Penile Cancer

Penile cancer occurs when malignant cells form in the skin and/or the soft tissues of the penis. Relatively rare in the United States, penile cancer accounts for about 1,300 new cases annually. Most penile tumors are squamous cell carcinomas which develop in the outer layers of the skin. The providers in Virginia Mason's Section of Urology specialize in the diagnosis and treatment of penile cancer. To discuss penile cancer risk factors, symptoms or to schedule a consultation, contact the Virginia Mason Section of Urology, in Seattle, by calling (206) 223-6772.

Symptoms of Penile Cancer

Penile cancer commonly presents as a wart-like lump or ulcer on the penis, typically on the head or foreskin. The area can be inflamed, with itching or burning at the site. About half of men diagnosed with the disease will have swollen lymph nodes in the groin. Swelling of the lymph nodes may simply be caused by an infected lesion, or it may indicate malignancy. However, spread of the disease to other parts of the body is uncommon. 

Risk Factors for Penile Cancer

  • Being over age 60.
  • Not being circumcised. Studies indicate men who are not circumcised at birth (have retained the foreskin on their penis) have a higher risk of developing penile cancer. One reason could be that circumcision may help prevent infection with the human papillomavirus (HPV), a sexually transmitted infection linked with developing penile cancer.
  • Having phimosis, a condition in which the foreskin cannot be pulled back.
  • Not practicing good hygiene.
  • Having many sexual partners (increases the risk of a sexually transmitted infection).
  • Smoking or using tobacco products. 

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Diagnosing Penile Cancer

Diagnosis begins with a physical examination. It is usually necessary to obtain a tissue sample, or biopsy, to examine under a microscope. The biopsy can be performed using a needle to collect sample cells. Sometimes removal of the entire abnormal area, called a wide local excision, is selected. Once cancer is diagnosed, patients may undergo a cystoscopy, a procedure in which a tiny camera is inserted through the opening of the penis and into the urethra and bladder. An MRI of the penis may also be performed to determine if the tumor has spread to the deeper structures of the penis.

Penile Cancer Staging

The extent of tumor spread is also referred to as the "stage" of the cancer. The stage includes information such as the size or invasiveness of the cancer and whether it has spread to the lymph nodes or other distant parts of the body.

  • Stage 0 — In stage 0, cells found on the surface of the penis are abnormal and may become cancer, or are identified as cancerous but have not yet penetrated the outermost layer of skin cells.
  • Stage I — Cancer has developed and affects the connective tissue just under the skin of the penis.
  • Stage II — Cancer has spread to either the connective tissue or the erectile tissue and one lymph node in the groin.
  • Stage III — Cancer is diagnosed in:
    • the connective or erectile tissue and more than one lymph node on one or both sides of the groin; or
    • the urethra or prostate, and may have spread to one or more lymph nodes on one or both sides of the groin.
  • Stage IV — In this stage, cancer has spread:
    • to tissues in or near the penis, possibly including lymph nodes in the groin or pelvis; or
    • to distant parts of the body.

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Treatment Options for Penile Cancer

Men with early stage penile cancer that has not spread to the glands or lymph nodes have an excellent chance of long-term survival (95 percent survival at five years from diagnosis). Survival decreases when the cancer has spread to the lymph nodes in the groin or pelvic region. Treatment options for penile cancer include:

  • Surgery — Surgery is the most common treatment for penile cancer. Virginia Mason offers the latest surgical techniques for treating the cancer while sparing normal tissues, including:
     
    • Mohs surgery — A procedure in which the area of cancerous skin cells is removed layer by ultra-thin layer, until no more cancer cells are seen in the removed tissue under a microscope. The treatment is ideal for early stage, skin-based cancers, leaving as much normal tissue intact as possible.
    • Surgeries using lasers or freezing — Lasers use a beam of intense light to destroy a surface lesion or other cancerous tissue. Abnormal tissue can also be destroyed by freezing, known as cryotherapy.
    • Circumcision — Removal of the foreskin of the penis.
    • Wide local excision — Cancerous tissue plus a margin of normal tissue around it are removed.
    • Removal of lymph nodes — The latest techniques to selectively "map" cancerous lymph nodes help ensure the least invasive surgical option is chosen.
       
  • Radiation therapy — Radiation can be used in combination with surgery, or alone. External beam radiation therapy delivers high-energy X-rays by machine outside the body. Internal radiation therapy is placed inside the body in the form of radioactive seeds, wires or catheters to destroy cancer cells. A new class of drugs called radiosensitizers is now being used and studied, which work to make cancer cells more sensitive to radiation.
     
  • Chemotherapy — Chemotherapy uses special cancer killing drugs delivered intravenously or directly to the area of the body being treated. The type and stage of cancer will determine the way chemotherapy is administered. Chemotherapy in a topical form may be used to treat stage 0 penile cancer.

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Follow-Up Treatment for Penile Cancer

Consistent follow up is essential after undergoing treatment for penile cancer. Your doctor will see you for regular physical exams in the first year following treatment. It is especially important to monitor the lymph nodes if they were not removed, as the risk of spread to the nodes is greatest in the first six months. Sometimes imaging studies such as ultrasound or CT scan may be used to detect tumors in the lymph nodes even before they can be felt on examination.

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