3757ea7105daa010VgnVCM100000ed730ad1RCRDapproved/patient/Cancer Types/Cancer Type DocumentsPenile Cancer2008-03-17T17:00:00Z

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Penile Cancer

penile cancer

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HPV and cancer

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clinical trial

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common terms used during a diagnosis of cancer

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preparing for treatment

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what to expect when having common tests, procedures, and scans

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chemotherapy

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addressing such needs

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healthy living after cancer

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Guide to Sarcoma

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the most common side effects of cancer and different treatments, along with ways to prevent or control them

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common terms used after cancer treatment is complete

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basic cancer terms used in this section

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www.cancerstaging.net

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managing the cost of your cancer care

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non-melanoma skin cancer

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non-melanoma skin cancer

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Guide to Melanoma

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informed consent

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list

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placebos in cancer clinical trials

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organizations that offer information on this specific type of cancer

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clinical trials

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radiation therapy

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lymphedema

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common terms used during cancer treatment

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searchable drug databases

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cancer surgery

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Overview

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Cancer begins when normal cells begin to 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 with the foreskin, a piece of skin covering the head of their penis, intact). The penis is the external genital organ of a man and consists of three chambers of spongy tissue that contain multiple blood vessels, nerves, and smooth muscle. The corpora cavernosa make up two of the chambers and 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 exit the body at an opening called the meatus. At the tip of the penis, the corpora cavernosa expands to form the helmet, or glans. 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, under a microscope, the cells resemble the tissues that make up skin. When cancer begins in squamous cells, it is called <a alt="non-melanoma skin cancer" href="/vgn-ext-templating/v/index.jsp?vgnextoid=88d5ea97a56d9010VgnVCM100000f2730ad1RCRD">non-melanoma skin cancer</a> and it can develop anywhere on the penis; most develop on or under the foreskin. When found at an early stage, epidermoid carcinoma can usually be cured. Basal cell penile cancer. Under the squamous cells in the lower epidermis (one of the layers of the skin tissues that cover the penis) are round cells known as basal cells. These can occasionally become cancerous. This is also called <a alt="non-melanoma skin cancer" href="/vgn-ext-templating/v/index.jsp?vgnextoid=88d5ea97a56d9010VgnVCM100000f2730ad1RCRD">non-melanoma skin cancer</a>. Less than 2% of penile cancers are basal cell cancers. Melanoma. The deepest layer of the epidermis contains scattered cells called melanocytes, which produce the melanin that gives skin color. Melanoma starts in melanocytes, and it is the most serious of the skin cancer types. This cancer occasionally occurs on the surface of the penis. Read the <a alt="Guide to Melanoma" href="/vgn-ext-templating/v/index.jsp?vgnextoid=5c14ea97a56d9010VgnVCM100000f2730ad1RCRD">Guide to Melanoma</a> for more information. 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, smooth muscle, and fat. For more information, read the <a alt="Guide to Sarcoma" href="/vgn-ext-templating/v/index.jsp?vgnextoid=1795ea97a56d9010VgnVCM100000f2730ad1RCRD">Guide to Sarcoma</a>. Statistics In 2009, an estimated 1,290 men in the United States will be diagnosed with penile cancer. An estimated 300 deaths from the disease will occur this year. Penile cancer is more common in some parts of Africa, where it accounts for up to 10% of cancers in men, than in the United States. The five-year relative survival rate (percentage of people who survive at least five years after the cancer is detected, excluding those who die from other diseases) of men with penile cancer is 78%. Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of cases of 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 or she 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. Statistics adapted from the American Cancer Society's publication, Cancer Facts and Figures 2009. Find out more about <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=fcfea3f97915e010VgnVCM100000ed730ad1RCRD&vgnextchannel=d6b5bf8f21e3a010VgnVCM100000f2730ad1RCRD">basic cancer terms used in this section</a>.

