Overview

Penile cancer is a rare disease in which malignant cells develop in the skin and/or soft tissues of the penis.

Who gets penile cancer?

Penile cancer is rare in the United States and there are only about 1,300 new cases diagnosed annually. In Africa and South America, it is much more common and accounts for up to 10% of cancers in men. Circumcision just after birth, a procedure in which the covering of the tip of the penis is removed, appears to protect men from getting the disease. The risk of penile cancer is about 3 times higher for men who are uncircumcised, or are circumcised later in life. Phimosis, or an unretractable foreskin, has also been associated with penile cancer.

Penile cancer commonly presents as a lump, mass or ulcer on the penis. Lesions can be raised and wart-like or flat. The penile lesion can be sore and inflamed, and there may be itching and burning in the region as well. Generally, penile cancers affect the head or foreskin of the penis rather than the shaft of the penis. About half of men with penile cancer will have swollen groin lymph nodes at diagnosis.

After performing a physical examination, it is usually necessary to obtain a tissue sample, or biopsy, of the cancerous cells for examination under the microscope. Tissue is obtained by inserting a needle into the area of abnormal skin or tissue or by removing the entire tumor in a surgical procedure called a wide local excision. Cancers are described by the type of cells from which they arise. More than 95% of penile cancers are squamous cell carcinomas, a type of cell that is flat and thin and makes up the outer layer of the skin. Once the cancer is diagnosed, a procedure called a cystoscopy may be performed, in which a tiny camera (scope) is inserted through the opening of the penis and advanced all the way to the bladder to look for spread of cancer to the urethra (tube connecting the bladder to the penis) and/or bladder. An MRI of the penis may also be performed to determine if the tumor has spread to the deeper structures of the penis.

Surgery

Surgery forms the foundation of treatment and can involve excision of the primary tumor and foreskin only, the entire penis, and/or the lymph nodes in the groin and pelvis. Patients with small tumors (Tis), may be eligible for local excision or local ablative techniques like laser treatment.

Slight more extensive disease (Ta) is usually treated with local excision, which means that the lesion itself plus a small amount of surrounding tissue is removed. T1 tumors are treated with a partial penectomy (removal of part of the penis). Generally, a margin of 2 cm is required for adequate resection on a penectomy. In other words, 2 cm of normal penis is generally removed. Larger tumors generally require removal of the entire penis. For patients with T2 and higher tumors without lymph nodes that can be felt on exam or seen on imaging studies (node negative), surgical removal of the shallow nodes on both sides of the groin may be done in addition to resection of the primary tumor. This can sometimes result in severe swelling in the groin and legs.

Radiation involves the use of high energy x-rays aimed at the tumor or the area from where the tumor was removed.

Chemotherapy is most commonly used in patients whose cancer has spread throughout the body to distant sites, and who need systemic therapy (therapy that reaches all parts of the body).