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Penile Cancer - Overview

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2013

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 on the side of your screen. 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 three chambers of spongy tissue that contain smooth muscle and many blood vessels and nerves. The corpora cavernosa makes up two 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 normal cells change and grow uncontrollably, forming a mass called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous, meaning it can spread to other parts of the body). Penile cancer is a rare form of cancer that occurs mostly in uncircumcised men (men who have a foreskin, the piece of skin 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 looked at with a microscope. Squamous cell carcinoma can begin anywhere on the penis; however, it usually develops on or under the foreskin. When found at an early stage, epidermoid carcinoma can usually be cured.

Basal cell carcinoma. Under the squamous cells in the lower epidermis (one of the layers of the skin tissues that cover the penis) are round cells called basal cells. These can sometimes become cancerous. 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, which make the melanin that gives skin color. Melanoma starts in melanocytes, and it is the most serious type of the skin cancer. This cancer sometimes occurs on the surface of the penis. Learn more about melanoma.

Sarcoma. About 1% of penile cancers are sarcomas, which are cancers that 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.

To continue reading this guide, use the menu on the side of your screen to select another section.

Penile Cancer - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2013

ON THIS PAGE: You will find information about how many men learn they have this type of cancer each year and some general survival information. Remember, survival rates depend on several factors. To see other pages, use the menu on the side of your screen.

This year, an estimated 1,640 men in the United States will be diagnosed with penile cancer. An estimated 320 deaths from the disease will occur this year. Penile cancer is more common in some parts of Asia, Africa, and South America, where it accounts for up to 10% of cancers in men, than in the United States.

The five-year survival rate is the percentage of people who survive at least five years after the cancer is detected, excluding those who die from other diseases. The five-year survival rate of men with penile cancer that has not spread at the time of diagnosis is about 85%. If the cancer has spread near the penis (local spread), the five-year survival rate is 59%. If the cancer has spread to other parts of the body (distant spread), the five-year survival rate is 11%.

Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of men with this type of cancer, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he will live with penile cancer. Because the survival statistics are measured in five-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's publication, Cancer Facts and Figures 2014.

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Penile Cancer - Risk Factors and Prevention

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2013

ON THIS PAGE:  You will find out more about what factors increase the chance of this type of cancer. To see other pages, use the menu on the side of your screen.

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 person’s risk of developing penile cancer:

Human papillomavirus (HPV) infection. The most important risk factor for penile cancer is infection with this virus. HPV is most commonly passed from person to person during sexual activity. There are different types, or strains, of HPV, and some strains are more strongly associated 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. HPV vaccines protect against certain strains of the virus.

Smoking. Smoking may contribute to the development of penile cancer, especially in men who are also infected with HPV. Learn more about quitting smoking.

Age. Penile cancer is most common in men older than 50. About 20% of the time, patients 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 (retract) the foreskin and thoroughly wash the penis on a regular basis to make sure that smegma does not cause irritation of the penis.

Phimosis. Phimosis occurs when the foreskin becomes tight or constricted and is difficult to retract, therefore causing a buildup of smegma. Men with phimosis are less likely to be able to thoroughly clean the penis.

HIV/AIDS infection. Infection with human immunodeficiency virus (HIV), the virus that causes acquired immune deficiency syndrome (AIDS), is a risk factor for penile cancer. When a person 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

Research continues to look into what factors cause this type of cancer and what men can do to lower their personal risk. There is no proven way to completely prevent this disease, but there may be steps you can take to lower your cancer risk.

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.

In addition, not smoking and avoiding sexual practices that could lead to an HPV or HIV/AIDS infection can help lower your risk of penile cancer. Talk with your doctor if you have concerns about your personal risk of developing penile cancer.

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Penile Cancer - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2013

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 on the side of your screen.

Men with penile cancer may experience the following symptoms or signs. Sometimes, men with penile cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom or sign on this list, please talk with your doctor.

  • A growth or sore on the penis, especially on the glans or foreskin, although it can also occur 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

Your doctor will ask you questions about the symptoms you are experiencing to help find out the cause of the problem, called a diagnosis. This may include how long you’ve been experiencing the symptom(s) and how often.