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Risk Factors and Prevention

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A risk factor is anything that increases a persons chance of developing cancer. Some risk factors can be controlled, such as smoking, and some cannot be controlled, such as age and family history. Although risk factors can 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 communicating them to your doctor may help you make more informed lifestyle and health-care choices. The following factors can raise a persons 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. Reduce your risk of HPV infection by limiting the 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. Learn more about <a alt="HPV and cancer" href="/vgn-ext-templating/v/index.jsp?vgnextoid=d652e09a32cff110VgnVCM100000ed730ad1RCRD&vgnextchannel=34f5bf8f21e3a010VgnVCM100000f2730ad1RCRD">HPV and cancer</a>. Smoking. Smoking may contribute to the development of penile cancer, especially in men who are also infected with HPV. Age. Most cases of penile cancer occur in men over age 50. About 20% of the time, patients are younger than 40. Smegma. Smegma is a thick substance that can accumulate 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, in order 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 also a risk factor. When a person is HIV-positive, their immune system is less able to fight off early-stage cancer. Psoriasis treatment. Men who have been treated with the drug psoralen combined with ultraviolet (UV) light have a higher risk of developing penile cancer. Circumcision status. Circumcision is a procedure to remove the foreskin of the penis and may provide some protection from penile cancer due to improved hygiene. 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 reduce their risk of developing penile cancer. While it is not possible to completely prevent penile cancer, a man can reduce his risk by avoiding smoking, avoiding sexual practices that could lead to HPV or HIV/AIDS infection, and practicing good hygiene.

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Symptoms

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Men with penile cancer may experience the following symptoms. 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 on this list, please talk with your doctor. <ul type="disc"> <li>A growth or ulcer on the penis, especially on the glans or foreskin, but can also occur on the shaft </li> <li>Changes in color of the penis </li> <li>Skin thickening on the penis </li> <li>Persistent discharge with foul odor beneath the foreskin </li> <li>Blood coming from the tip of the penis or under the foreskin </li> <li>Unexplained pain in the shaft or tip of the penis </li> <li>Irregular or growing bluish-brown flat lesions or marks beneath the foreskin or on the body of the penis </li> <li>Reddish, velvety rash beneath the foreskin </li> <li>Small, crusty bumps beneath the foreskin </li> <li>Swollen groin lymph nodes </li> <li>Irregular swelling at the end of the penis</li> </ul>

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Diagnosis

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Doctors use many tests to diagnose cancer and determine if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test: <ul type="disc"> <li>Age and medical condition </li> <li>The type of cancer suspected </li> <li>Severity of symptoms </li> <li>Previous test results</li> </ul> In addition to a physical examination, the following tests may be used to diagnose penile cancer: Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease). Fine needle aspiration/biopsy. A fine needle aspiration is a specific type of biopsy. A local anesthetic to numb the area may be injected into the skin near the nodule (tumor) prior to the biopsy; prior to doing this, the skin is often made numb with an anesthetic cream. The doctor will insert a thin needle into the nodule and extract (take out) cells and some fluid. The procedure may be repeated two or three times to obtain samples from different areas of the nodule. The pathologist will determine if the cells are cancerous (called positive for cancer), non-cancerous (called negative for cancer), or undetermined (unclear). Sentinel lymph node biopsy. This is another type of biopsy. It is important to know if cancer cells have spread to other areas beyond the penis. In this technique, the doctor removes one or a few sentinel lymph nodes, the first node(s) into which the lymph system drains near to the nodule, to check for cancer cells. In the case of penile cancer, the sentinel lymph nodes are located just under the skin in the groin. If cancer cells are detected, it means that the disease may have spread to other lymph nodes in the region or beyond through the blood and lymph vessels. However, there is a chance that a sentinel lymph node biopsy may not detect cancer cells in the lymph nodes, when in fact the cancer has spread. Inguinal (groin) lymph node dissection. This is the most accurate method to check whether the cancer has spread to any regional lymph nodes. In this procedure, all possible regional lymph nodes are removed and dissected. This procedure provides more information than the removal of a single node or a group of nodes. However, some men may have problems with wound healing after this procedure. Therefore, some doctors are using endoscopic techniques that are minimally invasive to avoid these problems. Visit the Current Research section for more information. X-ray. An x-ray is a picture of the inside of the body. For instance, a chest x-ray can help doctors determine if the cancer has spread to the lungs. Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patients vein to provide better detail. This is particularly useful in looking to see if the cancer has spread to lymph nodes within the groin, pelvis, and in the abdominal cavity and also allows imaging of 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 patients vein to create a clearer picture. Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patients body and absorbed by the organs or tissues being studied. This substance gives off energy that is detected by a scanner, which produces the images. Some doctors will use a PET scan to look for evidence of spread of penile cancer, although it has not specifically been approved for this use. It is known to be useful in staging squamous cancer of the lung and of the esophagus, and as experience increases it may eventually become a more standard tool in diagnosing penile cancer. Learn more about <a alt="what to expect when having common tests, procedures, and scans" href="/vgn-ext-templating/v/index.jsp?vgnextoid=2d27ea97a56d9010VgnVCM100000f2730ad1RCRD">what to expect when having common tests, procedures, and scans</a>. Find out more about <a alt="common terms used during a diagnosis of cancer" href="/vgn-ext-templating/v/index.jsp?vgnextoid=ca55c4b89c27e010VgnVCM100000ed730ad1RCRD&vgnextchannel=d6b5bf8f21e3a010VgnVCM100000f2730ad1RCRD">common terms used during a diagnosis of cancer</a>.

