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Penile Cancer - Introduction

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2016

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Penile Cancer. To see other pages, use the menu. Think of that menu as a roadmap to this full guide.

About the penis

The penis is the external genital organ of a man. It is made up of 3 chambers of spongy tissue that contain smooth muscle and many blood vessels and nerves. The corpora cavernosa makes up 2 of the chambers that are located on both sides of the upper part of the penis. The corpus spongiosum is located below the corpora cavernosa and surrounds the urethra, the tube through which urine and semen leave the body at an opening called the meatus. At the tip of the penis, the corpora cavernosa expands to form the head of the penis, or glans.

About penile cancer

Cancer begins when healthy cells change and grow out of control, forming a mass called a malignant tumor. Malignant means that the tumor is cancerous and can grow and spread to other parts of the body. There are also benign tumors of the penis that are not cancers. They can grow but do not spread.

Penile cancer is a rare form of cancer that occurs mostly in uncircumcised men, meaning they still have the piece of skin called the foreskin covering the head of their penis. Circumcision is the removal of the foreskin and may reduce the risk of penile cancer.

Types of penile cancer

There are several types of penile cancer, including:

  • Epidermoid/squamous cell carcinoma. Ninety-five percent (95%) of penile cancer is epidermoid, or squamous cell, carcinoma. This means that the cells look like the tissues that make up skin when seen through a microscope. Squamous cell carcinoma can begin anywhere on the penis. But, it usually develops on or under the foreskin. When found at an early stage, epidermoid carcinoma can usually be cured.

  • Basal cell carcinoma. Basal cells can sometimes become cancerous. These are round cells located under the squamous cells in a layer of skin called the lower epidermis. Basal cell carcinoma is a type of non-melanoma skin cancer. Less than 2% of penile cancers are basal cell cancers.

  • Melanoma. The deepest layer of the epidermis contains scattered cells called melanocytes. These cells make the melanin that gives skin color. Melanoma starts in melanocytes. It is the most serious type of skin cancer. This cancer sometimes occurs on the surface of the penis. Learn more about melanoma.

  • Sarcoma. About 1% of penile cancers are sarcomas,. Sarcomas develop in the tissues that support and connect the body, such as blood vessels, muscle, and fat. Learn more about sarcoma.

This section covers cancer that begins in or on the penis. Learn about cancer that starts in the testicles in a separate section of this website.

The next section in this guide is Statistics. It helps explain how many men are diagnosed with this disease and general survival rates. Or, use the menu to choose another section to continue reading this guide.

Penile Cancer - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2016

ON THIS PAGE: You will find information about how many men are diagnosed with this type of cancer each year. You will also learn some general information on surviving the disease. Remember, survival rates depend on several factors. To see other pages, use the menu.

This year, an estimated 2,030 men in the United States will be diagnosed with penile cancer.

About 340 men will die from the disease.

Penile cancer is rare in the United States and makes up less than 1% of all cancer diagnosed in men. It is more common in some parts of Asia, Africa, and South America.

The 5-year survival rate tells you what percent of men live at least 5 years after the cancer is found. Percent means how many out of 100. The 5-year survival rate for men with penile cancer that has not spread when it is first diagnosed is about 85%. If the cancer has spread to surrounding tissues or organs and/or the regional lymph nodes, the 5-year survival rate is 59%. If the cancer has spread to a distant part of the body, the 5-year survival rate is 11%.

It is important to remember that statistics on how many men survive this type of cancer are an estimate. The estimate comes from data based on thousands of men with this cancer in the United States each year. So, your own risk may be different. Doctors cannot say for sure how long any man will live with penile cancer. Also, experts measure the survival statistics every 5 years. This means that the estimate may not show the results of better diagnosis or treatment available for less than 5 years. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publication, Cancer Facts and Figures 2016, and the ACS website.

The next section in this guide is Risk Factors and Prevention. It explains what factors may increase the chance of developing this disease. Or, use the menu to choose another section to continue reading this guide.

Penile Cancer - Risk Factors and Prevention

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2016

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer. To see other pages, use the menu.

A risk factor is anything that increases a man’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors can increase a man’s risk of developing penile cancer:

  • Human papillomavirus (HPV) infection. The most important risk factor for penile cancer is infection with this virus. Sexual activity with a person who has HPV is the most common way someone gets HPV. There are different types of HPV, called strains. Research links some HPV strains more strongly with certain types of cancers. You can reduce your risk of HPV infection by limiting your number of sex partners, because having many partners increases the risk of HPV infection. Using a condom cannot fully protect you from HPV during sex. There are vaccines available to protect you from some HPV strains.

  • Smoking. Smoking may contribute to the development of penile cancer, especially in men who are also infected with HPV.

