Penile Cancer

What is penile cancer?

Cancer that starts in cells in the penis is called penile cancer. Penile cancer is very rare in the U.S. Most penile cancer (about 95%) is squamous cell carcinoma. This means the cancer starts in the flat skin cells (squamous cells) of the penis. Most squamous cell penile cancers start 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 and treated early, when it's small and before it has spread.

How common is penile cancer?

According to the American Cancer Society, penile cancer is rare, with just over 2,000 new cases diagnosed each year. The penile cancer survival rate is high, especially when it’s detected early. 

Overview

The penis is part of the external male genitalia. It contains many types of tissue, including skin, nerves, smooth muscle and blood vessels. The urethra is inside the penis. The urethra is the tube through which urine and semen leave the body. The tip of the penis is called the glans. The foreskin (prepuce) covers the glans. Every male has a foreskin at birth. Circumcision is the removal of part or the entire foreskin on the penis.

Symptoms

The symptoms of penile cancer can vary from person to person. The most common symptoms include:

• An ulcer, sore or growth on the penis, especially on the glans or foreskin
• Changes in skin color, skin thickening 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, especially if the foreskin is tight
• Swelling in the groin area, which may be caused by an enlarged lymph node

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

Risk Factors

Who is at risk for penile cancer?

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 papilloma virus (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.

Prevention

Can penile cancer be prevented?

There is no sure way to prevent penile cancer. But you may be able to lower your risk for penile cancer by making some lifestyle changes. These include:

• Not smoking
• Avoiding unsafe sexual practices
• Having good personal hygiene habits, especially if you are not circumcised

Diagnosis

How is penile cancer diagnosed?

If your health care provider thinks you might have penile cancer, you'll need certain exams and tests to be sure. Diagnosing penile cancer starts with your health care provider asking you questions. You will be asked about your health history, symptoms, risk factors and family history of disease.

A physical exam will also be done. It includes checking your penis, testicles, groin and belly (abdomen).

What is a biopsy?

A biopsy is the only way to know if you have penile cancer. Your health care provider will need to take a tiny piece of tissue, called a sample, for testing. This procedure is called a biopsy. The type of biopsy done depends on what is seen on your genitals. A local pain medicine will be used to numb the area when the biopsy is done.

Types of biopsies

There are two main types of biopsies for penile cancer.

• Excisional biopsy. The health care provider removes all of the abnormal area of skin. This might be done if the area is small.
• Incisional biopsy. This type of biopsy might be done if the abnormal area is large, is growing deep into the penis or has broken through the skin. Only part of the area is removed.

Lymph node biopsy

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

• Fine needle aspiration (FNA). This biopsy can be done in a health care provider's office or clinic. FNA is not used to take a tissue sample from the penis. It's used to check nearby lymph nodes. During FNA, medicine might be injected into the skin of your groin to make the area numb. Then a thin needle is put into a lymph node under your skin. A syringe is used to pull cells and a few drops of liquid out of the lymph node. These are tested for cancer. If a swollen node is deep in your body, ultrasound or a computed tomography (CT) scan can be used to guide the needle to the right place.
• Surgery. Surgery might be done to look at and take out nearby lymph nodes. This is called lymph node dissection.

After the biopsy, your health care provider will send the tissue to a pathologist. A pathologist is a health care provider who will check the tissue under a microscope and test it for cancer cells.

Treatment

How is penile cancer treated?

Types of treatment for penile cancer

Treatment for penile cancer is either local or systemic. Local treatments remove, destroy or control the cancer cells in one area. Surgery, radiation therapy and topical chemotherapy are local treatments. Systemic treatments, such as chemotherapy, are used to destroy or control cancer cells throughout the entire body.

You may have just one of these treatments. Or you may have more than one (combination therapy):

• Surgery. This is the most common treatment for penile cancer. The goal of surgery is to remove the tumor and leave as much of the penis as possible. Surgery may also be used to remove nearby lymph nodes. If the cancer has grown deep into the penis, part or all of it may need to be removed. This is called a penectomy.
• Radiation therapy. The goal of this treatment is to kill cancer cells by using high energy X-rays. Your health care provider may use it as the main treatment for penile cancer instead of surgery, or it may be used along with surgery. You may get it from a machine that directs the beams at the tumor (called external beam radiation therapy). Or radioactive wires or seeds might be put right into the tumor to kill cancer cells. This is called internal radiation or brachytherapy.
• Chemotherapy. Depending on the type of tumor, different chemotherapy medicines can be used to treat penile cancer. For very early-stage cancers (those that are small, not deep and haven't spread), chemotherapy may be put right on the skin as a cream. This is called topical chemotherapy. For advanced cancers, systemic chemotherapy may be used to reach cancer cells throughout the body. It's given by mouth or injected into a vein.

Clinical trials for new treatments

Researchers are always finding new ways to treat cancer. These are tested in clinical trials. Talk with your health care provider to find out if you should think about being part of a clinical trial.