Penile Cancer Screening and Diagnosis
Start the fight against penile cancer with an accurate diagnosis
Penile cancer is rare, and only about one in 100,000 men in North America and Europe are diagnosed with it each year. In most cases, the disease starts with precancerous cells on the foreskin or the glans of the penis. If precancerous cells later become cancer cells, they can grow uncontrollably and form a tumor. With the early diagnosis and treatment of precancerous cells, most penile cancers can be prevented or cured. When cancer is not treated, the disease may eventually move to other parts of the body.
There are several types of penile cancer:
- Squamous cell carcinoma, also known as epidermoid carcinoma, is a slow-growing cancer that is found in 95 percent of penile cancer cases.
- Basal cell carcinoma is a slow-growing cancer that is unlikely to spread. It is found in about 2 percent of the cases of penile cancer.
- Melanoma is an uncommon type of cancer that affects the penis and can spread very quickly.
- Adenocarcinoma is a very rare type of cancer that develops in the cells of the sweat glands.
- Sarcoma is slow-growing and rare penile cancer. It develops from muscle, blood vessels, or other tissue of the penis.
Signs and symptoms of penile cancer
The signs and symptoms of penile cancer can be similar to conditions that are noncancerous. If any symptoms do not improve within three weeks, it will be important to see your doctor as soon as possible. Symptoms may include:
- Changes in skin color
- Thickening of the skin
- Sore that may bleed
- Rash, red and velvety
- Bumps, small and crusty
- Growths, flat and bluish-brown
- Smelly discharge from the foreskin
- Bleeding from the foreskin
- Swelling at the tip of the penis
- Constricted foreskin
- Lumps in the groin area
Because some symptoms may be similar to other medical conditions, it is important for your doctor to rule out or diagnose cancer as soon as possible. Cancer responds best to treatment when it is done in the early stages.
Risk factors for penile cancer
Even though you may have one or more risk factors for penile cancer, it does not mean you have the disease or you will get it.
About 50 percent of men with penile cancer have human papillomavirus (HPV), which makes it the most important risk factor for the disease. HPV refers to a group of about 100 different viruses. These viruses are very common in boys and men who are sexually active, or have skin-to-skin contact with an area of the body infected with HPV. Some of the viruses cause small, cauliflower-like growths or warts, known as papillomas. They may be flesh-colored or red. In a small percentage of men, the virus can cause cells on the surface of the penis to become cancerous. To reduce the risk of penile cancer, boys and young men can receive a vaccine against HPV.
Other risk factors can increase the chances of developing penile cancer.
- Age 60 years or more
- Phimosis, chronic inflammation due to the inability to pull back the foreskin on an uncircumcised penis
- Poor personal hygiene
- Penile lichen sclerosus, a skin condition that causes itching and dryness
- Weak immune system
- Tobacco usage
- Heredity, but only in very rare cases
Diagnosing penile cancer
Many cancers of the penis begin on the skin and can be noticed in the early stages. Symptoms such as warts, sores, and even discolored areas of skin that are not painful should be checked by a doctor. Cancer on the penis that has been diagnosed early can be removed easily, causing little or no damage to the penis.
- Medical history: Your doctor will ask about your medical history, risk factors, and symptoms – when they began and what changes may have occurred.
- Physical exam: By looking carefully and closely at the penis, the doctor can identify the signs of penile cancer or other health conditions. To feel if your lymph nodes are swollen, the doctor will press on your groin area. If the doctor suspects you have penile cancer, a biopsy or imaging may be needed.
A biopsy involves removing skin tissue or a lump from the penis and examining it under a microscope to discover if cancer or another disease is present.
- Incisional biopsy: During this procedure, your doctor will remove skin tissue or part of a lump that looks abnormal. A pathologist will use a microscope to study the cells from the tissue or lump and see if they are cancerous. Usually this biopsy is done if there is a large sore or a deep growth in the penis. Often, this procedure only requires local anesthesia to numb the area.
- Excisional biopsy: This procedure may be done to remove an entire small sore or affected area. Either a local numbing medication will be given, or a general anesthesia may be used so you will be asleep for the procedure.
- Fine needle aspiration (FNA): This procedure is done to check lymph nodes when penile cancer is suspected to have spread to areas near the penis. First, the skin around the lymph node is numbed with a local anesthetic. Then, a thin hollow needle and syringe is used to pull out cells from the node. The cells are analyzed by a pathologist to determine if cancer is present.
- CT-guided needle biopsy: Computed tomography (CT) scans are used to guide a needle into areas, such as the lymph nodes, that may be affected by cancer. Cells are removed and sent to a pathologist who examines them under a microscope.
