Penile cancer

The penis is one of the male urinary and sex organs. It's made up of different types of tissue, such as skin, muscle and nerves.

The penis has 3 main areas:

• glans (head of the penis)
• foreskin (the fold of skin that covers the glans)
• shaft (the main part of the penis between the glans and the lower tummy)

When a man is sexually aroused, more blood flows to the penis. This makes it hard and erect. The penis also contains a tube called the urethra. It carries semen (sperm) from the testicles and urine (pee) from the bladder out of the body.

Signs and symptoms of penile cancer can include:

• a growth or sore (ulcer) anywhere on the penis, which may or may not be painful
• thickening or raised areas anywhere on the penis
• changes in the colour of the skin, like redness, white patches or areas that look blueish, brown or black
• discharge or bleeding
• pain, a lump, or discharge underneath the foreskin, which is usually only seen if the foreskin is pulled back

These symptoms can also happen with other conditions.

Always see your doctor straight away if you have any of these symptoms or any other changes. Penile cancer is easier to treat if it's diagnosed early.

If you have symptoms of penile cancer, you usually start by seeing your doctor. If the doctor thinks cancer could be causing them, you'll normally be referred to a urologist. This is a doctor who 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 your penis and check the area at the top of your legs (the groin) for any swelling.

Some people find this kind of examination embarrassing or distressing. Your doctor should explain what they're going to do and why they need to do it. They should also ask your permission before they touch you.

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

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

Before the biopsy, the doctor will inject a local anaesthetic into the penis. This numbs the area so you're more comfortable during the procedure.

Some people may need to have the biopsy done 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 tell you.

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

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

The MDT for penile cancer will usually include these 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 the different treatments, along with their advantages and disadvantages.

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

The specialist team will arrange further tests. These show whether the cancer is only in the penis or has spread, and the results help the 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.

Penile cancer can spread to the lymph nodes in the groin, and these are one of the first places it reaches. Lymph nodes are part of the lymphatic system, which helps protect you against infection and disease.

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

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

When a lymph node is bigger than normal, the doctor may use a needle to draw some fluid from it into a syringe. This is called a fine needle aspiration. The fluid is then 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 takes a sample of lymph nodes from one or both sides of the groin, through a small cut on each side. This may be done at the same time as the 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. So 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 then uses a small, hand-held instrument to find the lymph nodes that have picked up the radioactive liquid. Any blue or radioactive nodes are removed 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, and you may need support while you wait.

The stage of penile cancer tells you two things:

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

The grade is decided by a doctor, who looks at the cancer cells under a microscope. This gives an idea of how quickly the cancer may grow.

Once your doctors know the stage and grade, they can plan the best treatment for you.

A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).

Your doctor, cancer specialist or nurse will explain the different treatments and their side effects. They'll also talk with you about what to think over when making treatment decisions.

If there are pre-cancerous cells in the top layers of the skin, this is called Tis or carcinoma in situ (CIS). Tis is treated slightly differently from penile cancer.

These are the main treatments for penile cancer.

Surgery is the main treatment for larger cancers of the penis. Small early cancers can also be treated with minor surgery, depending on where they are.

Chemotherapy uses anti-cancer drugs to destroy cancer cells. Not everyone who has penile cancer will be given chemotherapy. It can be used:

• before surgery, to shrink the cancer and make it easier to remove
• after surgery, to reduce the risk 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. Not everyone who has penile cancer will have radiotherapy. Sometimes it's used instead of chemotherapy or surgery, usually if the cancer has spread to other parts of the body. It may also be given after surgery to remove lymph nodes in the groin, to reduce the risk of cancer coming back in this area.

You may have chemotherapy at the same time as radiotherapy so that it works better. This is called chemoradiation.

You may also be offered treatment as part of a clinical trial.

Macmillan Cancer Support has more information about treatment for penile cancer.

After penile cancer treatment, you'll have regular follow-up appointments with your surgeon or cancer specialist. They'll examine you, and you may have blood tests or scans.

These appointments usually continue for several years. If you have any problems, or notice any new symptoms between appointments, let your cancer team know as soon as possible. That could be your surgeon, cancer specialist, nurse or keyworker, if you have one.

You may get anxious between appointments. This is natural. It may help to get support from family, friends or a support organisation.

Macmillan Cancer Support also has further information to support you. You can:

• phone the Macmillan Support Line on 0808 808 00 00
• chat to Macmillan specialists online
• use the Macmillan penile cancer forum, where you can talk to others affected by penile cancer, ask questions and share your experience

Organisations like Orchid also offer more information and support for people with penile cancer.

Your doctor or nurse will explain any effects your treatment for penile cancer might have on your sex life. If the cancer is at an early stage, treatment is unlikely to affect your sex life directly.

It's usually safe to have sex once the treated area has completely healed and you feel ready. Your doctor or nurse can give you advice on this.

Surgery for penile cancer can sometimes affect your sex life. How much it does may depend on:

• the type of surgery you've had
• how this has affected your physical and emotional wellbeing

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

Recovering from the side effects of radiotherapy can take time, so you may not feel ready for sex straight away.

Radiotherapy may cause problems with getting and keeping an erection. This is called erectile dysfunction, or ED. Your doctor or nurse will talk to you about the risk of this happening to you.

There are different treatments to help with ED.

Chemotherapy given into a vein won't directly affect your sex life. But side effects such as tiredness may mean you don't feel like having sex. This often improves slowly once treatment is over.

Your doctor will advise you not to make someone pregnant while you're having chemotherapy, because the drugs may harm the developing baby. So use effective contraception throughout your treatment.

Even if you already live a healthy life, you may want to make some positive changes after treatment. Small changes, like eating well and keeping active, can improve your health and wellbeing and help your body recover.

Macmillan Cancer Support has more information on finishing cancer treatment.