If cancer is diagnosed, relieving symptoms and side effects 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 helps explain what tests and scans may be needed to learn more about the cause of the symptoms. Use the menu on the side of your screen to select Diagnosis, or you can select another section, to continue reading this guide.  

Penile Cancer - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2013

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages, use the menu on the side of your screen.

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

  • Age and medical condition
  • Type of cancer suspected
  • Signs and 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 during the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease).

  • 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).
  • A sentinel lymph node biopsy is a way to find out 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 found in these lymph nodes, it means that it is more likely that cancer has spread to other lymph nodes in the region 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 lymphedema (leg swelling). Research to find ways to prevent these side effects is ongoing. Visit the Latest 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. A CT scan can also be used to measure a tumor’s size. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein or given orally (by mouth) 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 or given orally 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 lengthen men’s lives or otherwise provide any benefit for men with penile cancer.

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.

The next section helps explain the different stages for this type of cancer. Use the menu on the side of your screen to select Stages, or you can select 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, 07/2013

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 on the side of your screen.

Grading and staging are ways of describing how fast-growing the cancer is and how much it has grown, including where the cancer is located and if or where it has spread. Doctors use diagnostic tests to determine 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 (chance of recovery).

Grades

Histologic grade describes how different the cancer cells look from normal cells when viewed with a microscope. A tumor's grade is described using the letter “G” and a number. Grade is important because it helps to predict the likelihood that the cancer may spread quickly. In general, a man with a lower grade tumor has a better prognosis.

GX: The tumor grade cannot be identified.

G1: Describes cells that look more like normal tissue cells (called well differentiated).

G2: The cells are somewhat different from normal cells (called moderately differentiated).

G3: Describes tumor cells that look very much like each other, but do not look very much like normal cells (called poorly differentiated).

G4: The tumor cells barely look like normal cells (called undifferentiated).

Stages

There are different stage descriptions for different types of cancer. One tool that doctors use to describe the stage is the TNM system. TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:

  • How large is the primary tumor, where is it located, and what is the grade of the tumor (see Grades above)? (Tumor, T)
  • Has the tumor spread to the lymph nodes near the tumor? (Node, N)
  • Has the cancer metastasized (spread) to other parts of the body? (Metastasis, M)

The results are combined to determine the stage of cancer for each person. There are five 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. 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 cancer that has not spread to other tissue. This is also called carcinoma in situ.

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

T1a: The tumor has grown into the subepithelial connective tissue (tissue below the top layers of skin). The tumor has not grown into blood or lymph vessels, and 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, and/or the tumor grading is G3 or higher.

T2: The tumor has grown into the corpus spongiosum or corpora cavernosum (internal chambers of the penis).

T3: The tumor has grown into the urethra.

T4: The tumor has grown into other nearby structures.

Node. 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 one inguinal lymph node (lymph node in the groin).

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

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

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

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 superficial (surface) layer of skin, and 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 superficial 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 cancer has grown no further than the urethra, and has spread to one groin lymph node, but has not spread to distant parts of the body (T1, T2, or T3; N1, M0).

Stage IIIb: The cancer has grown no further than the urethra, and has spread to more than one groin lymph node, but 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 (T4, any N, any M).
  • The cancer has spread to one or more inguinal (groin) lymph nodes, and it has grown from that lymph node into the surrounding tissue in the groin (any T, N3, any M).
  • The cancer has spread to at least one lymph node in the pelvis (any T, N3, any M) 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 there is a recurrence, the cancer may need to be staged again (called re-staging) using the system above.

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 (2010) published by Springer-Verlag New York, www.cancerstaging.net.

Information about the cancer’s stage will help the doctor recommend a treatment plan.  The next section helps explain the treatment options for this type of cancer. Use the menu on the side of your screen to select Treatment Options, or you can select another section, to continue reading this guide.

Penile Cancer - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2013

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 on the side of your screen.

