Penile Cancer

Symptoms of Penile Cancer

The symptoms below don’t always indicate penile cancer and are often caused by other conditions. However, it’s essential to see a doctor if you experience persistent symptoms (lasting more than four weeks or worsening) should be checked immediately. Early diagnosis can lead to more effective treatment.

Skin Changes

The earliest sign of penile cancer is usually a change in the skin of the penis. These changes often occur on the glans (tip) or the foreskin in uncircumcised men but can also appear on the shaft. Common changes include:

• Thickened skin
• Altered skin color
• Lumps or growths
• Sores or ulcers that may bleed
• A reddish, velvety rash under the foreskin
• Crusty bumps
• Flat, bluish-brown patches
• Foul-smelling discharge or bleeding under the foreskin

Swelling

Swelling at the tip of the penis, particularly when the foreskin is tight or difficult to retract, may be a sign of penile cancer.

Lumps Under the Skin in the Groin

If penile cancer spreads, it often moves to the lymph nodes in the groin, causing them to swell. Swollen lymph nodes may feel like smooth lumps under the skin.

It’s important to note that swollen lymph nodes are more often a response to infection rather than cancer. Penile cancer can lead to skin infections, which may cause nearby lymph nodes to swell even if the cancer hasn’t reached them.

If you notice any unusual changes in the appearance or feel of your penis, consult a healthcare provider promptly. Early evaluation can make a significant difference in outcomes.

Diagnosis and Stages 

Recognizing potential symptoms of penile cancer early and consulting a doctor is crucial. At the University of Colorado Cancer Center, we are committed to providing expert care and support throughout your diagnostic journey. Below, we outline what you can expect during the diagnostic process for penile cancer.

Medical History and Physical Examination

The diagnostic process begins with a comprehensive review of your medical history, including any symptoms you’ve experienced, their onset, and any changes over time. Your doctor will also discuss possible risk factors.

During the physical exam, the doctor will closely examine your genital area for signs of penile cancer or other conditions. Since penile cancer often originates in the skin, a careful visual and tactile examination can provide vital clues. The lymph nodes in your groin may also be assessed for swelling, which could indicate cancer spread or another health issue.

If initial findings suggest the possibility of penile cancer, further diagnostic tests, such as biopsies and imaging, will be required.

Biopsy: Confirming a Diagnosis

A biopsy is the definitive method for diagnosing penile cancer. During this procedure, a tissue sample is collected from the affected area and analyzed under a microscope to check for cancer cells. Common biopsy techniques include:

• Incisional Biopsy: A portion of the lesion is removed, typically for larger or ulcerated areas. This procedure is often done under local anesthesia in an outpatient setting.
• Excisional Biopsy: The entire lesion is removed, generally for smaller growths. Depending on the case, local or general anesthesia may be used.
• Lymph Node Biopsy: If cancer is suspected to have spread, lymph nodes may be evaluated using either fine needle aspiration (FNA) or surgical removal (sentinel lymph node biopsy or lymphadenectomy).
  

Imaging Tests

If cancer spread is suspected, imaging tests may be recommended to determine the extent of the disease. These include:

• CT Scans: Detailed cross-sectional images to assess tumor size and potential spread to lymph nodes or distant organs. CT-guided biopsies may also be performed.
• MRI: Detailed images using radio waves and magnetic fields, sometimes performed with the penis erect to better visualize the cancer.
• Ultrasound: A painless method using sound waves to determine how deeply the cancer has invaded tissue.
• Chest X-rays: Used to detect possible spread to the lungs.
  

Cancer Staging

After a diagnosis, staging helps determine the extent of the cancer and guides treatment planning. The American Joint Committee on Cancer (AJCC) TNM system is commonly used for penile cancer and assesses:

• T (Tumor): How far the cancer has grown into the penis and surrounding tissues.
• N (Nodes): Whether the cancer has spread to nearby lymph nodes.
• M (Metastasis): Whether the cancer has spread to distant parts of the body, such as the lungs, liver, or bones.
  

Each category is assigned a number or letter to describe the extent of the cancer, which is then combined into an overall stage ranging from 0 (localized) to IV (advanced).

Why Early Diagnosis Matters

Early detection of penile cancer is critical. When caught in its early stages, treatment can often be performed with minimal impact to the penis. In contrast, delayed diagnosis may necessitate more extensive treatment, including surgery or advanced therapies.

If you notice any unusual symptoms—such as sores, redness, growths, or other changes in the penis—don’t delay seeking medical attention. Our team at the CU Cancer Center is here to provide expert care and personalized support at every stage.

Stages of Penile Cancer

Staging is critical for determining the best treatment approach and prognosis. Below is a breakdown of the stages:

Stage 0

Also called carcinoma in situ (CIS). The cancer is confined to the top layer of skin and has not grown deeper (Tis or Ta).

There is no spread to nearby lymph nodes (N0) or distant parts of the body (M0).

Stage I

The tumor has grown into tissue just below the top layer of skin but has not invaded nearby blood vessels, lymph vessels, or nerves. It is not high grade (grade 3) (T1a).

The cancer has not spread to nearby lymph nodes (N0) or distant parts of the body (M0).

Stage IIA

The tumor has grown into tissue below the top layer of skin and either involves nearby blood vessels, lymph vessels, or nerves, or is high grade (grade 3) (T1b).

