Penile cancer is a rare type of cancer that forms on the skin and in the tissues of the penis. Common physical symptoms of penile cancer include sores that don’t heal, lumps, growths, or crusty bumps. Symptoms can look like other benign (noncancerous) conditions, so proper testing and diagnosis ensures the proper treatment methods. If detected early and treated quickly, penile cancer has a high success and cure rate.
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What Is Penile Cancer?
Penile cancer is a disease in which malignant cells are found on the skin and in the tissue of the penis.
The penis is part of the male urinary system and reproductive system. Its rod-like section is called the shaft, while the head or tip of the penis is called the glans. Foreskin is the skin that covers the glans or is removed if the male has been circumcised.
Almost all penile cancers develop from skin cells called squamous cells. They can develop anywhere on the penis, but most commonly occur on the foreskin in uncircumcised men or on the glans.
What are the types of penile cancer?
There are a few different types of penile cancer, depending on how the malignant cells form and where:
- Adenocarcinoma — This type of penile cancer, also known as Paget disease of the penis, develops in the sweat glands of the penis skin. It can be difficult to distinguish from carcinoma in situ (CIS).
- Basal cell carcinoma — Also known as basal cell cancer, this condition is a type of skin cancer that can occur on the penis skin. This cancer is rare, slow-growing, and doesn’t typically spread to other parts of the body.
- Melanoma — A type of skin cancer, these malignant cells are usually found on sun-exposed skin but are sometimes found on penis skin. This cancer can grow and spread rapidly.
- Sarcoma — While rare, this type of penile cancer develops from the muscles, tissues, or blood vessels of the penis.
- Squamous cell carcinoma — The most common type of penile cancer occurs in flat skin cells of the penis, also called squamous cells. This cancer can originate in the foreskin or glans. There are two types of squamous cell carcinomas:
- Carcinoma in situ (CIS) — In this early-stage cancer, the malignant cells haven’t spread into the deeper tissues of the skin. You may also hear this condition called Bowen disease if it occurs on the penis shaft and erythroplasia of Queyrat if the cancer originates on the glans.
- Verrucous carcinoma — This condition, also known as Buschke-Lowenstein tumor, is a rare cancer that looks like a genital wart. While they rarely spread to other body parts, they can grow very large and deep into the skin.
What are the stages of penile cancer?
Staging penile cancer is based on three criteria, known by the American Joint Committee on Cancer (AJCC) as the TNM system:
- Tumor (T) — Shape, size, and location of the tumor and if other parts of the body are impacted.
- Nodes (N) — If any lymph nodes have been impacted.
- Metastasis (M) — If the cancer is present in any other areas of the body.
These cancer cells can also be staged in different grades, depending on how abnormal the cancer cells appear compared to normal cells.
Penile cancer stages range from 0 to IV, depending on these factors.
How common is penile cancer?
According to the American Cancer Society, penile cancer is rare. It accounts for fewer than 1% of cancers in men in the U.S. Every year, doctors diagnose about 2,200 new cases in the U.S., and about 440 men die from it.
What causes penile cancer?
The exact cause of penile cancer is unknown, but research is finding links to certain health conditions.
Penile cancer risk factors
Common risk factors of penile cancer include:
- Age — About 80% of men who have penile cancer are over 55.
- Having an uncircumcised penis — Infant circumcision can lower the rate of penile cancer in adulthood.
- HIV — HIV infection is associated with penile cancer.
- Human papillomavirus (HPV) infection — HPV is a group of related viruses. They pass from person to person through unprotected sex or other skin-to-skin contact.
- Phimosis — Sometimes the foreskin becomes tight and difficult to retract, a condition known as phimosis. This can make examination of the penis and detection of penile cancer more difficult.
- Poor hygiene — Poor hygiene can lead to chronic inflammation, which has been associated with penile cancer.
- Smegma — This thick, odorous substance can build up if the foreskin isn’t cleaned properly and may irritate the penis.