- Sentinel lymph node biopsy (SLNB): This minimally invasive surgery will help your doctor find cancer that may have spread to the lymph nodes. Cancer cells typically travel in a path from the tumor site to lymph nodes near or farther from it. The doctor will inject a tracer substance into or near the tumor to find the path to the first diseased lymph node (called the sentinel lymph node). A small incision will be made to remove the diseased sentinel lymph node and any other diseased lymph nodes along the same path.
If the biopsy shows that penile cancer is present, more tests will be done to determine if the cancer cells have spread to other parts of the body. To plan the most effective treatment, it is important to know where the cancer cells have spread.
Several different types of imaging tests may be used to look for penile cancer. The detailed, cross-sectional images of your body can show the size of the tumor. Sometimes imaging can help predict if a noncancerous tumor may become cancerous later.
- Computed tomography (CT) also known as computed axial tomography (CAT) scans: Detailed and cross-sectional images of the penis and groin area are made quickly with several X-rays taken at various angles. The CT scan may find enlarged nodes or certain signs that the cancer has spread to other organs.
- Magnetic resonance imaging (MRI): Strong magnets, radio waves, and a computer are used to make detailed pictures of soft tissues inside your body. This painless procedure may be able to pinpoint if cancer cells have spread to the scrotum or other structures. Before the imaging begins, you may be given prostaglandin. This substance is similar to a hormone, and it helps to create better images by making the penis erect. The imaging procedure involves resting on a table and being moved into a tunnel-shaped scanner for 30-60 minutes while pictures are taken. No radiation is used.
- Positron emission tomography (PET) scan: During this painless procedure, glucose (sugar) is mixed with a very small amount of radioactive substance and injected into a vein. As you rest on a table, the solution is absorbed by certain organs and tissues. Then you will be moved into a tunnel scanner. The PET scanner traces the flow of the solution inside your body to find cancer cells. These diseased cells often use more glucose than normal cells.
- Ultrasound: To discover the extent of cancer in the penis, a painless ultrasound test may be done. Sound waves will create pictures of the penis, any enlarged lymph nodes, and other surrounding areas. A lubricating gel may be used before the technician moves the transducer on the skin.
Stages of penile cancer
Your doctor will want to find exactly where the cancer is located and how much of it is in your body. This process is called staging. For penile cancer, the stage is determined by the physical exam, biopsies, imaging, and other tests. A pathologist will look at cells taken during the biopsy and help identify the stage of cancer. Then your urologist and the tumor board will determine additional treatment options.
These are the main stages of penile cancer.
- Stage 0: Cancer is only in the top layer of skin on the penis.
- Stage 1: Cancer is in the tissue below the top layer of skin on the penis.
- Stage 2: Cancer is in the tissue below the top layer of skin on the penis. Also, it has grown into the nerves, lymph vessels, or blood vessels.
- Stage 3: Cancer is in the tissue below the top layer of skin on the penis. It may have grown into the spongy erectile tissue in the penis. The cancer has spread to lymph nodes in the groin.
- Stage 4: Cancer is in the scrotum, prostate, pubic bone, or other structures near the penis. The cancer may have spread to the lymph nodes.
Be on the lookout for penile cancer
The first step is to be aware of any changes or abnormalities that appear on the penis, even if they’re not uncomfortable or painful. Make note of any:
- White patches
- Other unusual areas
If you notice something strange, let your doctor know.
Penile cancer diagnosis
Your doctor will examine the penis and the groin area to note any possible signs of cancer. This includes feeling the lymph nodes in the groin area to determine if they are swollen.
If the examination or your symptoms suggest penile cancer, you may need additional tests. These include a biopsy and imaging tests.
A biopsy involves examining tissue in a lab to see if it contains cancer cells. There are two main types of penile biopsy: incisional biopsy and excisional biopsy. You may also need a biopsy of nearby lymph nodes to determine if penile cancer has spread. Your doctor will recommend the right biopsy options based on the abnormal area being examined. An incisional biopsy involves removing a piece of the abnormal area. We recommend incisional biopsies if the abnormal area is:
- A sore on the penis
- Growing into the penis
- Large (usually larger than 1 centimeter, or about 0.4 inch)
- Missing the top layer of skin
An excisional biopsy involves removing the entire abnormal area on the penis. We recommend excisional biopsies if the abnormal area is smaller than 1 centimeter and limited to one area of the penis.
Imaging tests allow us to see inside the penis or the surrounding areas of the body. Your doctor may recommend an imaging test to get a better look at an abnormal area of the penis or the surrounding areas. Some of the imaging tests we use to diagnose penile cancer include:
Next steps for penile cancer care
If we detect penile cancer during the testing process, we’ll discuss options and work with you to create a personalized treatment plan.