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Staging

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Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and if it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). There are different stage descriptions for different types of cancer. One tool that doctors use to describe the stage is the TNM system. This system uses three criteria to judge the stage of the cancer: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to the rest of the body. 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. TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer: <ul type="disc"> <li>How large is the primary tumor and where is it located? (Tumor, T) </li> <li>Has the tumor spread to the lymph nodes? (Node, N) </li> <li>Has the cancer metastasized (spread) to other parts of the body? (Metastasis, M)</li> </ul> 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: Carcinoma in situ (early cancer that has not spread to other tissue) is present. Ta: The tumor is noninvasive, verrucous (wart-like) carcinoma, somewhat resembling a small piece of broccoli or cabbage. T1: The tumor invades subepithelial connective tissue (tissue below the top layers of skin). T2: The tumor invades corpus spongiosum or corpora cavernosum (internal chambers of the penis). T3: The tumor invades the urethra or prostate gland. T4: The tumor invades other adjacent structures. Node. The N in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near the penis are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes. NX: The regional lymph nodes cannot be evaluated. N0: There is no regional lymph node metastasis. N1: There is metastasis to a single superficial, inguinal lymph node (lymph node in the groin just under the skin surface). N2: There is metastasis to multiple, superficial, inguinal lymph nodes on the same side or both sides of the body. N3: There is metastasis to lymph nodes that are deep within 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 other parts of the body. Cancer stage grouping Doctors assign the stage of the cancer by combining the T, N, and M classifications. Stage 0: The cancer has not invaded below the superficial (surface) layer of skin, and has not spread to lymph nodes or distant sites (Tis or Ta; N0, M0). Stage I: The cancer has invaded just below the superficial layer of skin, but has not spread to lymph nodes or distant sites (T1, N0, M0). Stage II: The cancer has invaded just below the superficial layer of skin and has spread to a single, superficial, groin lymph node but not distant sites. Or, the cancer has invaded deeply into the tissues of the penis, but not into the urethra or prostate and may or may not have spread to a single groin lymph node, but has not spread to distant sites (T1, N1, M0; T2, N0, M0; or T2, N1, M0). Stage III: The cancer has invaded the tissues of the penis, but not into the urethra or prostate, and has spread to many superficial groin lymph nodes, but has not spread to distant sites. Or, the cancer has invaded into the urethra or prostate and may or may not have spread to single or multiple, superficial, groin lymph nodes, but has not spread to distant sites (T1, N2, M0; T2, N2, M0; or T3, any N, M0). Stage IV: The cancer has invaded nearby tissues and may or may not have spread to groin lymph nodes but not to distant sites. Or, the cancer can have any depth of invasion, but has spread to lymph nodes deep in the groin but not to distant sites. Or, the cancer can have any depth of invasion, may or may not have spread to the lymph nodes, but has spread to distant sites (T4, any N, M0; any T, N3, M0; or any T, any N, M1). Recurrent: Recurrent cancer is cancer that comes back after treatment. Grading Histologic grade. In addition to determining the disease stage, doctors may also grade the tumor. Histologic grade describes how closely the cancer cells resemble normal tissue under a microscope. A tumor's grade is described using the letter G and a number. GX: The tumor grade cannot be identified. G1: Describes cells that look more like normal tissue cells (well differentiated). G2: The cells are markedly different from normal cells (moderately differentiated). G3: Describes tumor cells that look very much alike each other and have little resemblance to normal cells (poorly differentiated). G4: The tumor cells barely resemble normal cells (undifferentiated). 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, Sixth Edition(2002) published by Springer-Verlag New York,<a alt="www.cancerstaging.net" href="http://www.cancerstaging.net">www.cancerstaging.net</a>.