Alternatively, the tumor has grown into the corpus spongiosum, an internal chamber of the penis (T2).

The cancer has not spread to lymph nodes (N0) or distant parts of the body (M0).

Stage IIB

The cancer has grown into the corpus cavernosum, two internal chambers that run along the top of the penis (T3).

There is no spread to lymph nodes (N0) or distant parts of the body (M0).

Stage IIIA

The tumor has grown into tissue below the top layer of skin and may involve the corpus spongiosum and/or the corpus cavernosum (T1 to T3).

The cancer has spread to 1 or 2 nearby inguinal (groin) lymph nodes on the same side of the body (N1).

The cancer has not spread to distant parts of the body (M0).

Stage IIIB

The tumor has grown into tissue below the top layer of skin and may involve the corpus spongiosum and/or the corpus cavernosum (T1 to T3).

The cancer has spread to 3 or more inguinal lymph nodes on the same side of the body or to lymph nodes on both sides of the groin (N2).

The cancer has not spread to distant parts of the body (M0). 

Stage IV

Penile cancer in Stage IV can present in several ways:

Locally advanced:

The tumor has grown into nearby structures such as the scrotum, prostate, or pubic bone (T4).

The cancer may or may not have spread to nearby lymph nodes (any N) but has not spread to distant parts of the body (M0).

Lymph node involvement:

The tumor may or may not have invaded deeper layers of the penis or nearby structures (any T).

The cancer has spread to pelvic lymph nodes or grown outside a lymph node into surrounding tissues (N3).

There is no spread to distant parts of the body (M0).

Distant spread:

The tumor may or may not have grown into deeper layers of the penis or nearby structures (any T).

The cancer may or may not involve nearby lymph nodes (any N).

The cancer has spread to distant parts of the body, such as the lungs, liver, or bones (M1).

Understanding the stage of penile cancer is vital for treatment planning. Consult with your doctor for a clear explanation of your stage and its implications.

Treatments for Penile Cancer

Surgery is the main treatment for penile cancer at all stages. Early detection may allow treatment without removing part of the penis, but advanced cases may require partial or total penectomy. Your care team will help find the best option for curing the cancer while preserving the penis as much as possible.

For tumors invading deeper (T2 or higher), groin lymph node removal is typically necessary. Sentinel lymph node biopsy (SLNB) can be an alternative to removing all lymph nodes, offering a less invasive option.

Penile-sparing techniques like local treatments and limited surgeries aim to preserve sexual function, appearance, and the ability to urinate while standing.

Surgical Options:

• Circumcision: Often cures cancer confined to the foreskin. It may also be done before radiation therapy to prevent complications.
• Simple Excision: Removes the tumor and surrounding tissue, typically stitching the skin together.
• Wide Local Excision: Removes the tumor and a larger portion of healthy tissue to ensure all cancer cells are removed, with skin grafts if necessary.
• Mohs Surgery: Removes thin skin layers, examining them under a microscope, preserving healthy tissue and improving outcomes for early-stage cancers.
• Glansectomy: Removes part or all of the glans (penis tip) if cancer is confined there, using skin grafts for reconstruction.
• Partial or Total Penectomy: Removes part or all of the penis, depending on the extent of cancer. A perineal urethrostomy is created if the entire penis is removed.

Lymph Node Surgery:

• SLNB: Removes the sentinel lymph node to assess cancer spread without removing all groin lymph nodes.
• Inguinal Lymphadenectomy: Removes groin lymph nodes if they show signs of cancer.
• Pelvic Lymph Node Surgery: If cancer spreads to more than one groin lymph node, pelvic lymph nodes may be removed.

Radiation can be used as an alternative to surgery, after surgery, or for advanced cases to shrink tumors or alleviate symptoms. External beam radiation or brachytherapy may be used, each with different delivery methods.

Penile-Sparing Techniques are used for early-stage cancer and include laser ablation, cryotherapy, and topical treatments.

Chemotherapy targets cancer cells via topical or systemic drugs, depending on the cancer's spread. Side effects include fatigue, nausea, and increased infection risk.

Treatment by Stage:

• Stage 0: Local therapies like circumcision, laser ablation, cryotherapy, or Mohs surgery.
• Stage I: More extensive surgeries like Mohs, wide excision, or partial penectomy.
• Stage II: Penectomy and lymph node removal, with radiation therapy if needed.
• Stage III: Penectomy, lymph node surgery, and possibly chemotherapy or radiation.
• Stage IV: Surgery for local tumors, chemotherapy for distant spread, and symptom management.

Recurrent Cancer: Surgery, radiation, and chemotherapy may be used to manage recurrent cancer, with clinical trials offering additional options.

The University of Colorado (CU) Cancer Center partners with UCHealth, Children’s Hospital Colorado, and Rocky Mountain Regional VA to provide clinical care. Please make an appointment with one of our clinical partners to be seen by a CU Cancer Center doctor.

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UCHealth:

UCHealth Cancer Care - Anschutz Medical Campus
1665 Aurora Court Anschutz Cancer Pavilion
Aurora, CO 80045
720-848-0300

UCHealth Cherry Creek Medical Center
100 Cook Street
Denver, CO 80206
720-848-0000

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Rocky Mountain Regional VA Medical Center:
1700 North Wheeling Street
Aurora, CO 80045-7211
303-399-8020

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