Penile cancer

What causes penile cancer?

The exact cause of penile cancer is not known. Having certain risk factors may increase the risk of developing it. These can include:

• having human papilloma virus (HPV)
• having a tight foreskin
• smoking
• certain skin conditions
• being over the age of 50

But having one or more risk factors does not mean that you will develop penile cancer.

Penile cancer is not infectious and cannot be passed on to other people.

Macmillan Cancer Support have more information about the causes and risk factors of penile cancer.

Diagnosing penile cancer

If you have symptoms, you usually begin by seeing your GP. If your GP thinks that your symptoms could be caused by cancer, they usually refer you to a doctor called a urologist. A urologist treats problems of the penis, testicles, prostate gland or urinary system.

At the hospital, the urologist will ask you about your symptoms. They’ll examine the penis and check the area at the top of the legs (groin) for any swelling.

Some people might find this type of examination embarrassing or distressing. Your doctor should explain what they’re going to do and why they need to do it. They should ask for your permission to touch you.

You may feel more comfortable having another person in the room with you during your examination. If so, tell your doctor and they’ll arrange this for you.

Biopsy

The main test to diagnose penile cancer is a biopsy. For a biopsy, the doctor takes a sample of tissue from any abnormal or sore-looking areas on the penis.

Before a biopsy is taken, the doctor will inject a local anaesthetic into the penis. This numbs the area to make you more comfortable during the procedure.

Some people may need to have a biopsy taken under general anaesthetic. You can talk to your doctor about what is right for you.

Most people go home the same day. If you need to stay in hospital, your doctor or nurse will let you know.

After the biopsy you may have 1 or 2 stitches. You may have a dressing applied to the area to keep it clean. The stitches usually dissolve on their own.

Further tests for penile cancer

When you’re diagnosed, you should be referred to a team of healthcare professionals. This is called a multidisciplinary team (MDT). This will be at a hospital or centre that specialises in treating penile cancer.

The MDT team for penile cancer will usually include the following professionals:

• urologist – a doctor who specialises in treating urinary and genital problems
• clinical oncologist – a doctor who uses radiotherapy, chemotherapy and other anti-cancer drugs to treat people with cancer
• clinical nurse specialist (CNS) – a nurse who gives information about cancer, and support during treatment
• radiologist – a doctor who looks at scans and X-rays to diagnose problems
• pathologist – a doctor who looks at cells or body tissue under a microscope to diagnose cancer

The MDT may also include:

• a dietitian
• a physiotherapist
• a psychologist
• a counsellor

Your specialist doctor and nurse will talk to you about your treatment options. They will explain different treatments and their advantages and disadvantages.

Penile cancer is a rare type of cancer. This means your specialist team may be based some distance from your home and local hospital.

The specialist team will arrange further tests. These are to find out whether the cancer is only in the penis or if it has spread. The results help your specialist team plan your treatment.

These tests may include the following.

A CT scan takes a series of X-rays, which build up a three-dimensional picture of the inside of your body.

An MRI scan uses magnetism to build up a detailed picture of areas of your body.

Tests to check the lymph nodes

One of the first places penile cancer can spread to is the lymph nodes in the groin. Lymph nodes are part of the lymphatic system. The lymphatic system helps protect you against infection and disease.

If the cancer has spread, the lymph nodes in the groin may be bigger than normal. But this can also happen because of infection. Your doctor may arrange for you to have tests to check for signs of cancer in the lymph nodes.

An ultrasound scan uses soundwaves to build up a picture of the inside of the body. A gel is spread onto the groin and a small device that produces soundwaves is passed over it. This test is painless and only takes a few minutes.

When a lymph node is bigger than normal, the doctor may use a needle to take some fluid from it into a syringe. This is called a fine needle aspiration. The fluid is checked under a microscope for cancer cells.

Sometimes your doctor may recommend removing 1 or more lymph nodes. This operation is usually done under a general anaesthetic.

The surgeon removes a sample of lymph nodes from one or both sides of the groin. They remove the nodes through a small cut in each side of the groin. This may be done at the same time as surgery to remove the cancer.

A sentinel lymph node biopsy (SNLB) is a way of checking the smallest possible number of lymph nodes in the groin to see if they contain cancer cells. The sentinel nodes are the first nodes that lymph fluid from the penis drains to. This means they’re the nodes most likely to contain any cancer cells.

You have an SLNB done under a general anaesthetic. The surgeon injects a blue dye and a tiny amount of harmless, radioactive liquid into the area of the cancer. The dye drains into the sentinel lymph nodes and turns them blue.

The surgeon uses a small, hand-held instrument to find the lymph nodes that have picked up the radioactive liquid. They remove any blue or radioactive nodes through a small cut in the groin.

If these sentinel nodes don’t contain cancer, it’s very unlikely that any other lymph nodes will. This means you won’t need to have any more lymph nodes removed.