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Treatment

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The treatment of penile cancer depends on the size and location of the tumor, whether the cancer has spread, and the persons overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan, including a surgeon, a urologist (a doctor who specializes in urinary tract problems), medical oncologist, and radiation oncologist. Men with penile cancer may have concerns about how their treatment will 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. This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials as a treatment option when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, visit the Clinical Trials section. Descriptions of the most common treatment options for penile cancer are listed below. Surgery The goal of surgery is to remove the cancer, along with some surrounding tissue (called a margin) in order to make sure that the entire cancer is removed. A surgical oncologist is a doctor who specializes in treating cancer using surgery. A urologist can also treat penile cancer using surgery. The various types of surgery are performed under local or general anesthesia, depending on the patients preference and the doctors recommendations. Learn more about <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=d537d3cb276cb010VgnVCM100000ed730ad1RCRD&vgnextchannel=95d5bf8f21e3a010VgnVCM100000f2730ad1RCRD" alt="cancer surgery">cancer surgery</a>. Penectomy. The surgical removal of all or part of the penis is the most common and effective procedure to treat penile cancer that has invaded the inside of the penis. Cryosurgery. Cryosurgery (also called cryotherapy or cryoablation) uses liquid nitrogen to freeze and kill cells. The skin will later blister and slough off. This procedure will sometimes leave a pale scar. More than one freezing may be needed. Mohs surgery. This technique involves surgically removing the visible cancer, in addition to removing small fragments of normal tissue around the edge to ensure that no cancer is left behind. This is done under microscope control. Each small fragment is examined under a microscope until all cancer is removed. This is typically used for small tumors that are located on the surface of the penis. Circumcision. Circumcision involves an operation to remove the foreskin from the penis, along with some surrounding skin. This method is generally used if the cancer is limited to the foreskin. Laser therapy Laser therapy is the use of an intensely 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 Staging 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, and several treatments may be needed. Radiation can be focused on the tumor itself and/or may also be 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 swelling (edema) of the leg(s) because of damage to the lymphatic channels that may drain fluid from the legs, called <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=34d3a3197c667110VgnVCM100000ed730ad1RCRD" alt="Lower Extremity Lymphedema: Leg Swelling After Cancer Treatment">lymphedema</a>. Most side effects go away soon after treatment is finished, although lymphedema can be a chronic condition. Learn more about <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=f77441eca8daa010VgnVCM100000ed730ad1RCRD&vgnextchannel=95d5bf8f21e3a010VgnVCM100000f2730ad1RCRD" alt="radiation therapy">radiation therapy</a>. Chemotherapy Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. Topical chemotherapy is when the drugs are placed directly onto the skin in the form of a topical cream. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. Some people may receive chemotherapy in their doctor's office; others may go to the hospital. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a specific time. The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished. Advanced penile cancer is often treated with a combination of chemotherapy and radiation therapy. Chemotherapy drugs that have some beneficial effects for penile cancer include bleomycin (Blenoxane), methotrexate (multiple brand names), cisplatin (Platinol), gemcitabine (Gemzar) and paclitaxel (Taxol) or docetaxel (Taxotere). It should be noted that not all of these drugs are readily available for penile cancer, and may only be available as part of a <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=62f1ea97a56d9010VgnVCM100000f2730ad1RCRD" alt="clinical trials">clinical trial</a>. Because penile cancer is uncommon, the published information on chemotherapy is not as extensive as for other types of cancer. Today, there is general agreement among cancer specialists that drug combinations that involve two or three drugs are likely to have better results than single agents; the drugs most commonly used for penile cancer include cisplatin, methotrexate and paclitaxel or docetaxel. Learn more about <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=474541eca8daa010VgnVCM100000ed730ad1RCRD&vgnextchannel=95d5bf8f21e3a010VgnVCM100000f2730ad1RCRD" alt="chemotherapy">chemotherapy</a> and <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=d7b541eca8daa010VgnVCM100000ed730ad1RCRD&vgnextchannel=95d5bf8f21e3a010VgnVCM100000f2730ad1RCRD" alt="preparing for treatment">preparing for treatment</a>. 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 <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=3b8903e8448d9010VgnVCM100000f2730ad1RCRD" alt="searchable drug databases">searchable drug databases</a>. Find out more about <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=68bca28cf7a9e010VgnVCM100000ed730ad1RCRD&vgnextchannel=d6b5bf8f21e3a010VgnVCM100000f2730ad1RCRD" alt="common terms used during cancer treatment">common terms used during cancer treatment</a>.