This section outlines treatments that are the standard of care (the best proven treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Your doctor can help you review all treatment options. For more information, visit the 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 urologist (a doctor who specializes in urinary tract problems), a medical oncologist, and a radiation oncologist.

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. The most common treatment options for penile cancer include surgery, radiation therapy, and chemotherapy. Laser therapy is also used for early-stage cancers.

Men with penile cancer may have concerns about if and how their treatment could affect their sexual function and fertility, and these topics should be discussed with their doctor before treatment begins. Sometimes, more than one treatment option is available.

Take time to learn about 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 usually involves the removal of the tumor and surrounding 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. The various types of surgery are performed under 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.

Mohs surgery. This technique is used to remove the cancer that can be seen on the surface of the penis, in addition to a small amount of normal tissue around the edge 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.

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 one freezing may be needed.

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

Penectomy. The surgical removal of part or all of the penis is the most common and effective procedure to treat penile cancer that has grown into the inside of the penis. A partial penectomy is usually performed when the cancerous tissue and 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 determine the stage (see Diagnosis) or to treat penile cancer. Removing the lymph nodes when the cancer has spread to the lymph nodes but not anywhere else can get rid of the cancer. 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 in the leg, called lymphedema, 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.

Learn more about cancer surgery.

Laser therapy

Laser therapy is the use of a very powerful beam of light to kill cancer cells. Laser therapy may be an option for some men with early-stage penile cancer, specifically men with Tis and small T1 squamous cell carcinoma of the penis, and for men with small T2 tumors who do not wish to have surgery. (Visit the Stages section for more information.) A disadvantage of laser therapy is that it can be difficult for the doctor to determine how far the cancer has spread.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to kill 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 (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 to kill any cancer cells that have spread there.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. If radiation therapy is focused on the groin, there is a risk of causing fluid buildup and swelling (called edema) of the leg(s) because of damage to the lymphatic channels that drain fluid from the legs, a condition called lymphedema. Most side effects go away soon after treatment is finished, although lymphedema can be a chronic (ongoing) condition.

Learn more about radiation therapy.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body.  It is usually given intravenously (IV; in a vein) but some chemotherapy is taken orally (by pill). Topical chemotherapy is cream that is placed directly on the skin. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. A patient may receive one drug at a time or combinations of different drugs at the same time. A chemotherapy regimen (schedule) usually consists of a specific number of cycles of treatment given over a set period of time. For example, a cycle of treatment may last three weeks and the treatment plan may be made up of four cycles, which is 12 weeks (four 3-week cycles) from the beginning to the end of the treatment plan.

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 kill enough of the cancer to make surgery possible. Chemotherapy is also used for penile cancer that has spread to other parts of the body (see Metastatic penile cancer, below).

Chemotherapy drugs that may be used for penile cancer include bleomycin (Blenoxane), methotrexate (multiple brand names), cisplatin (Platinol), gemcitabine (Gemzar), ifosfamide (Ifex), and paclitaxel (Abraxane, Taxol) or docetaxel (Docefrez, Taxotere). It should be noted that not all of these drugs are readily available for penile cancer, and they may only be available as part of a clinical trial. Because penile cancer is uncommon, there is not as much published information on chemotherapy for penile cancer than for other cancers. There is no clear evidence that chemotherapy for penile cancer helps men live longer or improve their quality of life. Therefore, the decision to use 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 two or three 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.

Learn more about 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 can help a person at any stage of illness. 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, and other therapies. You may also receive palliative treatments similar to those meant to elimination the cancer, such as surgery, radiation therapy, and 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 supportive 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 is addressed as quickly as possible. Learn more about palliative care.

Recurrent penile cancer

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 can be temporary or permanent. This uncertainty leads to many survivors feeling worried or anxious 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 the 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 (regional recurrence), or in another place (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, including whether the cancer’s stage and grade have changed. 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.

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.

Metastatic penile cancer

If cancer has spread to another location in the body, it is called metastatic cancer. 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. Men with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about seeking a second opinion before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include clinical trials.

Your health care team may recommend a treatment plan that includes a combination of the treatments discussed above. 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. Supportive 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.

