Penile Cancer

What Is Penile Cancer?

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

Penile cancer is rarely found in men in the United States. Although there are different types of penile cancer, about 95% are squamous cell carcinoma. This means they begin in the flat skin cells of the penis, called squamous cells.

Most squamous cell penile cancers begin on the foreskin or on the glans. Squamous cell penile cancer is slow-growing and can usually be cured if found early.

Penile Cancer

Penile Cancer Symptoms

Although many men with penile cancer have early symptoms, you may have no symptoms until the cancer is in its later stages. You may notice symptoms but think they are due to something other than cancer. Tell your doctor about any changes in the skin of your penis, the color of the skin, or any unusual discharge, such as bleeding or foul odor. In many cases, the first sign of penile cancer is an ulcer, sore, or growth on the penis. The growth is usually painless and shows up on the glans or the foreskin, but can also show up on the shaft of the penis. These are some other symptoms:

  • Changes in skin color, thickening of the skin, tissue growth
  • A red, velvet-like rash
  • Bleeding
  • 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

These symptoms may or may not mean penile cancer. If you have any of them, you should see your doctor right away.

Diagnosing Penile Cancer

If your doctor suspects that a change in the skin of your penis might be cancer, a small piece of tissue from the area of concern, called a biopsy, will be sent to be tested. If the pathologist has found cancer in your biopsy, your doctor may order more tests to help decide which treatment plan would be best. These tests can also help stage the cancer, or see if it has spread. You may need more than one of these tests.

Ultrasound

What Is an Ultrasound?

Ultrasonography, which is sometimes called sonography, uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. The sound waves bounce off body parts and send back an image, like sonar on a submarine. A computer then looks at the signals sent back by the sound waves and creates an image of the body using those signals.

Ultrasounds are used to view internal organs as they function, and to assess blood blow through various vessels. Ultrasound procedures are often used to examine many parts of the body such as the abdomen, breasts, female pelvis, prostate, scrotum, thyroid and parathyroid, and the vascular system. During pregnancy, ultrasounds are performed to evaluate the development of the fetus.

Computed tomography (CT) scan

Computed Tomography Scan (CT Scan)

Magnetic resonance imaging (MRI)

What Is Magnetic Resonance Imaging (MRI)?

A magnetic resonance (REZ-oh-nans) imaging scan is usually called an MRI. An MRI does not use radiation (X-rays) and is a noninvasive medical test or examination. The MRI machine uses a large magnet and a computer to take pictures of the inside of your body. Each picture or “slice” shows only a few layers of body tissue at a time. The pictures can then be examined on a computer monitor.

Pictures taken this way may help caregivers find and see problems in your body more easily. The scan usually takes between 15 to 90 minutes. Including the scan, the total examination time usually takes between 1.5 to 3 hours.

A substance called gadolinium is injected into a vein to help the physicians see the image more clearly. The gadolinium collects around cancer cells so they show up brighter in the picture. Sometimes a procedure called magnetic resonance spectroscopy (MRS) is done during the MRI scan. An MRS is used to diagnose tumors based on their chemical make-up.

How does MRI work?

The MRI machine is a large, cylindrical (tube-shaped) machine that creates a strong magnetic field around the patient. This magnetic field, along with a radiofrequency, alters the hydrogen atoms’ natural alignment in the body.

A magnetic field is created and pulses of radio waves are sent from a scanner. The radio waves knock the nuclei of the atoms in the body out of their normal position; as the nuclei realign back into proper position, they send out radio signals.

These signals are received by a computer that analyzes and converts them into an image of the part of the body being examined. This image appears on a viewing monitor. Some MRI machines look like narrow tunnels, while others are more open.

MRI may be used instead of a CT scan in situations where organs or soft tissue are being studied, because with MRI scanning bones do not obscure the images of organs and soft tissues, as does CT scanning.

Other related procedures that are used to assess the heart may include:

  • Resting or exercise electrocardiogram (ECG)
  • Signal-averaged electrocardiogram (ECG)
  • Holter monitor
  • Cardiac catheterization
  • Chest X-ray
  • Computed tomography (CT scan) of the chest
  • Electrophysiological studies
  • Myocardial perfusion scans
  • Radionuclide angiography
  • Ultrafast CT scans

Sentinel lymph node biopsy

Sentinel Lymph Node Biopsy

The removal of the sentinel lymph node (the first lymph node to which the cancer is likely to spread). A radioactive tracer and/or blue dye is injected near the tumor before surgery in a process called lymphatic mapping (or lymphoscintigraphy). The radioactive tracer or dye flows through the lymph channels in the skin to first draining lymph nodes in the region(s) around the melanoma. The injection of the radioactive tracer is performed in the Nuclear Medicine Department either the evening before surgery or several hours before surgery. A body scan is then performed to help the surgeon localize the sentinel lymph node before beginning the operation. This first lymph node(s) to receive the tracer is removed for biopsy. A pathologist then views the tissue under a microscope to look for cancer cells and often uses additional tissue stains (immunostains) to determine whether microscopic evidence of melanoma is evident in the regional lymph nodes. If cancer cells are not found, no further surgery is necessary.

Stages of Penile Cancer

Once cancer of the penis is found, more tests will be done to find out if the cancer has spread from the penis to other parts of the body (staging). It is important to know the stage of the disease in order to plan treatment. The following stages are used for cancer of the penis:

Stage 0

Cancer is found only on the surface of the skin of the penis. Stage 0 cancer is also called carcinoma in situ.

Stage I

Cancer has spread to connective tissue just under the skin of the penis.

Stage II

Cancer has spread to either:

  • connective tissue just under the skin of the penis and to one lymph node in the groin; or
  • erectile tissue (spongy tissue that gets larger to make an erection) and may have spread to one lymph node in the groin.

Stage III

Cancer has spread to either:

  • connective tissue or erectiletissue of the penis and to more than one lymph node in the groin; or
  • the urethra or prostate, and may have spread to one or more lymph nodes in the groin.

Stage IV

Cancer has spread:

  • to tissues next to the penis and may have spread to lymph nodes in the groin or pelvis; or
  • anywhere in or near the penis and in one or more lymph nodes deep in the pelvis or groin; or
  • to distant parts of the body.

Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the same area or in another place.

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