Penile Cancer: The Basics

How is it diagnosed?

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.

How is it staged?

Once a penile cancer is found, it is necessary to perform more tests to see if the tumor has spread so that appropriate treatment can be recommended. These may involve imaging studies such as CT scans or MRI scans, or procedures such as a cystoscopy (see above).

The extent of the tumor spread is also referred to as the "stage". The stage helps guide your doctor’s recommendations regarding the optimal treatment for the penile cancer as well as the prognosis. The staging system for penile cancer is the "TNM" system described by the American Joint Committee on Cancer. The "T" describes the size or invasiveness of the tumor; the "N" describes the spread of the tumor to any glands, or lymph nodes, near the tumor; and the "M" describes any distant spread, or metastasis, to other organs or sites of the body. Grade, or how well the tumor cells are organized, is also used in making treatment decisions, but is not included in the official "TNM" staging system. The different stages of penile cancer are as follows:

Tis: carcinoma in situ, or a tumor that involves only the cells in which it began and has not spread to other tissues
Ta: a tumor that has not invaded through the outmost layer of cells, or epithelium, that makes up the skin
T1: a tumor that has invaded through the epithelium to involve the connective tissue below the skin
T2: a tumor that has invaded through the connective tissues to involve the corpus spongiosum or corpus cavernosum, the deep spongy tissues of the penis
T3: a tumor that has invaded the urethra (the tube that connects the bladder and penis) or prostate gland
T4: a tumor that has invaded other structures such as the bones of the pelvis
N0: the cancer has not spread to glands or lymph nodes in the groin or pelvis
N1: the cancer has spread to a single shallow gland or lymph node in the groin, called a superficial inguinal lymph node
N2: the cancer has spread to more than one shallow gland or lymph node in the groin, either or one side or both sides of the groin
N3: the cancer has spread to one or more deep glands or lymph nodes in the groin, called deep inguinal lymph nodes, or has spread to lymph nodes in the pelvis (such as internal iliac or hypogastric lymph nodes, external iliac lymph nodes, or obturator lymph nodes)
M0: the cancer has not spread to distant organs or sites of the body
M1: the cancer has spread to distant organs or sites of the body
The different grades of penile cancer are as follows:

G1: well-organized tumor cells; considered low grade
G2-3: moderately-organized tumor cells; considered intermediate grade
G4: poorly-organized tumor cells; considered high grade

The overall stage of the tumor (Stage I, II, III, or IV) is then based on a combination of the T, N, and M categories:

Stage 0: Tis, N0, M0 and Ta, N0, M0

Stage I: T1, N0-1, M0

Stage II: T2, N0-1, M0 or T1-2, N2, M0

Stage III: T3, N0-2, M0

Stage IV; T4, N0-3, M0 or T1-4, N3, M0

A tumor may also be described as relapsing. This means that the tumor has come back after it was originally treated. It may return to the site where it first started or to other areas of the body.

What is the prognosis of penile cancer?

The prognosis is based largely on the stage of the tumor, as well as the grade. Patients with low grade and low stage tumors have an excellent prognosis and long-term survival. Patients with tumors that have not spread to the glands or lymph nodes likewise have an excellent prognosis, with 95% survival at 5 years from diagnosis. The survival rate decreases when the disease spreads to the lymph nodes in the groin, and very few patients are alive at 5 years if the tumor has spread to lymph nodes in the pelvis.

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How is it diagnosed?

How is it staged?

What is the prognosis of penile cancer?