Penile cancer, or cancer of the penis, is a relatively rare form of cancer that affects the skin and tissues of the penis. It occurs when normally healthy cells in the penis become cancerous and begin to grow out of control, forming a tumor. The cancer may eventually spread to other areas of the body, including the glands, other organs, and lymph nodes. Approximately 1,300 cases of penile cancer are diagnosed in the United States every year.
The first noticeable symptom of penile cancer is typically a lump, mass, or ulcer on the penis. It may look like a small, insignificant bump or a large, infected sore. In most cases, it will be located on the head or foreskin instead of on the shaft of the penis.
Other symptoms of penile cancer include:
- changes in the color of the penis
- thickening of the penile skin
- swollen lymph nodes in the groin
Call your doctor right away if you’re experiencing any of these symptoms. Getting an early diagnosis and treatment is critical for increasing the chances of a positive outcome.
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)
Your doctor can make a penile cancer diagnosis by performing a physical examination and by performing certain diagnostic tests.
During the physical exam, your doctor will look at your penis and inspect any lumps, masses, or sores that are present. If cancer is suspected, your doctor will likely want to perform a biopsy. A biopsy involves the removal of a small sample of skin or tissue from the penis. The sample is then analyzed to determine whether cancer cells are present.
If the biopsy results show signs of cancer, your doctor may want to perform a cystoscopy to see if the cancer has spread. A cystoscopy is a procedure that involves the use of an instrument called a cystoscope. A cystoscope is a thin tube with a small camera and light at the end. During cystoscopy, your doctor will gently insert the cystoscope into the penis opening and through the bladder. This allows your doctor to view the different areas of the penis and the surrounding structures, making it possible to determine whether the cancer has spread.
In some cases, an MRI of the penis is sometimes conducted to make sure that cancer hasn’t invaded the deeper tissues of the penis.
There are six stages of penile cancer. The stage of the cancer describes how far the cancer has spread. Based on the results of the diagnostic tests, your doctor will determine which stage you are currently in. This will help them determine the best treatment plan for you and allow them to estimate your outlook. The staging criteria for penile cancer are outlined in the table below:
|Stage 0||• cancer hasn’t spread to any other tissues in the penis|
• cancer has spread the connective tissue below the first layer of skin
|Stage 1||• cancer has spread to the connective tissue below the skin, the erectile tissues, or the urethra|
• cancer hasn’t spread to any glands, lymph nodes, or other parts of the body
|Stage 2||• cancer has spread to the connective tissue below the skin, the erectile tissues, or the urethra|
• cancer has spread to a single gland or lymph node in the groin
|Stage 3a||• cancer has spread to the connective tissue below the skin, the erectile tissues, or the urethra|
• cancer has spread to more than one shallow gland or lymph node in the groin
• cancer hasn’t spread to any other parts of the body
|Stage 3b||• cancer has spread to the connective tissue below the skin, the erectile tissues, or the urethra|
• cancer has spread to more than one shallow gland or lymph node in the groin
• cancer has spread to other structures, such as the prostate gland and pelvic bones
|Stage 4||• cancer has spread to deep glands or lymph nodes|
• cancer has spread to other areas and organs of the body
The two main types of penile cancer are invasive and noninvasive. Noninvasive penile cancer is a condition in which the cancer hasn’t spread to deeper tissues, lymph nodes, and glands. Invasive penile cancer is a condition in which the cancer has moved deep into the penis tissue and surrounding lymph nodes and glands.
Some of the main treatments for noninvasive penile cancer include:
- circumcision, which involves the removal of the foreskin of the penis
- laser therapy, which uses high-intensity light to destroy tumors and cancer cells
- chemotherapy, which is an aggressive form of chemical drug therapy that helps eliminate cancer cells in the body
- radiation therapy, which uses high-energy radiation to shrink tumors and kill cancer cells
- cryosurgery, which uses liquid nitrogen to freeze tumors and remove them
Treatment for invasive penile cancer requires major surgery. Surgery may involve the removal of the tumor, entire penis, or lymph nodes in the groin and pelvis.
Excisional surgery may be performed to remove the tumor from the penis. You’ll be given a local anesthetic, which will numb the area and prevent you from feeling any pain. Your surgeon will then remove the tumor and affected area, leaving a border of healthy tissue and skin. The incision will be closed with stitches.
Moh’s surgery is another type of surgery that might be done to treat penile cancer. The goal of Moh’s surgery is to remove the least amount of tissue possible while still getting rid of all the cancer cells. During the procedure, your surgeon will remove a thin layer of the affected area and then examine it under a microscope to determine whether it contains cancer cells. This process is repeated until there are no cancer cells present in the tissue samples.
Partial penectomy is a surgery that removes part of the penis. This operation will only work if the tumor is less than 2 centimeters in diameter. For tumors larger than 2 centimeters, the entire penis will have to be removed. Full removal of the penis is called a total penectomy.
Regardless of the type of surgery performed, you’ll need to follow up with your doctor every two to four months during the first year after your surgery. If your entire penis is removed, your cancer will have to be in full remission for at least two years before you can be a candidate for penis reconstructive surgery.
Many people who are diagnosed with penile cancer in the early stages often make a full recovery. In fact, the cure rate for people with tumors that never spread to the glands or lymph nodes is 80 to 100 percent. Once the cancer reaches the lymph nodes in the groin, however, the survival rate drops to less than 50 percent within a five-year period.
It’s important to note that these are general statistics and that your outlook may differ depending on your age and overall health. The most important thing you can do to increase your chances of recovery is to stick with the treatment plan suggested by your doctor.
It’s important to have a strong support network that can help you deal with any anxiety or stress you may be feeling. You may also want to consider joining a cancer support group where you can discuss your concerns with others who can relate to what you’re going through. Ask your doctor about support groups in your area. You can also find information on support groups on the National Cancer Institute and the American Cancer Society websites.
Written by: Shannon Johnson
Medically reviewed on Feb 16, 2016 by Steve Kim, MD