Penile Cancer

Penile cancer is a rare form of cancer that occurs mostly in male patients who aren’t circumcised. Epidermoid/squamous cell carcinoma is the most common type of penile cancer (95 percent).

Types & Stages

Some types of penile cancer include:

• Squamous cell carcinoma (SCC) forms in the top part of your skin layer (epithelium). It makes up 95 percent of all penile cancers.
   
• Melanoma begins in cells that control how dark or light your skin is, called melanocytes. Melanoma is a more aggressive form of cancer.
   
• Basal cell carcinoma (BCC) begins in the bottom layer of your epithelium. BCC is a slow-growing form of penile cancer.
   
• Adenocarcinoma starts in your glandular cells, which make sweat, mucus or other body fluids.
   
• Urothelial carcinoma forms in your urothelium, the tissue that lines your bladder, kidneys and other parts of your urinary system. 
   
• Sarcoma. This type of cancer develops in muscle or connective tissue and is extremely rare.

Signs & Symptoms

Visit a doctor if you’re experiencing any changes or pain in the penis, including:

• A growth or sore on the penis (can be on foreskin or shaft)
• Change in the color of the penis
• Skin of the penis starts to thicken

Diagnosis

Your doctor may do the following:

• Exam. Your doctor will examine you to check for unusual skin changes, like a lump or discoloration on your penis. They’ll also ask about your symptoms, habits and past illnesses.
   
• Imaging tests. You may need imaging tests to see if the cancer has spread. Depending on the cancer, your healthcare provider may order a CT scan, MRI or ultrasound.
   
  • CT scan compiles a series of detailed X-ray images taken from different angles. 
     
  • Magnetic resonance imaging (MRI) uses a magnet and radio waves to take a series of detailed images of the penis and other adjacent tissues.
     
  • Ultrasound uses high-energy sound waves that reflect off internal tissues, and the resulting echoes collectively form a visual image called a sonogram.
     
• Tissue biopsy. This is the only way to confirm a cancer diagnosis. During the procedure, your healthcare provider removes suspicious-looking cells or tissues. A pathologist views the cells under a microscope to check for signs of cancer.

Treatment

Treatment depends on the size of the tumor, whether it’s spread, and how likely it is that the cancer will return. For early-stage cancer, your healthcare provider may recommend one or more of the following treatments:

• Circumcision. If the cancer is only on your foreskin, your healthcare provider may remove the tissue.
   
• Cryotherapy. This procedure uses extreme cold to destroy the tumor.
   
• Excision. Your doctor may cut the cancer cells or tumor from your penis.
   
• Laser ablation. This procedure uses lasers that uses uses extreme heat (radiofrequency ablation) or cold (cryoablation) to destroy the tumor.
   
• Topical chemotherapy. This is a cream that you regularly apply to your penis. Common medicines include fluorouracil and imiquimod.
   
• Mohs surgery. During this procedure, your doctor removes cancerous skin layer by layer until arriving at the healthy tissue underneath.
   
• Radiation therapy. Your doctor may use energy beams, like X-rays, to destroy cancer cells or shrink a tumor before surgery.

For cancer that’s more advanced, your healthcare provider may recommend:

• Lymphadenectomy. Your doctor may remove your lymph nodes (most commonly in your groin area) if the cancer spreads there.
   
• Penectomy. A partial penectomy removes part of your penis. A total penectomy removes your entire penis. For a total penectomy, your surgeon will create an opening in your belly or perineum (the skin between your anus and scrotum) so you can urinate.

Your healthcare provider may use radiation, chemotherapy or both before or after surgery.

Causes & Risk Factors

Penile cancer risk factors are:

• Being 55 or over. About 80% of penile cancer diagnoses in the U.S. occur within this age range.
   
• Being uncircumcised. Circumcision removes the foreskin of your penis, exposing the head. Many risk factors related to penile cancer are likely related to having a foreskin.
   
• HPV (human papillomavirus). Many of the same high-risk strains of HPV that cause cervical cancer have been found in men with penile cancer.
   
• HIV (human immunodeficiency virus). Researchers aren’t sure why, but penile cancer is more common in men with HIV.
   
• Lichen sclerosus (LS) is an inflammatory disorder that may cause the head of your penis or your foreskin to feel painful, irritated or itchy.
   
• Phimosis causes your foreskin to become so tight that you can’t retract it (pull it back) to access the head of your penis.
   
• Poor hygiene. Not washing your penis frequently or thoroughly enough may increase your risk of smegma (a thick, cheesy-looking secretion around your genitals). The resulting irritation and inflammation may increase your cancer risk.
   
• PUVA treatment (psoralen and ultraviolet A photochemotherapy), is a type of treatment for psoriasis that uses radiation.
   
• Tobacco use. Smoking cigarettes, chewing tobacco or using snuff can slow your body’s ability to fight infection, raising your cancer risk. Tobacco may also damage cells, causing changes that lead to cancer.

Screening

There are no widely recommended screening tests for penile cancer, but many penile cancers can be found early, when they're small and before they have spread to other parts of the body. Almost all penile cancers start in the skin, so they're often noticed early. If you see or feel something abnormal—a new redness, growth or other change in your penis—visit your doctor.