Penile Cancer

Factors that contribute to an increased risk for developing penile cancer include:

• Age 60 or older
• Smoking
• Many past sexual partners
• Human papillomavirus (HPV)
• Lack of circumcision at birth
• Phimosis, a condition that makes it difficult to pull back the foreskin
• Poor personal hygiene
• UV light treatment for psoriasis
• AIDS (Acquired Immune Deficiency Syndrome)

Early detection is crucial to recovery, so it is imperative that men tell their physician if they notice any of the following on the foreskin, skin of the shaft of the penis or surface of the head of the penis:

• Ulcer or sore
• Discoloration or redness
• Irritation
• Lump
• Discharge
• Bleeding

Your urologist will meet with you to discuss your concerns and to conduct a thorough evaluation. Diagnostic tests and procedures may include:

• Medical history
• Physical examination
• Biopsy to remove suspicious cells and view them under a microscope to check for cancer.

Your urologist will order additional tests to determine whether cancer cells have spread within the penis or to other body parts. This is called staging. Tests may include:

• CT-scan uses a computer linked to an x-ray machine to make detailed pictures of areas inside the body.
• MRI (magnetic resonance imaging) uses magnet radio waves and a computer to make detailed pictures of areas inside the body.

Stages:

• Stage I: Cancer is in connective tissue just under the skin of the penis
• Stage II: Cancer has spread to lymph or blood vessels or through connective tissue to erectile tissue or to the urethra.
• Stage IIIa: Cancer has spread to one lymph node in the groin.
• Stage IIIb: Cancer has spread to more than one lymph node on one side of the groin or to lymph nodes on both sides of the groin.
• Stage IV: Cancer has spread to tissues near the penis such as the prostate, and may have spread to lymph nodes in the groin or pelvis or distant parts of the body.

Treatment for penile cancer depends on the stage of the cancer, where it is located, the size of the tumor and whether the cancer is newly diagnosed or has returned. Your urologist will discuss the best treatment for your particular situation and needs. The following therapies may be recommended:

• Surgery for penile cancer Our urologic surgeons are dedicated to maintaining quality of life for our patients and try to preserve as much of the penis as possible during surgery. Surgical options include:
  • Circumcision removes the penis foreskin and some of the nearby skin.
  • Partial penectomy removes the tumor with a margin of healthy tissue. Total penectomy removes the entire penis in cases of large penile cancer tumors. The surgeon reroutes the urethra and makes a urethrostomy opening for urination. Penile reconstruction surgery creates a new penis using a flap of skin from the forearm or lower leg.
  • Mohs microsurgery removes thin layers of skin and examines them immediately under a microscope. The process is repeated until no more cancer cells are seen.
  • Cryosurgery uses an instrument to freeze and destroy abnormal tissue.
  • Laser surgery uses a laser beam as a knife to vaporize penile cancer cells.
• Radiation therapy for penile cancer Radiation therapy treats early stage penile cancer in conjunction with lymph node surgery. It also helps control the spread of cancer and relieves symptoms in more advanced cases. Depending upon the stage and the location, the following radiation may be recommended:
  • External radiation therapy targets cancer using radiation from a machine outside the body.
  • Internal radiation therapy uses a radioactive substance inside needles, seeds, wires or catheters that are placed into the penile cancer site or near it.
• Chemotherapy for penile cancer Chemotherapy uses drugs to kill cancer cells or to stop them from dividing. The way chemotherapy is administered depends on the stage of penile cancer. Chemotherapy options include:
  • Topical chemotherapy, an anti-cancer medicine cream, usually 5-fluorouracil or 5-FU, is applied to precancerous or early penile cancer
  • Systemic chemotherapy is injected into a vein or given by mouth
  • Imiquimod is a cream that boosts the body's immune system

You will receive a thorough diagnostic evaluation and receive clinically-proven treatment by a board-certified urologist who specializes in penile cancer. Your experience post-treatment will vary depending upon the stage of your cancer. When found early, penile cancer has a high cure rate. Advanced penile cancer is more difficult to cure and the treatment also causes serious side effects. That is why early detection – and the involvement of an experienced urologist – is so important.

Brigham and Women’s Faulkner Hospital practices a multidisciplinary approach to patient care, collaborating with colleagues in other medical specialties. Specialists also include radiologists, pathologists, nurse specialists, social workers, palliative care specialists and dietitians.

Go to our online health library to learn more about urology diseases and tests.

Visit Dana-Farber Brigham Cancer Center for more information about penile cancer.