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Doctors use many tests to diagnose cancer and find out if it has metastasized (spread). Some tests may also determine which treatments are likely to be the most effective. For most types of cancer, a biopsy (see below) is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:
- Age and medical condition
- Type of cancer suspected
- Severity of symptoms
- Previous test results
In addition to a physical examination, the following tests may be used to diagnose penile cancer:
Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease).
Fine needle aspiration/biopsy. A fine needle aspiration is a specific type of biopsy. First, the skin is often made numb with an anesthetic (a medication to block the awareness of pain) cream, followed by an injection of local anesthetic into the area near the tumor. The doctor will insert a thin needle into the tumor and remove some cells and fluid. The procedure may be repeated two or three times to obtain samples from different areas of the tumor. The samples will then be sent to a laboratory, where a pathologist will determine if the cells are cancerous (called positive for cancer), non-cancerous (called benign or negative for cancer), or undetermined (called non-diagnostic).
Sentinel lymph node biopsy. This is another type of biopsy. It is important to know if cancer cells have spread to other areas beyond the penis. In this technique, the doctor removes one or a few sentinel lymph nodes—the first lymph node(s) into which the lymph system drains into near to the tumor—to check for cancer cells. Lymph nodes are the tiny, bean-shaped organs that help fight infection. In the case of penile cancer, the sentinel lymph nodes are located just under the skin in the groin. If cancer cells are detected, it means that the disease may have spread to other lymph nodes in the region or to other parts of the body through the blood and lymph vessels. However, there is a chance that a sentinel lymph node biopsy may not find cancer cells in the lymph nodes, when in fact the cancer has spread.
Inguinal (groin) lymph node dissection. This is the most accurate way to find out whether the cancer has spread to any lymph nodes near the penis. In this procedure, the lymph nodes near the penis are removed and checked for cancer. This procedure provides more information than the removal of a single lymph node or a group of lymph nodes. However, after this procedure, some men may have problems with wound healing and long-lasting and possibly severe lymphedema (leg swelling). Research to find ways to prevent these side effects is ongoing. Visit the Current Research section for more information.
X-ray. An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation.
Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail. A CT scan helps find out if the cancer has spread to lymph nodes in the groin, pelvis, and the abdomen and also allows the doctor to see if the cancer has spread to the lungs, liver, and other tissues.
Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium may be injected into a patient’s vein to create a clearer picture.
Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body. This substance is absorbed mainly by organs and tissues that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body. However, PET scans have not been approved for use in men with penile cancer, and research studies have not shown that PET scans increase survival or otherwise provide any benefit for men with penile cancer.
Find more about what to expect when having common tests, procedures, and scans.
After these diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging. Learn more about the first steps to take after a diagnosis of cancer.