- Tobacco use — Men who smoke have a higher rate of penile cancer than those who don't.
Complications of penile cancer
If left undiagnosed, penile cancer can spread and metastasize to other parts of the body, becoming harder to treat. If the cancer is late-stage and impacting the penis significantly, a penectomy may be necessary, which removes part or all of the penis. For some people, this means they are unable to have sexual intercourse through penetration and will have their urethra rerouted through the perineum.
How can I prevent penile cancer?
Even though it is impossible to fully prevent penile cancer from developing, the best prevention method is avoiding the risk factors, including:
- Genital hygiene — For uncircumcised people, retracting the foreskin to clean the entire penis ensures good genital hygiene.
- Testing for HPV — HPV doesn’t always show symptoms and can remain dormant for many years, so testing makes sure you understand where you stand with HPV.
- Tobacco — Using tobacco products increases your risk for many types of cancer.
What Are the Signs and Symptoms of Penile Cancer?
Some symptoms of penile cancer may not be visible unless the foreskin is pulled back. Most penile cancers do not cause pain, but some can cause ulcerations and bleeding. The first sign of penile cancer is often a change in the skin of the penis.
These changes may include:
- A bad-smelling discharge from under the foreskin.
- A red rash under the foreskin.
- A sore that bleeds.
- A sore that doesn't heal.
- Crusty bumps.
- Flat, dark-colored growths.
- Painless lumps.
- Redness or irritation.
- Skin becoming thicker.
- Swelling at the end of the penis.
If cancer has spread from the penis, you may also feel swelling of the lymph nodes in your groin.
When should I see a doctor about my penile cancer symptoms?
If you are experiencing any of the above symptoms, it is important to schedule an appointment with your primary care physician.
How Do You Diagnose Penile Cancer?
A number of benign conditions, including genital warts and infections, may give similar symptoms to penile cancer. For this reason, it is very important to get a correct diagnosis as early as possible.
Diagnosing penile cancer includes:
- Medical history — Your doctor will ask you questions regarding your symptoms and discuss your medical history.
- Physical exam — Your doctor will look at your genital area for signs of penile cancer or other health concerns. Your doctor might also look at the lymph nodes in your groin to see if they are swollen.
- Tests — Penile cancer is initially diagnosed with a biopsy. Other tests might be performed if needed.
Tests to diagnose penile cancer
If your medical history or physical exam suggests you might have penile cancer, your doctor will perform other tests.
Common tests include:
- Biopsy — A small sample of tissue is removed from the penis and is looked at under a microscope.
- Imaging tests — Photos of the inside of your body through x-ray, MRI, or sound waves. If your doctor suspects cancer has spread to another part of the body, these tests may be used.
- CT scan — This shows how big the tumor is and can determine if the cancer has spread elsewhere, such as the lymph nodes.
- MRI — These scans use radio waves and magnets rather than x-rays to show detailed images of the inside of the body.
- Ultrasound — This will show how deeply the cancer has spread into the penis and find enlarged lymph nodes in the groin.
Penile cancer prognosis
The prognosis of penile cancer depends on different factors, including:
- Size, shape, and location of the tumor.
- Stage of cancer.
- Whether this is a first cancer or a recurrence.
- Whether the cancer has spread to other parts of the body.
For people who have earlier stages of penile cancer, success rates are relatively high. For later-stage and advanced penile cancer, survival rates decrease. Now more than ever, more men are surviving for many years after penile cancer treatment.
How Do You Treat Penile Cancer?
Squamous cell penile tumors tend to grow slowly and can usually be cured when they are detected early. Early detection leads to treatment that is simpler, more effective, and less likely to cause significant side effects or complications.
The three main methods for treating penile cancer are surgery, radiation therapy, and chemotherapy.
Surgery to treat penile cancer
Surgery is the most common treatment for all stages of penile cancer. Depending on the type and stage of cancer, these surgical procedures may be beneficial:
- Circumcision — For people with stage 0 and 1 CIS penile cancer in the foreskin, circumcision may be the only procedure needed to cure the condition.