  • Age. Penile cancer is most common in men older than 50. The average age that men in the United States are diagnosed with penile cancer is about 68 years. However, black and Hispanic men are more likely to be diagnosed earlier, at an average age of 60. In the United States, about 80% of men with penile cancer are at least 55 when diagnosed, whereas worldwide, about 20% of men diagnosed with penile cancer are younger than 40.

  • Smegma. Smegma is a thick substance that can build up under the foreskin and is caused by dead skin cells, bacteria, and oily secretions from the skin. Smegma may contain small amounts of cancer-causing substances. Uncircumcised men should pull back, or retract, the foreskin and thoroughly wash the penis on a regular basis. This is to make sure that smegma does not irritate the penis.

  • Phimosis. Phimosis occurs when the foreskin becomes tight and is difficult to retract. This causes smegma to build up more easily. Men with phimosis are less likely to be able to thoroughly clean the penis.

  • HIV/AIDS. Infection with human immunodeficiency virus (HIV), the virus that causes acquired immune deficiency syndrome (AIDS), is a risk factor for penile cancer. When a man is HIV-positive, their immune system is less able to fight off early-stage cancer.

  • Psoriasis treatment. Men who have received the drug psoralen combined with ultraviolet (UV) light have a higher risk of developing penile cancer.

Prevention

Different factors cause different types of cancer. Researchers continue to look into what factors cause this type of cancer. Although there is no proven way to completely prevent this disease, you may be able to lower your risk. Talk with your doctor for more information about your personal risk of cancer.

  • Circumcision. Circumcision may provide some protection from penile cancer because removing the foreskin helps keep the area clean. Epidermoid/squamous cell carcinoma of the penis almost never occurs in men who are circumcised. However, it is important to note that circumcision alone cannot prevent penile cancer.

  • Personal hygiene. Men who carefully and completely clean under the foreskin on a regular basis can lower their risk of developing penile cancer.

  • Lifestyle factors. Not smoking and avoiding sexual practices that could lead to an HPV or HIV/AIDS infection can help lower your risk of penile cancer.

The next section in this guide is Symptoms and Signs. It explains what body changes or medical problems this disease can cause. Or, use the menu to choose another section to continue reading this guide.

Penile Cancer - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2016

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu.

Men with penile cancer may experience the following symptoms or signs. Sometimes, men with penile cancer do not have any of these changes. Or, the cause of a symptom may be another medical condition that is not cancer.

  • A growth or sore on the penis, especially on the glans or foreskin, but cancer also occurs on the shaft

  • Changes in the color of the penis

  • Skin thickening on the penis

  • Persistent discharge with a foul odor beneath the foreskin

  • Blood coming from the tip of the penis or from under the foreskin

  • Unexplained pain in the shaft or tip of the penis

  • Irregular or growing bluish-brown flat lesions or marks beneath the foreskin or on the penis

  • Reddish, velvety rash beneath the foreskin

  • Small, crusty bumps beneath the foreskin

  • Swollen lymph nodes in the groin

  • Irregular swelling at the end of the penis

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Or, use the menu to choose another section to continue reading this guide.

Penile Cancer - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2016

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. To see other pages, use the menu.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know whether an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory.  If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

This list describes options for diagnosing this type of cancer, and not all tests listed will be used for every man. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and medical condition

  • The results of earlier medical tests

In addition to a physical examination, the following tests may be used to diagnose penile cancer:

  • Biopsy. If there is an unusual change on or in a man’s penis or nearby lymph nodes, a biopsy may be needed to learn more about the change. 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. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

If cancerous cells are seen in a tissue sample, then the biopsy is called positive for cancer. If no cancer is found, then the biopsy is called benign or negative for cancer. Sometimes, the pathologist cannot tell if the cells collected are cancerous, which means the biopsy is called indeterminate or non-diagnostic.

The following types of biopsies may be used for penile cancer:

    • A punch biopsy or elliptical excision may be used for an abnormal change that can be seen on the penis. In a punch biopsy, the doctor uses a sharp round surgical tool to remove a circular piece of tissue. In an elliptical excision, the doctor uses a scalpel or other tool to cut out a piece of tissue.

    • A fine needle aspiration is a specific type of biopsy. First, the skin is usually made numb with a topical medication that blocks the sensation of pain. Then, a medication is injected into the area near the tumor to prevent pain in tissues beneath the skin. The doctor will then insert a thin needle into the tumor and remove some cells and fluid. The procedure may be repeated 2 or 3 times to collect samples from different areas of the tumor.

