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The penis contains several types of cells. The main types of penile cancer are:
- Squamous cell carcinoma
- Kaposi sarcoma
- Basal cell
In the United States, penile cancer is diagnosed in about 1,300 men each year. The penile cancer rate is much higher in India and some South American and African countries.
Penile Cancer Risk Factors
Anything that increases your chance of getting penile cancer is a risk factor. These include:
- Age: Most cases are seen in men 50 to 70 years old. About a third are in men under 50.
- Tobacco use
- Human papillomavirus (HPV): This sexually transmitted disease has more than a dozen subtypes. HPV 16 and HPV 18 are linked most often to penile cancer.
- Lack of circumcision at birth
- Phimosis: A condition that makes it difficult to pull back the foreskin. This can lead to the buildup of body oils, bacteria and other debris known as smegma.
- UV light treatment of psoriasis
- AIDS (acquired immune deficiency syndrome)
Behavioral and lifestyle changes can help prevent penile cancer. Visit our prevention and screening section to learn how to manage your risk.
Some men who develop penile cancer have obvious symptoms in the early stages. Others may not have symptoms until the disease has spread. Penile cancer symptoms vary from man to man. They may include:
- Change in the skin of the penis
- Wart-like growth or lesion that may or may not be painful
- Open sore that won't heal
- Reddish rash
- Small, crusty bumps
- Flat, bluish-brown growths
- Swelling at the end of the penis
- Persistent, smelly discharge under the foreskin
- Swollen lymph nodes in the groin if the cancer has spread
You may not be able to see these symptoms unless the foreskin is pulled back.
Unfortunately, many men do not want to talk about these symptoms with their doctors. This may delay them from seeking treatment until penile cancer is advanced and harder to treat.
Although these symptoms may not mean you have penile cancer, you should report any changes in the penis to your doctor as soon as possible. They may be signs of another health problem.
Did You Know?
MD Anderson’s experts use the latest technology and techniques, as well as remarkable skill, to accurately diagnose penile cancer. The earlier penile cancer is diagnosed, the higher the chances for successful treatment. This is why it is important to report any changes in your penis to your doctor.
Since penile cancer begins in the skin of the penis, men often notice them in the early stages. However, some men are hesitant to mention the changes to their doctors, which delays their treatment.
Penile Cancer Diagnosis
If you have penile cancer symptoms, your doctor will ask you questions about your health, your lifestyle, including smoking and drinking habits, and your family medical history. The doctor will examine your penis.
If your doctor suspects you may have penile cancer, one or more of the following tests may be used to diagnose penile cancer and determine if it has spread. These tests also may be used to find out if treatment is working.
Biopsy: A biopsy usually is the first test performed to find out if you have penile cancer. The type of procedure depends on the type of tissue or lesion.
Incisional biopsy: A small part of abnormal tissue is removed. This procedure is used most often for lesions that are larger, ulcerated or that appear to have spread deep into the tissue.
Excisional biopsy: The whole growth or lesion is removed. Usually, this type of biopsy is performed for small abnormal areas. If the lesion is on the foreskin, you doctor may suggest circumcision.
Fine needle aspiration (FNA): This type of biopsy may be used to examine the tissue in lymph nodes. A thin needle is inserted into the groin area. Then cells are drawn out and looked at under a microscope.
Imaging tests, which may include:
- CT or CAT (computed axial tomography) scans
- MRI (magnetic resonance imaging) scans
- PET (positron emission tomography) scans
Penile Cancer Staging
If you are diagnosed with penile cancer, your doctor will determine the stage of the disease. Staging is a way of classifying cancer by how much disease is in the body and where it has spread when it is diagnosed. This helps the doctor plan the best way to treat the cancer.
Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads.
Penile Cancer Stages
(Some of the following is based on information from the National Cancer Institute)
Stage 0: Penile cancer has not grown into tissue below the top layers of skin and has not spread to lymph nodes or distant sites.
Stage 1: Penile cancer has grown into tissue just below the superficial layer of skin but has not grown into blood or lymph vessels. It has not spread to lymph nodes or distant sites.
Stage II: Any of the following:
- Penile cancer has grown into tissue just below the superficial layer of skin and is either high-grade or has grown into blood or lymph vessels. It has not spread to lymph nodes or distant sites.
- The cancer has grown into one of the internal chambers of the penis (the corpus spongiosum or corpora cavernosum). The cancer has not spread to lymph nodes or distant sites.
- The cancer has grown into the urethra (tube that urine passes through). It has not spread to lymph nodes or distant sites.
Stage IIIa: Penile cancer has grown into tissue below the superficial layer of skin. It also may have grown into the corpus spongiosum (tissue within the penis) or the urethra (the small tube through which urine passes from the bladder to the outside of the body). The cancer has spread to a single groin lymph node. It has not spread to distant sites.
Stage IIIb: Penile cancer has grown into the tissues of the penis and may have grown into the corpus spongiosum, the corpus cavernosum or the urethra. It has spread to two or more groin lymph nodes. It has not spread to distant sites.
