Penile Cancer

Cancer that starts in cells in the penis is called penile cancer. Penile cancer is rare in the U.S. Most penile cancer (about 95%) is squamous cell carcinoma. This means the cancer begins in the flat skin cells (squamous cells) of the penis. Most squamous cell penile cancers begin on the foreskin or on the tip of the penis (glans). Squamous cell penile cancer typically grows slowly. It can usually be cured if it is found early.

Many men with penile cancer have early symptoms. But you may have no symptoms until the cancer is in its later stages. You may notice symptoms but think they are from something other than cancer. Tell your healthcare provider about any changes in the skin of your penis such as:

• An ulcer, sore, or growth on the penis. The growth is usually painless. But it can be painful in some cases. It usually shows up on the glans or foreskin, but it can also show up on the shaft of the penis.

• Changes in skin color, thickening of the skin, or tissue growth.

• A red, velvet-like rash.

• Bleeding from a growth or sore.

• Small and crusty bumps.

• Flat growths with a bluish brown color.

• A discharge under the foreskin, with or without an odor.

• Swelling at the tip of the penis.

• Swelling in the groin area. This may be caused by an enlarged lymph node.

Many of these symptoms may be caused by other health problems. But it is important to see your healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have cancer.

If your healthcare provider thinks you might have penile cancer, you will need certain exams and tests to be sure. Diagnosing penile cancer starts with your healthcare provider asking you questions. He or she will ask about your health history, your symptoms, risk factors, and family history of disease. Your healthcare provider will also give you a physical exam.

The physical exam includes checking your penis, testicles, groin, and belly (abdomen).

Your healthcare provider will need to take a small sample of tissue (biopsy). The type of biopsy the healthcare provider does depends on what he or she sees on your genitals. You usually will get a local pain medicine when the biopsy is done.

There are two main types of biopsies for penile cancer.

Surgical biopsies:

• Excisional biopsy. For this type of biopsy, the healthcare provider removes all of the abnormal area of skin.

Incisional biopsy. The healthcare provider may do this type of biopsy if the abnormal area is larger or has broken through the skin. This biopsy removes only part of the area.

This test is done to see if the cancer has spread to lymph nodes in the groin. It is done in one of two ways:

• Fine needle aspiration (FNA). This biopsy can be done in a healthcare provider's office or clinic. FNA is not used to take a tissue sample from the penis. It takes a sample from nearby lymph nodes. During FNA, you may get local pain medicine injected into the skin of your groin. The healthcare provider will then put a thin needle into the lymph node. He or she will remove cells and a few drops of liquid. Sometimes this is done while looking at the node with ultrasound or a CT scan.

• Surgery. The healthcare provider may use surgery to look at the nearby lymph nodes. He or she may remove tissue for a biopsy.

After the biopsy, your healthcare provider will send the tissue to a pathologist. A pathologist is a healthcare provider who will check the tissue under a microscope for cancer cells.

When your healthcare provider has the results of your biopsy, he or she will contact you with the results. Your provider will talk with you about other tests you may need if penile cancer is found. Make sure you understand the results and what follow up you need.

The International Union Against Cancer and the American Joint Committee on Cancer have developed a standard system of describing how much the cancer has grown. It is known as the TNM system.

In the TNM system:

• The T says how far the main tumor has grown.

• The N says whether the cancer has spread to lymph nodes in the area of your original tumor.

• The M says whether your cancer has spread (metastasized) to other organs in the body.

Numbers after each of these letters provide more details about each piece of information. 

Once a man's T, N, and M factors have been determined, a healthcare provider puts this information together in what is called stage grouping. Stage grouping is used to find out your overall cancer stage. It is listed as numbers. Stage I is the earliest stage. Stage III is the most advanced stage. The letter after the numeral further tells the cancer. For example, Stage IIC.

• Stage 0. Stage 0 is a cancer that is only on the surface of the skin. It is also known as carcinoma in situ and is considered noninvasive at this stage.

• Stage I. For this stage, cancer cells have grown into the tissue just below the surface of the skin, without growing into blood or lymph vessels. The cancer cells look a lot like normal cells under a microscope. 

• Stage II. In this stage, cancer cells have grown into the tissue just below the surface of the skin. But the cells look more abnormal (high grade) or have invaded the blood or lymph vessels. Or the cancer has grown deeper into the penis, possibly into the urethra. The cancer has not spread to nearby lymph nodes or to distant organs. 

• Stage III. In this stage, the main tumor is still within the penis, but cancer cells have spread to one or more lymph nodes. It has not spread to distant organs. 

• Stage IV. In this stage, cancer cells have spread to nearby structures such as the prostate. Or it has spread to lymph nodes in the pelvis, or from lymph nodes in the groin to nearby tissues. It may have also spread to distant organs.

• Recurrent. Recurrent cancer means that the cancer has come back after it has been treated.

The grade of a cancer means how abnormal the cancer cells look under a microscope.

Healthcare providers consider the grade, stage, and your health when recommending a treatment plan. They also look at your feelings and preferences. Staging information helps healthcare providers compare your own case with other men who have penile cancer. Based on studies done on groups of men in similar stages of the disease, a healthcare provider can make some predictions about how the cancer may behave and how different treatments may work.

Risk factors for penile cancer include:

• Age. The risk of penile cancer goes up with age. It occurs more often in men older than 50.

• Not being circumcised. Circumcision is surgery to remove part or all of the foreskin on the penis. This can be done at birth or later on in life. Researchers say that circumcision may protect against cancer of the penis by making it easier to keep the penis clean. This seems to lower cancer risk if done as a newborn. It does not lower the risk if done as an adult.

• Phimosis and smegma. A male who is uncircumcised may have foreskin on his penis that is difficult to retract or is constricted (phimosis). This condition can make it very difficult to clean the penis. This in turn can cause a buildup of dead cells and skin (smegma) under the foreskin and around the glans. The buildup can cause inflammation of the penis. This may increase the risk for penile cancer.  

• Human papillomavirus (HPV) infection. Certain types of HPV have been linked to penile cancer. HPV infection is fairly common. In fact, some research suggests that about half of all men have a genital HPV infection at any given time, but the body usually clears the infection.

• Smoking. Men who smoke are at higher risk for penile cancer than those who don't. Cancer-causing chemicals in tobacco smoke may harm the DNA in cells in the penis. This may lead to penile cancer.

• AIDS. Men who have AIDS may be at higher risk for penile cancer. This may be because AIDS causes a weakened immune system.

Ultraviolet light treatment for psoriasis. Men who have had certain treatments for psoriasis may have a slightly higher risk for penile cancer. These treatments use psoralen medicine followed by ultraviolet A light therapy (PUVA). Men who are treated with PUVA now have their genitals covered during treatment.

Talk with your healthcare provider about your risk factors for penile cancer. No standard screening tests are available for penile cancer. There is also no definite way to prevent cancer of the penis. But several things may lower your risk:

• Practice safe sex. This will make it less likely for you to get HPV (or HIV, the virus that causes AIDS). It is not yet clear if the HPV vaccine can reduce the risk for penile cancer. 

• Don’t smoke.

• Follow good personal hygiene habits. If you have not been circumcised, retract the foreskin and clean under it regularly. 

Routinely check for any skin changes on your penis. These changes might be warts, sores, ulcers, white patches, or blisters. If you notice any of these changes on the skin of your foreskin, glans, or shaft of your penis, tell your healthcare provider right away. Don't let embarrassment keep you from seeing your provider about these issues.

If you have questions about penile cancer, talk with your healthcare provider. Your provider can help you understand more about this cancer.