    • A sentinel lymph node biopsy is a way to find out if cancer cells have spread to lymph nodes near the penis. In this technique, the doctor removes 1 or a few sentinel lymph nodes to check for cancer cells. Lymph nodes are the tiny, bean-shaped organs that help fight infection. They are connected to each other by tiny vessels called lymphatic vessels. Sentinel lymph nodes are the first lymph node(s) into which the lymph from the tumor drains. If there are multiple lymph vessels draining the area where the tumor is located, then there may be more than 1 sentinel node. For penile cancer, the sentinel lymph nodes are located just under the skin in the groin. If cancer cells are found in these lymph nodes, it means that the cancer is more likely to have spread to other nearby lymph nodes or to other parts of the body through the blood and lymph vessels. Even if cancer cells are not found during a sentinel lymph node biopsy, there is still a chance that 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, as well as long-lasting and possibly severe leg swelling, called lymphedema. Research to find ways to prevent these side effects is ongoing (see Latest Research). 

  • 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 3-dimensional picture of the inside of the body using x-rays taken from different angles. A computer then combines these images into a detailed, cross-sectional view that shows abnormalities or tumors. A CT scan can also be used to measure a tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill to swallow. 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. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow.

After 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.

The next section in this guide is Stages and Grades. It explains the system doctors use to describe the extent of the disease. Or, use the menu to choose another section to continue reading this guide.  

Penile Cancer - Stages and Grades

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2016

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. To see other pages, use the menu.

Grading and staging are ways of describing how fast-growing the cancer is and how much it has grown. This includes where the cancer is located and if or where it has spread. Doctors use diagnostic tests to find out the cancer's grade and stage. So, grading and staging may not be complete until all the tests are finished. Knowing the grade and stage helps the doctor to decide what kind of treatment is best and helps predict a patient's prognosis, which is the chance of recovery. A lower grade or stage cancer is associated with a better chance of recovery than a higher grade or stage cancer.

Grade (G)

One way doctors describe penile cancer is by grade (G). The grade describes how much the cancer cells look like healthy cells when viewed under a microscope. The doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together. If the cancer looks similar to healthy tissue and contains different cell groupings, it is called differentiated or a low-grade tumor. If the cancerous tissue looks very different from healthy tissue, it is called poorly differentiated or a high-grade tumor. The cancer’s grade may help the doctor predict how quickly the cancer will spread.

GX: The tumor grade cannot be identified.

G1: Describes cells that look more like healthy tissue cells, called well differentiated.

G2: The cells are somewhat different from healthy cells, called moderately differentiated.

G3: Describes tumor cells that look very much like each other, but do not look very much like healthy cells. This is called poorly differentiated.

G4: The tumor cells barely look like healthy cells, called undifferentiated.

TNM staging system

One tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located What is the grade of the tumor (see Grades above)?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?

  • Metastasis (M): Has the cancer metastasized to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each man. There are 5 stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer so doctors can work together to plan the best treatments.

Here are more details on each part of the TNM system for penile cancer:

Tumor (T)

Using the TNM system, the "T" plus a letter and/or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail. This helps the doctor develop the best treatment plan for each patient. Specific tumor stage information is listed below:

TX: The primary tumor cannot be evaluated.

T0: There is no tumor.

Tis: An early, noninvasive precancerous growth. This is also called carcinoma in situ.

Ta: The tumor is a noninvasive, wart-like carcinoma, which looks somewhat like a small piece of broccoli or cabbage.

T1a: The tumor has invaded into the subepithelial connective tissue, which is tissue below the top layers of skin. The tumor has not grown into blood or lymph vessels. The tumor grade (see above) is G2 or lower.

T1b: The tumor has grown into the subepithelial connective tissue. The tumor has grown into blood or lymph vessels. The tumor grade is G3 or higher.

T2: The tumor has grown into the corpus spongiosum or corpora cavernosum, which are internal chambers of the penis.

T3: The tumor has grown into the urethra.

T4: The tumor has grown into other nearby structures such as the pubic bone, the scrotum, or the prostate.

Node (N)

The “N” in the TNM staging system stands for lymph nodes near the cancer, called regional lymph nodes. The regional lymph nodes for penile cancer are located in the groin and the pelvis. Lymph nodes in other parts of the body are called distant lymph nodes. Staging places cancers that have spread to regional lymph nodes and cancers that have spread to distant lymph nodes in separate categories. The N in TNM staging only refers to the regional lymph nodes.