Stage IV: Any of the following:
- The cancer has spread to lymph nodes in the pelvis or the cancer spread in the groin lymph nodes has grown through the lymph nodes' outer covering and into the surrounding tissue. The cancer has not spread to distant sites.
- Penile cancer has grown into the prostate or other nearby structures. It may or may not have spread to groin lymph nodes. It has not spread to distant sites.
- The cancer has spread to distant sites.
Recurrent penile cancer is cancer that went away with treatment but later came back. Recurrent penile cancer may return in the penis or any other part of the body.
When you're treated at MD Anderson for penile cancer, some of the nation's top specialists focus their expertise on you. They communicate with each other – and with you – to ensure you receive the most advanced penile cancer treatment with the least impact on your body.
As one of the nation's leading cancer centers, MD Anderson sees many more penile cancer patients than the average oncologist. This means we have a higher level of experience and expertise, which is crucial to your treatment and recovery.
Like all surgeries, penile cancer surgery often is more successful when performed by a specialist with a great deal of experience. This is particularly true for organ-preserving surgeries, Mohs surgery and plastic surgery reconstruction, which usually are used to treat penile cancer.
Since MD Anderson is one of the nation's most active cancer centers, clinical trials of new agents are available for some penile cancer patients.
Penile Cancer Treatments
If you are diagnosed with penile cancer, your doctor will discuss the best options to treat it. This depends on several factors, including the type and stage of the cancer and your general health.
Surgery is the most frequent form of penile cancer treatment, but laser therapy and radiation may be used for smaller tumors. The type of treatment usually depends on how far the cancer has spread.
Your penile cancer treatment will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.
Penile Cancer Surgery
Surgery to remove all or part of the penis is called penectomy. Penile preservation surgery (the penis is not removed) is used to treat penile cancer whenever possible.
Circumcision: Surgical removal of the penis foreskin and some of the nearby skin. This procedure may be done if the penile cancer has not spread beyond the foreskin. It also may be done before radiation therapy.
Partial penectomy: The tumor is removed along with a margin of healthy tissue. In the past, a 2-centimeter margin was removed in all cases of penile cancer. Recent research suggests such wide margins may not be needed. Surgeons try to spare as much of the glans (head) and shaft as possible to keep urinary and sexual function.
Total penectomy: Removal of the entire penis for treatment of large penile cancer tumors. The surgeon reroutes the urethra (tiny tubes that urine passes through) behind the testicles, and an urethrostomy (hole) is created so you can urinate. Penile reconstruction surgery using a flap of skin from the forearm to create a new penis has been done, but the procedure is rare.
Mohs surgery (microscopically-controlled surgery): The surgeon surgically removes a thin layer of skin and looks at it right away under a microscope. This process is repeated until the cells are free of cancer.
Laser surgery: Light from a laser vaporizes penile cancer cells.
New radiation therapy techniques and remarkable skill allow MD Anderson doctors to target penile cancer more precisely, delivering the maximum amount of radiation with the least damage to healthy cells. In penile cancer, radiation therapy may be used to treat early stage tumors, with surgery to remove lymph nodes, and in advanced cancers to control spread and help relieve symptoms.
MD Anderson offers the most up-to-date and advanced chemotherapy options for penile cancer.
Topical chemotherapy: An anti-cancer medicine, usually 5-fluorouracil or 5-FU, is applied as a cream for several weeks. This generally is used only for precancerous or very early penile cancer.
Systemic chemotherapy: Medicine injected into a vein or given by mouth.
Imiquimod: A drug in a cream form that boosts the body's immune system. It sometimes is used to treat very early stage penile cancer.
Why come to MD Anderson for penile cancer care?
The experts at MD Anderson's Genitourinary Cancer Center are among the nation's most skilled and experienced at penile cancer treatment and diagnosis. While urologists outside major cancer centers typically see one case of penile cancer every two to three years, more than 30 men with penile cancer are treated at MD Anderson each year. This translates to an extraordinary level of expertise that can make a direct difference in your successful treatment and recovery.
Customized, Comprehensive Care
At MD Anderson, you receive personalized penile cancer treatment from a team of some of the most renowned experts in the nation. This group, which includes medical and surgical oncologists, as well as other physicians and a specially trained support staff, collaborates to ensure you receive the most advanced penile cancer treatments with the least impact on your body. As one of the premier cancer research institutions, we are able to offer a range of clinical trials of new agents to treat penile cancer.
And, at MD Anderson you're surrounded by the strength of one of the nation's largest and most experienced comprehensive cancer centers, which has all the support and wellness services needed to treat the whole person – not just the disease.
Cancer is like a teeter-totter. Sometimes you gotta go down to get back up.
HPV-Related Cancers Moon Shot
More than 60% of penile cancer cases are caused by human papillomavirus (HPV) infection, for which a safe and effective vaccine currently exists. MD Anderson’s HPV-Related Cancers Moon Shot™ aims to improve outcomes for penile cancer patients through prevention initiatives and new treatments.Learn more