Surgical Procedures: Penectomy to Treat Penile Cancer
When there are malignant (cancerous) cells in or on the tissue of the penis, this is referred to as penile cancer. The penis is the external male reproductive organ responsible for both reproduction and urination. The most common type of penile cancer is squamous cell carcinoma. Other cancers such as melanoma, verrucous carcinoma, adenocarcinoma (Paget’s disease of the penis), basal cell carcinoma and sarcoma can occur.
Men at higher risk for developing penile cancer include smokers, the uncircumcised, those with human papillomavirus (HPV) or AIDS, men over 60 years old, men with a history of UV light treatment for psoriasis and men with conditions such as phimosis (tight foreskin) or smegma (secretions under the foreskin).
How is staging performed?
Staging is a way to find out how far the cancer has spread in your body. Your provider will have you get a few tests to figure out the stage of your cancer. These tests may include:
Physical Exam: This is a general exam to look at your body and to talk about your past health issues.
Biopsy:A biopsy takes cells from the cancer, or a piece of the cancer, to see what type of cancer it is and how it behaves. A doctor called a pathologist looks at the sample in a laboratory. Types of biopsy for diagnosing penile cancer include fine needle biopsy (FNA), incisional biopsy, excisional biopsy, sentinel lymph node biopsy and/or lymph node dissection.
Imaging: Radiology tests can look inside your body to look at the cancer and determine if it has spread. These tests can include:
- CAT scan (CT scan).
- Magnetic Resonance Imaging (MRI).
- Positron emission tomography (PET Scan).
Penile cancer spreads to other parts of the body through the tissue, lymph and blood systems. Cancer stage determines how extensive the cancer is, how far it has spread and what treatment course will be recommended. For penile cancer, doctors will use the American Joint Committee on Cancer TNM staging system, which will provide your healthcare team with information on the extent of the tumor (T), spread to the lymph nodes (N) and distant metastasis (spread) (M). The TNM values are then combined to determine a stage of I through IV.
What is a penectomy and how is it performed?
Men with penile cancer may be treated with surgery. In certain situations removal of the penis (called penectomy), in part or in whole, may be recommended. In some cases the scrotum and lymph nodes will also be removed.
- Partial Penectomy: Removal of the end of the penis, leaving the shaft intact.
- Total Penectomy: Removal of the entire penis, with the creation of a urinary opening between the scrotum and anus- perineal urethrostomy.
- Emasculation: Removal of the penis and testicles. Typically, this is used to treat advanced cancers.
- Lymph Node Removal: In some cases lymph nodes may need to be removed; typically this is reserved for deep tissue invasion.
- Sentinel Lymph Node Removal: It may be necessary to remove a lymph node, called the sentinel node. During the procedure, a special dye or radioactive substance is used and injected near the cancerous tumor; the first lymph node to be seen with dye is removed for evaluation. If there is cancer, then additional lymph nodes will be removed. If no cancer is present, further lymph node removal is not needed.
- Inguinal Lymph Node Removal: Through an incision made in the groin, inguinal lymph nodes are removed.
What are the risks associated with penile surgery?
There are risks and side effects related to having a small bowel resection. Risks and side effects may be:
- Reaction to anesthesia. (Anesthesia is the medication you are given to help you sleep through the surgery, not remember it and to manage pain. Reactions can include wheezing, rash, swelling and low blood pressure.)
- Issues with wound healing or skin breakdown.
- Lymphedema, also known as swelling.
- Fluid collections.
- Narrowed urethra.
- Potential to have to sit to urinate.
- Potential inability to have sexual intercourse.
- Need for lifelong testosterone supplementation if undergoing emasculation.
- Potential need for penile reconstructive surgery.
- Chronic pain.
- Change in self-image and/or depression.
- Blood clots.
What is recovery like?
Recovery from a penile surgery may include a stay in the hospital for one to two nights depending on the procedure you had. You may have a temporary urinary catheter to drain urine from your bladder and will be taught how to care for the catheter care.
Your medical team will discuss with you the medications you will be taking, such as those for pain, blood clot, infection, and constipation prevention and/or other conditions.
Your provider will talk to you about any activity restrictions you will have.
How can I care for myself?
You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.
Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.
There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.
Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.
- Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.
This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.
American Cancer Society. Surgery for Penile Cancer. https://www.cancer.org/cancer/penile-cancer/treating/surgery.html
Healthline. Penectomy for Penile Cancer. https://www.healthline.com/health/mens-health/penectomy
Sosnowski, R. et al. Quality of life in penile carcinoma patients - post-total penectomy. 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4986308/