If the doctor evaluates the lymph nodes before the biopsy or surgery, based on a physical examination and/or other tests, the letter “c”, for “clinical” staging, is placed in front of the N. If the doctor evaluates the lymph nodes after a biopsy or surgical removal of the lymph nodes, which is more accurate, the letter “p”, for “pathologic” staging, is placed in front of the N. The information below describes the pathologic staging.

pNX: The regional lymph nodes cannot be evaluated.

pN0: Cancer has not spread to the regional lymph nodes.

pN1: Cancer has spread to 1 inguinal lymph node, which is the cluster of lymph nodes in the groin.

pN2: Cancer has spread to more than 1 inguinal lymph node on one or both sides of the body.

pN3: The cancer has spread to 1 or more inguinal, or groin, lymph nodes, and it has grown from that lymph node into the surrounding tissue in the groin, and/or the cancer has spread to lymph nodes in the pelvis, on one or both sides of the body.

Metastasis (M)

The “M” in the TNM system indicates whether the cancer has spread from the penis to other parts of the body, called distant metastasis.

MX: Distant metastasis cannot be evaluated.

M0: There is no distant metastasis.

M1: There is metastasis to parts of the body other than the penis and the regional lymph nodes.

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M classifications.

Stage 0: The cancer has not grown below the surface layer of skin. It has not spread to lymph nodes or distant parts of the body (Tis or Ta; N0, M0).

Stage I: A low-grade cancer that has grown just below the surface layer of skin. It has not spread to lymph nodes or distant parts of the body (T1a, N0, M0).

Stage II: The cancer is invasive and is high grade and/or has grown into blood or lymph vessels and/or into the internal chambers of the penis and/or the urethra. It has not spread to lymph nodes or distant parts of the body (T1b, T2, or T3; N0, M0).

Stage IIIa: The tumor does not extend beyond the penis and urethra and has spread to 1 groin lymph node, but it has not spread to distant parts of the body (T1, T2, or T3; N1, M0).

Stage IIIb: The tumor does not extend beyond the penis and urethra, and has spread to more than 1 groin lymph node. It has not spread to pelvic lymph nodes or distant parts of the body (T1, T2, or T3; N2, M0).

Stage IV: Any of the following:

  • The cancer has grown into nearby tissues such as the pubic bone, the scrotum, or the prostate (T4, any N, any M).

  • The cancer has spread to 1 or more lymph nodes in the groin, and it has grown from that lymph node into the surrounding tissue in the groin (any T, N3, M0).

  • The cancer has spread to at least 1 lymph node in the pelvis (any T, N3, M0) and/or to distant lymph nodes outside the pelvis or to other parts of the body (any T, any N, M1).

Recurrent: Recurrent cancer is cancer that has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition published by Springer-Verlag New York, www.cancerstaging.net.

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Or, use the menu to choose another section to continue reading this guide.

Penile Cancer - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2016

ON THIS PAGE: You will learn about the different ways doctors use to treat men with this type of cancer. To see other pages, use the menu.

This section tells you the treatments that are the standard of care for this type of cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn if it is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Your doctor can help you consider all your treatment options. To learn more about clinical trials, see the About Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. For penile cancer, this team often includes a surgeon, a doctor called a urologist who specializes in urinary tract problems, a medical oncologist, and a radiation oncologist. Cancer care teams also include a variety of other health care professionals, including physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Descriptions of these common treatment options are listed below. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. The most common treatment options for penile cancer include surgery, radiation therapy, and chemotherapy.

Men with penile cancer may have concerns whether their treatment could affect their sexual function and fertility. These topics should be discussed with their doctor before treatment begins. Sometimes, more than a single treatment option is available.

Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue, called a margin, during an operation. A surgical oncologist is a doctor who specializes in treating cancer using surgery. The surgical oncologists who treat penile cancer are usually urologists who have special training in cancer surgery.

Surgery for penile cancer is usually done while a patient receives local or general anesthesia, depending on the patient’s preference and the doctor’s recommendations. Local anesthesia is injected in the area where the surgery is being done. General anesthesia makes a person unconscious and blocks any pain during surgery, leaving little or no awareness or memory of the procedure. The types of surgery that may be used for penile cancer are described below.

  • Laser therapy. Laser therapy is the use of a very powerful beam of light to destroy cancer cells. Laser therapy may be an option for some men with early-stage penile cancer, including:

    A disadvantage of laser therapy is that it can be difficult for the doctor to determine how far the cancer has spread.

    • Cryosurgery. Cryosurgery, also called cryotherapy or cryoablation, uses liquid nitrogen to freeze and kill cells. The skin will later blister and peel. This procedure will sometimes leave a pale scar. More than 1 freezing may be needed.

    • Circumcision. Circumcision (see Risk Factors) is generally used if the cancer is only on the foreskin.