- Glansectomy — This surgery removes all or part of the tip of the penis and may use a skin graft to reshape the glans. This is an option if the tumor is small and located on the glans, or tip, of the penis.
- Lymph node surgery — This surgery is necessary when lymph nodes around the penis have been impacted by cancer. There are a few different methods of lymph node surgery and your care team will discuss the best option for your situation.
- Mohs surgery — Microscopically controlled surgery, Mohs is a procedure that removes the layer of skin with the tumor and examines it under a microscope while in surgery. If cancer is present, that layer of skin is removed and the next layer is tested. This slow process is done until the skin doesn’t present any cancer cells. This method helps save more normal tissue around the tumor area.
- Partial penectomy — Removes only part of the penis, so some of the shaft remains.
- Total penectomy — If the penis will be shorter than 3cm after surgery, a total penectomy will remove the entire penis. The surgeon will create a new opening to urinate through the perineum, the area of skin between the penis and anus.
- Simple excision — In this surgery, the tumor and some cells nearby are cut out and the skin is closed and stitched together. Sometimes a wide local excision is necessary, which removes a larger portion of cells around the tumor.
In very rare cases, the entire scrotum, including the testicles, and rectum must be removed, which is called emasculation. This major surgery requires testosterone supplements indefinitely.
Radiation therapy to treat penile cancer
Radiation is an alternative to surgery, especially if the tumor is small. Radiation uses high-energy rays to kill cancer cells. It is also used to keep cancer from returning.
Radiation may be used before surgery to shrink tumor size or after surgery if cancer has spread to the lymph nodes. It can also be an option for later-stage penile cancer to slow the growth of tumors.
If you are uncircumcised and choose radiation therapy to treat penile cancer, you will be circumcised before treatment begins. Circumcision is necessary to reduce the risk of the foreskin swelling and causing other medical problems.
The disadvantages of radiation therapy for penile cancer include:
- Burning sensation when urinating.
- Destruction of healthy tissue cells near the tumor site.
- Erectile dysfunction.
- Issues urinating.
- Oozing, tender, peeling, sensitive skin.
- Penis skin darkening or changing texture.
- Swelling at radiation site.
Chemotherapy to treat penile cancer
Chemotherapy is a treatment for more advanced penile cancer. If your cancer has spread beyond the penis, chemo drugs may help eliminate cancer cells.
Two types of chemotherapy are used to treat penile cancer:
- Systemic chemotherapy — Powerful cancer-killing drugs are injected into a vein or taken orally to attack and destroy cancer cells in the body. These are typically administered in cycles as a combination of drugs.
- Topical chemotherapy — Administered as an at-home cream, topical chemotherapy uses cancer-killing drugs applied right to the skin to attack cancer cells in the body. Because it is topical, it is only used for earlier-stage cancers or precancers.
Unfortunately, systemic chemotherapy to treat penile cancer is a tough treatment option that has many side effects, including:
- Constipation or diarrhea.
- Extreme fatigue.
- Hair loss.
- Increased risk of infection.
- Kidney damage.
- Nausea and vomiting.
- Nerve damage.
- Sores in the mouth.
Topical therapies to treat penile cancer
Topical therapies are available for low-risk penile cancers which will then require close monitoring:
- Cryosurgery — Also called cryoablation and cryotherapy, this treatment method uses liquid nitrogen to freeze cancer cells. Cryosurgery requires multiple rounds to kill off malignant cells and can take a couple of months to heal, often leaving a scar.
- Laser ablation — This treatment method uses a laser light to fry off cancer cells. This procedure is done under anesthesia, so you would not feel the treatment. The wound can take a few months to heal and requires careful monitoring for healing and recurrence.
- Topical creams — Some drugs, such as Imiquimod, can be used in cream form to treat CIS penile cancer. Applied several times a week, this option can cause skin irritation.