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Side Effects

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Cancer and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, and other physical side effects of cancer treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors also have many ways to provide relief to patients when such side effects do occur. Fear of treatment side effects is common after a diagnosis of cancer, but it may be helpful to know that preventing and controlling side effects is a major focus of your health-care team. Before treatment begins, talk with your doctor about possible side effects of the specific treatments you will be receiving. The specific side effects that can occur depend on a variety of factors, including the type of cancer, its location, the individual treatment plan (including the length and dosage of treatment), and the persons overall health. In particular, men are encouraged to talk with their doctor about any possible sexual and/or fertility problems due to the specific treatment plan. Ask your doctor which side effects are most likely to happen (and which are not), when side effects are likely to occur, and how they will be addressed by the health-care team if they do happen. Also, be sure to communicate with the doctor about side effects you experience during and after treatment. Learn more about <a alt="the most common side effects of cancer and different treatments, along with ways to prevent or control them" href="/vgn-ext-templating/v/index.jsp?vgnextoid=5c47ea97a56d9010VgnVCM100000f2730ad1RCRD">the most common side effects of cancer and different treatments, along with ways to prevent or control them</a>. In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. Learn more about the importance of <a alt="addressing such needs" href="/vgn-ext-templating/v/index.jsp?vgnextoid=53f0ee3b20016110VgnVCM100000ed730ad1RCRD">addressing such needs</a>, including concerns about <a alt="managing the cost of your cancer care" href="/vgn-ext-templating/v/index.jsp?vgnextoid=2c7947a77924f110VgnVCM100000ed730ad1RCRD">managing the cost of your cancer care</a>. Learn more about late effects or long-term side effects by reading the After Treatment section or talking with your doctor.

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After Treatment

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After treatment for penile cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years, with specific examination of the penis itself and the lymph nodes in the groin. The risk of recurrence depends on several factors, including the type of penile cancer and the extent of the disease. Depending on the anticipated level of risk of the cancer recurring, a patient may need occasional chest x-rays or CT scans, as well as some blood tests. Once the patient has been successfully treated for penile cancer, it is wise to practice safe (protected) sex and to ensure that careful hygiene is practiced. Currently, there is no proven way to lower the chances of recurrence or a second primary 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 upon your needs, physical abilities, and fitness level. Learn more about <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=67a441eca8daa010VgnVCM100000ed730ad1RCRD" alt="healthy living after cancer">healthy living after cancer</a>. Find out more about <a href="/vgn-ext-templating/v/index.jsp?vgnextoid=1d46a987fa2ce010VgnVCM100000ed730ad1RCRD" alt="common terms used after cancer treatment is complete.">common terms used after cancer treatment is complete</a>.