    • Excision. An excision is a removal of the tumor and some surrounding healthy tissue using a scalpel or other surgical tool. Sometimes the surgeon may remove a larger area of healthy tissue around the tumor to make sure that all the cancer is removed. Sometimes, a skin graft is needed to cover the area where the skin was removed. A skin graft uses skin from another part of the body to close the wound and reduce scarring.

    • Mohs surgery. This technique is used to remove the cancer that can be seen on the surface of the penis. In addition to the tumor, a small amount of healthy tissue around the edge is removed to make sure that no cancer is left behind. During the procedure, each small piece of tissue is examined under a microscope until all of the cancer is removed. This is most often used for small tumors that are only on the surface of the penis. This procedure can be more expensive than an excision.

    • Penectomy. This is the surgical removal of part or all of the penis. It is the most common and effective procedure to treat penile cancer that has grown inside of the penis. Because this is disfiguring surgery, it is important to determine whether it is needed or if removing only the tumor is possible. If a penectomy is needed to treat the cancer effectively, a partial rather than total penectomy is a better option if the cancerous tissue and a 2 cm margin of healthy tissue can be removed while leaving enough length of the penis for the patient to urinate naturally. When this is not possible, a total penectomy is performed, which is the removal of the entire penis. The surgeon will tunnel the urinary tract underneath the scrotum, requiring the patient to urinate in a sitting position.

    • Lymph node dissection. Removal of the lymph nodes in the groin and/or pelvis is often performed to find out the stage (see Diagnosis) or to treat penile cancer. This is done even if there are no signs that the cancer has spread to the lymph nodes. If the groin lymph nodes are larger before surgery, then surgery to remove these lymph nodes is generally more extensive. While removing groin lymph nodes on both sides is common, removing deeper lymph nodes in the pelvis is generally only done if cancer is found in groin lymph nodes. Removing the lymph nodes when the cancer has spread to the lymph nodes but not anywhere else can get rid of the cancer and lymph node surgery can increase the likelihood of cure. However, when the lymph nodes in both the groin and the pelvis are removed on the same side of the body, there is often severe swelling called lymphedema in the leg on that side of the body. This can cause discomfort and infections that often come back. When making such a treatment decision, you and your doctor should carefully weigh the benefits of removing any cancer that may have spread to lymph nodes with the risk of side effects from the surgery.

    Overall, the possible side effects of surgery depend on the stage of disease and the type of procedure, among other factors. Talk with your surgeon beforehand about the possible side effects and your recovery period.

    Learn more about the basics of cancer surgery.

    Radiation therapy

    Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy.

    A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. For penile cancer, radiation therapy can be focused on the tumor in the penis and/or directed at the lymph nodes in the groin and sometimes the pelvis to destroy any cancer cells that have spread there.

    Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. In addition, radiation therapy can increase the risk of developing other cancers in the future. If radiation therapy is focused on the groin, there is a risk of lymphedema in the leg(s) because of damage to the lymphatic channels that drain fluid from the legs. Most side effects go away soon after treatment is finished, although lymphedema can be an ongoing condition.

    Learn more about the basics of radiation therapy.

    Chemotherapy

    Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication.

    A chemotherapy regimen, or schedule, usually consists of a specific number of cycles of treatment given over a set period of time. For example, a treatment cycle may last 3 weeks and the treatment plan may be made up of 4 cycles of 3 weeks each, which is 12 weeks total.

    There are 2 types of chemotherapy that may be used for penile cancer: topical chemotherapy and systemic chemotherapy.

    Topical chemotherapy

    For small noninvasive cancers, or “carcinoma in situ,” lower doses of chemotherapy can be used on the surface of the skin. Such drugs include fluorouracil (Efudex, Fluoroplex ) or imiquimod (Aldara).

    Systemic chemotherapy

    Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

    Chemotherapy may be given before surgery when the doctor is concerned that the tumor in the penis may be too large to be completely removed with surgery or has spread to the regional lymph nodes. Then, chemotherapy may be used to shrink a tumor so it can be completely removed. Penile cancer that cannot be removed with surgery is sometimes treated with a combination of chemotherapy and radiation therapy. If the cancer has not spread beyond the pelvis, chemotherapy and/or radiation therapy may be given to destroy enough of the cancer to make surgery is possible. Chemotherapy is also used for penile cancer that has spread to other parts of the body (see Metastatic penile cancer, below).

    Common systemic drugs for penile cancer include:

    • Bleomycin (Blenoxane)

    • Cisplatin (Platinol)

    • Docetaxel (Docefrez, Taxotere)

    • Gemcitabine (Gemzar)

    • Ifosfamide (Ifex)

    • Methotrexate (multiple brand names)

    • Paclitaxel (Taxol)

    Not all of these drugs are readily available for men with penile cancer. They may only be available as part of a clinical trial. Because penile cancer is uncommon, there is not as much published information on systemic chemotherapy for penile cancer as for many other cancers. There is no clear evidence that chemotherapy for penile cancer helps men live longer or improves their quality of life. Therefore, the decision to use systemic chemotherapy for penile cancer is not simple. When chemotherapy is used, there is general agreement among cancer specialists that drug combinations that include cisplatin and involve 2 or 3 drugs work better than a single drug, but this has not been proven in clinical trials.

