looked at under a microscope to see if there are any cancer cells.

The prognosis (chance of recovery) and choice of treatment depend on the stage of the cancer (whether it is just in the penis or has spread to other places), and the patient’s general state of health.

Stage Explanation

Stages of cancer of the penis

Once cancer of the penis is found, more tests will be done to find out if the cancer has spread from the penis to other parts of the body (staging). It is important to know the stage of the disease in order to plan treatment. The following stages are used for cancer of the penis:
Stage 0

Cancer is found only on the surface of the skin of the penis. Stage 0 cancer is also called carcinoma in situ.
Stage I

Cancer has spread to connective tissue just under the skin of the penis.
Stage II

Cancer has spread to either:

  • connective tissue just under the skin of the penis and to one lymph node in the groin; or
  • erectile tissue (spongy tissue that gets larger to make an erection) and may have spread to one lymph node in the groin.

Stage III

Cancer has spread to either:

  • connective tissue or erectile tissue of the penis and to more than one lymph node in the groin; or
  • the urethra or prostate, and may have spread to one or more lymph nodes in the groin.

Stage IV

Cancer has spread:

  • to tissues next to the penis and may have spread to lymph nodes in the groin or pelvis; or
  • anywhere in or near the penis and in one or more lymph nodes deep in the pelvis or groin; or
  • to distant parts of the body.

Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the same area or in another place.

Treatment Option Overview

How cancer of the penis is treated

There are treatments for all patients with cancer of the penis. Four kinds of treatment are used:

  • Surgery (taking out the cancer in an operation)
  • Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells and shrink tumours)
  • Chemotherapy (using drugs to kill the cancer cells)
  • Biological therapy (using the immune system to fight cancer)

Surgery is the most common treatment of all stages of cancer of the penis. A doctor may take out the cancer using one of the following operations:

  • Wide local excision takes out only the cancer and some normal tissue on either side.
  • Mohs microsurgery is an operation that removes the cancer and as little normal tissue as possible. During this surgery, the doctor uses a microscope to look at the cancerous area to make sure all the cancer cells are removed.
  • Laser surgery uses a narrow beam of light to remove cancer cells.
  • Cryosurgery uses an instrument to freeze and destroy abnormal tissue, such as carcinoma in situ. This type of treatment is also called cryotherapy.
  • Circumcision is an operation that removes the foreskin.
  • Amputation of the penis is an operation that takes out all or part of the penis. It is the most common and most effective treatment of cancer of the penis. In a partial penectomy, part of the penis is taken out. In a total penectomy, the whole penis is removed. Lymph nodes in the groin may be taken out during surgery.

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumours. Radiation may come from a machine outside the body (external radiation) or from putting materials that contain radiation through thin plastic tubes into the area where the cancer cells are (internal radiation). Radiosensitizers are drugs that make tumour cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more tumour cells. Radiation may be used alone or after surgery.

Chemotherapy uses drugs to kill cancer cells. Fluorouracil cream (a topical anticancer drug) is sometimes used on the skin of the penis for very small surface cancers. Chemotherapy may also be given by pill or by a needle in a vein. When chemotherapy is given in this way, it is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells outside the penis.

Biological therapy tries to get the body to fight cancer. It uses materials made by the body or made in a laboratory to boost, direct, or restore the body’s natural defenses against disease. Biological treatment is sometimes called biological response modifier (BRM) therapy. Imiquimod is a topical biological response modifier that may be used for small cancers on the surface of the penis.
Treatment by stage

Treatment of cancer of the penis depends on the stage of the disease, the type of disease, and the patient’s age and overall condition.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have unwanted side effects. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in many parts of the country for most stages of cancer of the penis. Information about ongoing trials is available from the NCI Web site.

Stage 0 Penile Cancer

Treatment of stage 0 penile cancer may be one of the following:

  • Microsurgery.
  • Topical treatment using fluorouracil or imiquimod.
  • Laser surgery.
  • Cryosurgery.

Stage I Penile Cancer

If the cancer is only in the foreskin, treatment will probably be wide local excision and circumcision.

If the tumour begins in the glans, treatment may include:

  • Amputation of the penis (partial penectomy). Lymph nodes in the groin may also be removed.
  • External or internal radiation therapy.
  • Mohs microsurgery.

Treatment of stage I penile cancer may also be a clinical trial of laser therapy.

Stage II Penile Cancer

Treatment of stage II penile cancer may include the following:

  • Surgery (partial or total amputation of the penis with or without removal of lymph nodes in the groin).
  • Radiation therapy followed by surgery.
  • A clinical trial of laser surgery.

Stage III Penile Cancer

Treatment of stage III penile cancer may include the following:

  • Surgery (amputation of the penis and removal of lymph nodes in the groin) with or without radiation therapy.
  • Radiation therapy.
  • A clinical trial of radiosensitizers.
  • A clinical trial of chemotherapy before or after surgery.

Stage IV Penile Cancer

Treatment of stage IV penile cancer is usually palliative (to relieve symptoms and improve the quality of life). Treatment may include the following:

  • Surgery.
  • Radiation therapy.
  • A clinical trial of chemotherapy before or after surgery.
  • A clinical trial of chemotherapy combined with radiation therapy.

Recurrent Penile Cancer

If the cancer has come back (recurred), treatment may include the following:

  • Surgery (amputation of the penis).
  • Radiation therapy.
  • A clinical trial of biologic therapy.
  • A clinical trial of chemotherapy.

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