If treatment fails

Recovery from cancer is not always possible. If the cancer is metastatic or if treatment is not successful, the disease may be called advanced or terminal cancer.

This diagnosis is stressful, and this is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. 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 six months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. 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 bereavement.

The next section helps explain clinical trials, which are research studies. Use the menu on the side of your screen to select About Clinical Trials, or you can select 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, 07/2013

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 on the side of your screen.

Doctors and scientists are always looking for better ways to treat patients with penile cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials.

Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. 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 are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

There are also clinical trials that study new ways to ease symptoms and side effects during treatment and manage the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease.

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, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill”. The use of placebos in cancer clinical trials is rare. 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.

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.

For specific topics being studied for penile cancer, learn more in the Latest Research section.

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.

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.

The next section helps explain the areas of research going on today about this type of cancer. Use the menu on the side of your screen to select Latest Research, or you can select another section, to continue reading this guide.

Penile Cancer - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2013

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 on the side of your screen.

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. Imiquimod (Aldara) is an immunotherapy cream that is being researched for use on the skin of the penis for early-stage cancer. Learn more about 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 normal 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 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 (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.

Supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current penile cancer treatments in order 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 addresses how to cope with the symptoms of the disease or the side effects of its treatment. Use the menu on the side of your screen to select Coping with Side Effects, or you can select another section, to continue reading this guide.

Penile Cancer - Coping with Side Effects

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2013

ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu on the side of your screen.

Fear of treatment side effects is common after a diagnosis of cancer, but it may help to know that preventing and controlling side effects is a major focus of your health care team. This is called palliative or supportive care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

Common side effects from each treatment option for penile cancer are described in detail within the Treatment section. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Side effects depend on a variety of factors, including the cancer’s stage, the length and dosage of treatment(s), and your overall health.

Before treatment begins, talk with your doctor about possible side effects of each type of treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them. And, ask about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a man with penile cancer. Learn more about caregiving.

In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies. Learn more about the importance of addressing such needs, including concerns about managing the cost of your cancer care

During and after treatment, be sure to tell the health care team about the side effects you experience, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care. Learn more by reading the After Treatment section or talking with your doctor.

The next section helps explain medical tests and check-ups needed after finishing cancer treatment. Use the menu on the side of your screen to select After Treatment, or you can select another section, to continue reading this guide.

Penile Cancer - After Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2013

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

After treatment for penile cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations, such as specific examination of the penis and the lymph nodes in the groin, and/or other medical tests to monitor your recovery for the coming months and years. 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. ASCO offers cancer treatment summary forms to help keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

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

Men recovering from penile cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based on your needs, physical abilities, and fitness level. Learn more about the next steps to take in survivorship, including making positive lifestyle changes.

The next section offers a list of questions you may want to ask. Use the menu on the side of your screen to select Questions to Ask the Doctor, or you can select 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, 07/2013

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.

General questions:

  • 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?
  • What treatment options do I have?
  • What clinical trials are open to me?
  • 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 coordinating my overall treatment and follow-up care?
  • 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 related to my cancer care, who can help me with these concerns?
  • Whom should I call for questions or problems?

For people who need surgery:

  • Will I need to stay in the hospital for this surgery? For how long?
  • What are the common side effects of this surgery?
  • Do I have options other than surgery?

For people who need radiation therapy or laser therapy:

  • What type of therapy am I getting?
  • How can I prepare for this treatment?
  • What side effects can I expect from this treatment, and how can they be managed?
  • Do I have other options for treatment?

For people who need chemotherapy or immunotherapy:

  • What type of drugs will I receive?
  • How do I prepare for this treatment?
  • What side effects can I expect from this treatment, and how can they be managed?
  • How likely is this therapy to be successful? Are there other options?

After treatment:

  • What are the chances that the cancer will return?
  • What follow-up tests do I need, and how often do I need them?
  • What support services are available to me? To my family?

The next section offers some more resources that may be helpful to you. Use the menu on the side of your screen to select Additional Resources, or you can select another section, to continue reading this guide.

Penile Cancer - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2013

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 on the side of your screen to select another section to continue reading this guide.