    The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, mouth sores, hair loss, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished. Chemotherapy may also increase the risk of cardiovascular disease and of other cancers in the future.

    Learn more about the basics of chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

    Getting care for symptoms and side effects

    Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

    Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process. People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

    Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as surgery, radiation therapy, or chemotherapy. Talk with your doctor about the goals of each treatment in your treatment plan.

    Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible. Learn more about palliative care.

    Metastatic penile cancer

    If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Also, clinical trials might be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your treatment plan chosen.

    Metastatic penile cancer is generally incurable, but there are treatments that can help relieve symptoms to make a man more comfortable and lengthen his life. Your treatment plan may include a combination of surgery, radiation therapy, and chemotherapy. Chemotherapy for penile cancer that has spread to other parts of the body is used to shrink the cancer and prevent it from growing or spreading for as long as possible. Palliative care will also be important to help relieve symptoms and side effects.

    For most men, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

    Remission and the chance of recurrence

    A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called “no evidence of disease” or NED.

    A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence

    If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place, called a local recurrence, nearby, called a regional recurrence, or in another place, called a distant recurrence. The risk of recurrence depends on several factors, including the type of penile cancer and how much the cancer has grown and spread.

    When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the therapies described above such as surgery, radiation therapy, and chemotherapy, but they may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

    People with recurrent cancer often experience emotions such as despair, disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

    If treatment fails

    Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

    This diagnosis is stressful, and advanced cancer is difficult to discuss for most people. It is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns so that they can provide care that is consistent with your wishes. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

    Patients who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life by addressing both physical discomfort and emotional distress. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

    After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

    The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Or, use the menu to choose another section to continue reading this guide.

    Penile Cancer - About Clinical Trials

    This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2016

    ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu.

    What are clinical trials?

    Doctors and scientists are always looking for better ways to care for patients with penile cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the U.S. Food and Drug Administration (FDA) was tested in clinical trials.

    Many clinical trials focus on new treatments. Researchers want to learn if a new treatment is safe, effective, and possibly better than the treatment doctors use now. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there is no guarantee that the new treatment will be safe, effective, or better than what doctors use now.

    Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects. There are also clinical trials studying ways to prevent cancer.

    Deciding to join a clinical trial

    Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating penile cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with penile cancer.

    Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” However, placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

    Patient safety and informed consent

    To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

    Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends.

    Finding a clinical trial

    Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for penile cancer, learn more in the Latest Research section.

    Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

    In addition, this website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

    The next section in this guide is Latest Research. It explains areas of scientific research currently going on for this type of cancer. Or, use the menu to choose another section to continue reading this guide.

    Penile Cancer - Latest Research

    This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2016

    ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of cancer and how to treat it. To see other pages, use the menu.

    Doctors are working to learn more about penile cancer, ways to prevent it, how to best treat it, and how to provide the best care to men diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

    • Immunotherapy. Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. Learn more about the basics of immunotherapy.
    • Targeted therapy.Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting the damage to healthy cells.

      Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. As a result, doctors can better match each patient with the most effective treatment whenever possible. In addition, many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments.

      Clinical trials are being done using drugs that block the epidermal growth factor receptor, EGFR, a protein that helps cancer cells grow and multiply. Researchers have found that drugs that block EGFR may be effective for stopping or slowing the growth of penile cancer.

    • Radiation therapy. Researchers are working to find the best way to use radiation therapy for penile cancer. This could include a combination of therapies, including radiation therapy and chemotherapy, in an effort to avoid surgery to remove the penis. Improved techniques use CT scans to plan treatment, which may help find the dose that best treats the cancer while causing fewer side effects.

    • Radiosensitizers. In addition, researchers are looking at the use of radiosensitizers in the treatment of penile cancer. Radiosensitizers are drugs that make tumor cells more sensitive to radiation therapy, which makes radiation therapy more effective.

    • Combination therapy. Researchers are studying whether the combination of chemotherapy and radiation therapy better reduces the risk of recurrence and/or increases survival than standard treatments.

    • Minimally invasive surgery. Minimally invasive surgery uses small incisions and a camera placed under the skin to perform a lymph node dissection to find out if the cancer has spread. Researchers are also studying endoscopic, or use of a thin, lighted flexible tube, and robotically-assisted surgery to diagnose and remove penile cancer that may have spread to regional lymph nodes.

