Surgical Procedures: Surgery and Staging for Penile Cancer

When there are cancer cells in or on the tissue of your penis, it is called penile cancer. Your penis is used for both reproduction and urination. The most common type of penile cancer is squamous cell carcinoma. Other types include melanoma, verrucous carcinoma, adenocarcinoma (Paget’s disease of the penis), basal cell carcinoma, and sarcoma.

What is staging and how is it done?

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. For penile cancer, these tests may be:

Physical Exam: This is an exam to look at your body and a chance to talk about your past health issues.

Biopsy: A biopsy takes cells from the tumor, or a piece of the cancer, to see what type of cancer it is and how it looks under a microscope. A doctor called a pathologist looks at the sample in a laboratory.

Imaging: Radiology tests can look inside your body at the cancer and see if it has spread. These tests are:

• CAT scan (CT scan).
• Positron emission tomography scan (PET scan).
• Magnetic resonance imaging (MRI).

Penile cancer spreads to other parts of your body through the tissue, lymph, and blood systems. Cancer stage tells how extensive the cancer is, how far it has spread, and what treatment course will be recommended. For penile cancer, providers use the American Joint Committee on Cancer TNM staging system. This system tells 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 (one) through IV (four).

Surgical Procedures Used for the Treatment of Penile Cancer

Surgery is often used to treat penile cancer. The procedure that you have depends on many factors, including the size and location of the cancer. Your surgeon will talk to you about your specific procedure.

Surgical procedures used to treat penile cancers are:

Mohs Microsurgery: Layers of skin are removed until there is no cancer left. After each layer is removed, it is looked at with a microscope right away to make sure there are no cancer cells. This leaves as much normal tissue as possible.

Laser Surgery: A laser beam removes lesions from the surface of your penis.

Cryosurgery: Abnormal tissue is frozen and destroyed.

Circumcision: Part of or all of your foreskin is removed.

Wide Local Excision: All of the cancerous area and a small area of nearby normal tissue is removed.

Amputation: Removal of the penis. Can be partial or total:

• Partial Penectomy: Removal of the end of the penis, leaving the shaft intact.
• Total Penectomy: Removal of the whole penis. An opening is made between your scrotum and anus, called a perineal urethrostomy. This lets urine leave your body.

Emasculation: Removal of your penis and testicles. Often used to treat advanced cancers.

Lymph Node Removal: Removal of lymph nodes.

Sentinel Lymph Node Removal: A special dye or radioactive substance is injected near the tumor and is absorbed (taken in). The first lymph node to be seen with dye is removed and checked for cancer. If there is cancer in this “sentinel lymph node," more lymph nodes will be removed.

Inguinal Lymph Node Removal: Inguinal lymph nodes are removed through an incision (cut) in your groin.

What are the risks of penile surgery?

As with any surgery, there are risks and possible side effects. These can be:

• Reaction to anesthesia (Anesthesia is the medication you are given to help you sleep through the surgery, to not remember it, and to help with pain. Reactions can include wheezing, rash, swelling, and low blood pressure).
• Infection.
• Issues with wound healing.
• Lymphedema (swelling).
• Fluid buildup.
• Narrowed (thinning) urethra that can make it hard to urinate.
• You may need to sit to urinate.
• You may be unable to have sexual intercourse.
• Need for testosterone supplements if you have emasculation surgery.
• Need for reconstructive surgery.
• Chronic pain.
• Change in self-image.

What is recovery like?

You may need to stay in the hospital during your recovery from penile surgery. You may have a temporary urinary catheter to drain urine from your bladder. You will be given instructions on catheter care before leaving the hospital.

Your provider will give you information about the medications you will be taking, such as those for the prevention of pain, blood clots, infection, and constipation, along with medications that treat other conditions.

Your provider will talk with you about your activity restrictions depending on the surgery you have had.

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 provider tells you that you can go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your provider 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 provider 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 to 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 provider about your plan and recovery.