If there are cancer cells in any sentinel nodes, you’ll need more surgery. This will remove all the lymph nodes in the affected area.

Waiting for test results can be a difficult time. Macmillan Cancer Support have more information that can help.

Staging and grading of penile cancer

The stage of the cancer describes:

• the size and position of the cancer
• whether it has spread

A doctor decides the grade of the cancer by how the cancer cells look under a microscope. This gives an idea of how quickly the cancer may grow.

Knowing the stage and grade helps your doctors plan the best treatment for you.

A group of specialists will sit together to work out the best possible treatment plan for you. This group is called a multidisciplinary team, or MDT.

Your doctor, cancer specialist or nurse will explain the different treatment options and their side effects. They will also talk you through the things worth thinking about when you are deciding on treatment.

If pre-cancerous cells are found only in the top layers of the skin, this is called Tis, or carcinoma in situ (CIS). Tis is treated a little differently from penile cancer itself. Macmillan Cancer Support has more information on treatment for Tis.

The treatments below are the main ones used for penile cancer.

Surgery is the main treatment for larger cancers of the penis. Depending on where a small, early cancer is located, it can sometimes be treated with minor surgery instead.

Chemotherapy uses anti-cancer drugs to destroy cancer cells. Not everyone with penile cancer needs chemotherapy. It can be used:

• before surgery, to shrink the cancer and make it easier to remove
• after surgery, to lower the chance of the cancer coming back
• to treat cancer that has spread to other parts of the body

Radiotherapy uses high-energy rays to destroy cancer cells. It is sometimes used in place of chemotherapy, though not everyone with penile cancer will need it. At times it is used instead of chemotherapy or surgery altogether, usually when the cancer has spread elsewhere in the body.

Radiotherapy may also be given after surgery to remove lymph nodes in the groin, to lower the risk of the cancer returning in that area. Macmillan Cancer Support has more information on how radiotherapy is used for penile cancer.

You may be given chemotherapy alongside radiotherapy so the treatments work better together. This combined approach is called chemoradiation.

You may also be offered the chance to take part in a clinical trial. Macmillan Cancer Support has more information on penile cancer treatment.

After penile cancer treatment

You will have regular follow-up appointments with your surgeon or cancer specialist once treatment ends. At these visits, you will be examined, and you may also need blood tests or scans.

These check-ups usually carry on for several years. If you notice any problems or new symptoms between appointments, let your cancer team know as soon as you can. This could be your surgeon, cancer specialist, nurse, or keyworker, if you have one.

Feeling anxious between appointments is natural and common. Leaning on family, friends or a support organisation can help during this time.

Macmillan Cancer Support also offers further help. You can:

• call the Macmillan Support Line on 0808 808 00 00
• chat with Macmillan specialists online
• join the Macmillan penile cancer forum, where you can talk to others going through the same thing, ask questions and share your experience

Organisations such as Orchid also offer information and support for people with penile cancer.

Relationships and sex

Your doctor or nurse will explain how your treatment might affect your sex life. If your cancer was caught early, treatment is unlikely to have a direct effect on this part of your life.

It is usually safe to have sex once the treated area has fully healed and you feel ready for it. Your doctor or nurse can guide you on this.

After surgery

Surgery for penile cancer can sometimes affect your sex life. This can depend on:

• the type of surgery you had
• how it has affected you physically and emotionally

Macmillan Cancer Support has more information on penile cancer surgery and how it may affect your sex life.

After radiotherapy

Recovering from the side effects of radiotherapy can take time before you feel ready for sex again.

Radiotherapy can sometimes cause difficulty getting or keeping an erection, known as erectile dysfunction, or ED. Your doctor or nurse will talk to you about your own risk of this. Several treatments are available to help with ED.

After chemotherapy

If you are having chemotherapy through a vein, it will not directly affect your sex life. However, side effects such as tiredness may leave you not in the mood for sex. This tends to ease gradually once treatment is finished.

Your doctor will advise you to avoid getting someone pregnant while you are having chemotherapy, since the drugs could harm a developing baby. Using effective contraception during treatment is important.

Late effects after radiotherapy

Some people notice side effects months or even years after finishing radiotherapy. These are known as late effects.

After radiotherapy, the healthy tissue in the penis may thicken over time. This can narrow the urethra, the tube that carries urine through the penis, making it harder to pass urine.

If this happens, a simple operation can stretch the urethra to treat it. If you have trouble passing urine, tell your doctor straight away.

Macmillan Cancer Support has more information on the late effects of pelvic radiotherapy.

Wellbeing and recovery

Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes after treatment.

Making small changes like eating well and keeping active can improve your health and wellbeing and help your body recover.

Macmillan Cancer Support have more information on finishing cancer treatment.

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