    • Palliative care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current penile cancer treatments to improve patients’ comfort and quality of life.

    Looking for More About the Latest Research?

    If you would like additional information about the latest areas of research regarding penile cancer, explore this related item that takes you outside of this guide:

    The next section in this guide is Coping with Treatment. It offers some guidance in how to cope with the physical, emotional, and social changes that cancer and its treatment can bring. Or, use the menu to choose another section to continue reading this guide.

    Penile Cancer - Coping with Treatment

    This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2016

    ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu.

    Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, men don’t all experience the same side effects even when given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment. As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. Doctors call this part of cancer treatment “palliative care.” It is an important part of your treatment plan, regardless of your age or the stage of disease.

    Coping with physical side effects

    Common physical side effects from each treatment option for penile cancer are described within the Treatment Options section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the cancer’s stage, the length and dose of treatment, and your general health.

    Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

    Coping with emotional and social effects

    You can have emotional and social effects as well as physical effects after a cancer diagnosis. This may include dealing with difficult emotions, such as anxiety or anger, or managing your stress level. Sometimes, patients have problems expressing how they feel to their loved ones, or people don’t know what to say in return.

    Men and their families are encouraged to share their feelings with a member of their health care team. You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

    Coping with financial effects

    Cancer treatment can be expensive. It is often a big source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost stops them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Learn more about managing financial considerations, in a separate part of this website.

    Caring for a loved one with cancer

    Family members and friends often play an important role in taking care of a man with penile cancer. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away.

    Caregivers may have a range of responsibilities on a daily or as-needed basis. Below are some of the responsibilities caregivers take care of:

    • Providing support and encouragement

    • Giving medications

    • Helping manage symptoms and side effects

    • Coordinating medical appointments

    • Providing a ride to appointments

    • Assisting with meals

    • Helping with household chores

    • Handling insurance and billing issues

    Learn more about caregiving.

    Talking with your health care team about side effects

    Before starting treatment, talk with your doctor about possible side effects. Ask:

    • Which side effects are most likely?

    • When are they are likely to happen?

    • What can we do to prevent or relieve them?

    Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you don’t think the side effects are serious. This discussion should include physical, emotional, and social effects of cancer.

    Also, ask how much care you may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan.

    The next section in this guide is Follow-up Care. It explains the importance of check-ups after cancer treatment is finished. Or, use the menu to choose another section to continue reading this guide.

    Penile Cancer - Follow-up Care

    This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2016

    ON THIS PAGE: You will read about your medical care after cancer treatment is completed, and why this follow-up care is important. To see other pages, use the menu.

    Care for men diagnosed with cancer doesn’t end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not returned, manage any side effects, and monitor your overall health. This is called follow-up care.

    Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead.

    Currently, there is no proven way to lower the chances of recurrence or a another type of cancer, but it is wise to practice safe, meaning protected, sex and proper hygiene after treatment for penile cancer.

    Learn more about the importance of follow-up care.

    Watching for recurrence

    One goal of follow-up care is to check for a recurrence. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will also ask specific questions about your health. Some men may have blood tests or imaging tests as part of regular follow-up care, but testing recommendations depend on several factors including the type and stage of cancer originally diagnosed and the types of treatment given.

    For men recovering from penile cancer follow-up care may include specific examinations of the penis and the lymph nodes in the groin. Depending on the risk of the cancer recurring, a man may need occasional chest x-rays or CT scans, as well as some blood tests.

    Managing long-term and late side effects

    Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. In addition, other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

    Talk with your doctor about your risk of developing such side effects based on the type of cancer, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may also have certain physical examinations, scans, or blood tests to help find and manage them.

    Keeping personal health records

    You and your doctor should work together to develop a personalized follow-up care plan. Be sure to ask about any concerns you have about your future physical or emotional health. ASCO offers forms to help create a treatment summary to keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

    This is also a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the general care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

    If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with him or her, as well as all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

    The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Or, use the menu to choose another section to continue reading this guide.

    Penile Cancer - Survivorship

    This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2016

    ON THIS PAGE: You will read about how to cope with challenges in everyday life after a cancer diagnosis. To see other pages, use the menu.

    What is survivorship?

    The word “survivorship” means different things to different people. Common definitions include:

    • Having no signs of cancer after finishing treatment.

    • Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to have treatment over the long term, to either reduce the risk of recurrence or to manage chronic disease.

    Survivorship is one of the most complicated parts of having cancer. This is because it is different for everyone.

    Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain of how to cope with everyday life.

    Survivors may feel some stress when frequent visits to the health care team end following treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true as new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexuality and fertility concerns, and financial and workplace issues.

    Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

    • Understanding the challenge you are facing,

    • Thinking through solutions,

    • Asking for and allowing the support of others, and

    • Feeling comfortable with the course of action you choose.

    Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the center where you received treatment.

    Changing role of caregivers

    Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a man diagnosed with penile cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

    However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving in this article.

    A new perspective on your health

    For many people, survivorship serves as a strong motivator to make positive lifestyle changes.

    Men recovering from penile cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

    In addition, it is important to have recommended medical check-ups and tests (see Follow-up Care) to take care of your health. Cancer rehabilitation may also be recommended, and this could mean any of a wide range of services such as physical therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible.

    Talk with your doctor to develop a survivorship care plan that is best for your needs.

    Looking for More Survivorship Resources?

    For more information about cancer survivorship, explore these related items. Please note these links will take you to other sections of Cancer.Net:

    • ASCO Answers Cancer Survivorship Guide: Get this 44-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The booklet is available as a PDF, so it is easy to print out.

    • Cancer.Net Patient Education Video: View a short video led by an ASCO expert that provides information about what comes next after finishing treatment.

    • Survivorship Resources: Cancer.Net offers an entire area of this website with resources to help survivors, including for survivors in different age groups.

    The next section offers Questions to Ask the Doctor to help start conversations with your cancer care team. Or, use the menu to choose another section to continue reading this guide.

    Penile Cancer - Questions to Ask the Doctor

    This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2016

    ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu on the side of your screen.

    Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

    Questions to ask after getting a diagnosis

    • What type of penile cancer do I have?

    • What is the stage and grade of the cancer? What does this mean?

    • Can you explain my pathology report (laboratory test results) to me?

    Questions to ask about choosing a treatment and managing side effects

    • What treatment options do I have?

    • What clinical trials are available for me? Where are they located, and how do I find out more about them?

    • What treatment plan do you recommend? Why?

    • Do I need treatment right away?

    • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

    • Could I benefit from a second opinion? Why or why not?

    • Who will be part of my health care team, and what does each member do?

    • Who will be leading my overall treatment?

    • What are the possible side effects of this treatment, both in the short term and the long term?

    • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

    • Will this treatment change how I urinate?

    • Could this treatment affect my sex life? If so, how and for how long?

    • Could this treatment affect my ability to have children? If so, should I talk with a fertility specialist before cancer treatment begins?

    • Should I see a psychologist, counselor, or other professional to help me deal with any fear and body image concerns?

    • If I’m worried about managing the costs of cancer care, who can help me?

    • Whom should I call for questions or problems?

    • What support services are available to me? To my family?

    • Is there anything else I should be asking?

    Questions to ask about having surgery

    • What type of surgery will I have? Will lymph nodes be removed?

    • Will the lymph nodes in my groin be removed? On 1 side or both?

    • How long will the operation take?

    • How long will I be in the hospital?

    • Can you describe what my recovery from surgery will be like?

    • What are the possible long-term effects of having this surgery?

    • When should I call your office or go to an emergency room?

    • Do I have options other than surgery?

    Questions to ask about having radiation therapy or laser therapy

    • What type of treatment is recommended?

    • What is the goal of this treatment?

    • How long will it take to give this treatment?

    • What side effects can I expect during treatment?

    • What are the possible long-term effects of having this treatment?

    • What can be done to relieve the side effects?

    • When should I call your office or go to an emergency room?

    • Do I have other options for treatment?

    Questions to ask about having chemotherapy or immunotherapy

    • What type of treatment is recommended?

    • What is the goal of this treatment?

    • How long will it take to give this treatment?

    • What side effects can I expect during treatment?

    • What are the possible long-term effects of having this treatment?

    • What can be done to relieve the side effects?

    • When should I call your office or go to an emergency room?

    • How likely is this therapy to be successful? Are there other options?

    Questions to ask about planning follow-up care

    • What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

    • What long-term side effects or late effects are possible based on the cancer treatment I received?

    • What follow-up tests will I need, and how often will I need them?

    • How do I get a treatment summary and survivorship care plan to keep in my personal records?

    • Who will be leading my follow-up care?

    • What survivorship support services are available to me? To my family?

    The next section in this guide is Additional Resources. It offers some more resources on this website beyond this guide that may be helpful to you. Or, use the menu to choose another section to continue reading this guide.

    Penile Cancer - Additional Resources

    This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2016

    ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Penile Cancer. To go back and review other pages, use the menu on the side of your screen.

    Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond. Here are a few sections that may get you started in exploring the rest of Cancer.Net:

    This is the end of Cancer.Net’s Guide to Penile Cancer. Use the menu to select another section to continue reading this guide.