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Questions to Ask the Doctor

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Regular communication with your doctor is important in making informed decisions about your health care. Consider asking the following questions of your doctor: General questions: <ul type="disc"> <li>What type of penile cancer do I have? </li> <li>What is the stage of the cancer, and what does this mean? </li> <li>What is the grade of the cancer, and what does this mean? </li> <li>Can you explain my pathology report (laboratory test results) to me? </li> <li>What treatment options do I have? </li> <li>What clinical trials are open to me? </li> <li>What treatment do you recommend? Why? </li> <li>Do I need treatment right away? </li> <li>What is the goal of this treatment? </li> <li>What about a second opinion? </li> <li>What are the possible side effects of this treatment, both in the short term and the long term? </li> <li>How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities? </li> <li>Will this treatment affect my sex life, and if so, how? </li> <li>Will this treatment affect my ability to father children in the future (fertility)? If so, can you recommend a fertility specialist before treatment begins? </li> <li>Should I be seeing a psychologist, counselor, or other mental health professional to help me deal with any fear and body image issues? </li> <li>If Im worried about managing the costs related to my cancer care, who can help me with these concerns?</li> </ul> For people who need surgery: <ul type="disc"> <li>Will I need to stay in the hospital for this surgery? For how long? </li> <li>What are the common side effects of my surgery? </li> <li>Are there alternatives to surgery?</li> </ul> For people who need radiation therapy or laser therapy: <ul type="disc"> <li>What type of therapy am I getting? </li> <li>What does the preparation for this treatment involve? </li> <li>What side effects can I expect from this treatment? </li> <li>What can be done to treat the side effects? </li> <li>Are there alternatives to this therapy?</li> </ul> For people who need chemotherapy: <ul type="disc"> <li>What type of chemotherapy will I receive? </li> <li>What does the preparation for this treatment involve? </li> <li>What side effects can I expect from this treatment? </li> <li>What can be done to treat the side effects?</li> <li>How likely is chemotherapy to be successful? Are there alternatives to chemotherapy?</li> </ul> After treatment: <ul type="disc"> <li>What are the chances that the cancer will return? </li> <li>Can you refer me to someone who can advise me regarding my sex life after treatment? </li> <li>What follow-up tests do I need, and how often do I need them? </li> <li>What support services are available to me? To my family?</li> </ul>

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Current Research

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Research for penile cancer is ongoing. The following advancements may still be under investigation in clinical trials and may not be approved or available at this current time. Always discuss all diagnostic and treatment options with your doctor. Laser therapy. Laser therapy is the use of an intensely powerful beam of light to kill cancer cells. There is current research studying the expanded use of lasers to treat early-stage penile cancer. Radiation therapy. Current research involves finding the best way to utilize radiation therapy for penile cancer. This could include a combination of therapies, including radiation therapy and chemotherapy, in an effort to avoid the surgical removal of the penis. Improved techniques are now available that involve linking CT scans to treatment planning, which may allow greater precision in the dosage of therapy with less side effects. Combination therapy. Clinical trials are currently researching whether the combination of chemotherapy and radiation therapy will give better results��a lower recurrence rate and/or improved survivalthan standard treatments. Minimally invasive surgery. Minimally invasive surgery is based on techniques that use small incisions and a camera located under the skin to perform a lymph node dissection to determine if the cancer has spread. Current research is studying endoscopic and robotically-assisted technology to diagnose and remove penile cancer that may have spread to regional lymph nodes.

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Patient Information Resources

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In addition to Cancer.Net, there are other sources of information about this type of cancer available online. Cancer.Net maintains a <a alt="list" href="/vgn-ext-templating/v/index.jsp?vgnextoid=649903e8448d9010VgnVCM100000f2730ad1RCRD">list</a> of national, not-for-profit organizations that may be helpful in finding additional information, services, and support. As always, be sure to talk with your doctor about questions you may have about information you find about this disease. View <a alt="organizations that offer information on this specific type of cancer" href="/vgn-ext-templating/v/index.jsp?vgnextoid=649903e8448d9010VgnVCM100000f2730ad1RCRD">organizations that offer information on this specific type of cancer</a>.

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Clinical Trials Resources

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Doctors and scientists are always looking for better ways to treat patients with penile cancer. A clinical trial is a way to test a new treatment to prove that it is safe, effective, and possibly better than a standard treatment. The clinical trial may be evaluating a new drug, a new combination of existing treatments, a new approach to radiation therapy or surgery, or a new method of treatment or prevention. Patients who participate in clinical trials are 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. 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 finding new drugs and other therapies is 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 <a alt="placebos in cancer clinical trials" href="/vgn-ext-templating/v/index.jsp?vgnextoid=73c6915c1bea7110VgnVCM100000ed730ad1RCRD&vgnextchannel=9b7903e8448d9010VgnVCM100000f2730ad1RCRD">placebos in cancer clinical trials</a>. To join a clinical trial, patients must participate in a process known as <a alt="informed consent" href="/vgn-ext-templating/v/index.jsp?vgnextoid=bcadc63d749f1110VgnVCM100000ed730ad1RCRD">informed consent</a>. 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. Learn more about <a alt="clinical trials" href="/vgn-ext-templating/v/index.jsp?vgnextoid=62f1ea97a56d9010VgnVCM100000f2730ad1RCRD">clinical trials</a>, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find cancer clinical trials. For specific topics being studied for penile cancer, learn more in the Current Research section.

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