The exact cause of penis cancer is unknown. The chances of developing cancer of the penis may be increased by certain risk factors.

The human papilloma virus (HPV) is a common virus that most sexually active people will have been exposed to. It can cause genital warts, which increase the risk of cancer of the penis.

Smoking can increase the risk of cancer of the penis.

Having a tight foreskin that will not pull back easily (phimosis) can irritate or cause inflammation of the skin of the penis. Cancer of the penis is less common in men who are circumcised (have all or part of their foreskin removed), but the reason for this isn’t clear.

Some skin conditions that affect the penis may develop into cancer if left untreated. Always see your doctor if you have white or red scaly patches on the head of the penis, or red moist patches of skin on your penis.

Cancer of the penis cannot be passed on to other people.

The first signs of penis cancer are often a thickening or change in colour of the skin. Later symptoms may include a growth or sore on the head of the penis (the glans), the foreskin or the shaft of the penis. There may be discharge or bleeding from the growth or sore.

The cancer may look like a flat growth with a bluish-brown colour, a red rash, or small, crusty bumps. Sometimes the cancer can only be seen when the foreskin is pulled back.

These symptoms can also happen with other conditions. But always see your doctor straight away if you have any symptoms. Cancer of the penis is easier to treat if it's diagnosed early.

A doctor at the hospital will ask questions about your symptoms. They will examine your penis and check your groin for any swellings.

The doctor may take a sample of tissue (a biopsy) from any sore or abnormal looking areas on the penis. This is done under a local or general anaesthetic, so you won’t feel it being done. You can take painkillers afterwards if needed. The biopsy is examined under a microscope to look for signs of cancer.

After you are diagnosed with penis cancer, you will be referred to a doctor at a hospital or centre that specialises in treating this cancer. This may be some distance from your home and local hospital.

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

CT (computerised tomography) scan

A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body. The scan takes 10–30 minutes and is painless. It uses a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.

You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It’s important to let your doctor know if you are allergic to iodine or have asthma, because you could have a more serious reaction to the injection.

You’ll probably be able to go home as soon as the scan is over.

MRI scan

This test uses magnetism to build up a detailed picture of areas of your body. The scanner is a powerful magnet so you may be asked to complete and sign a checklist to make sure it's safe for you. The checklist asks about any metal implants you may have, such as a pacemaker, surgical clips, bone pins, etc. You should also tell your doctor if you've ever worked with metal or in the metal industry as very tiny fragments of metal can sometimes lodge in the body. If you do have any metal in your body it's likely that you won't be able to have an MRI scan. In this situation another type of scan can be used.

Before the scan, you'll be asked to remove any metal belongings including jewellery. Some people are given an injection of dye into a vein in the arm, which doesn't usually cause discomfort. This is called a contrast medium and can help the images from the scan to show up more clearly. During the test you'll lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It's painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It's also noisy, but you'll be given earplugs or headphones. You can hear, and speak to, the person operating the scanner.

Tests to check the lymph nodes

If cancer of the penis spreads, one of the first places it can go to are lymph nodes (sometimes called glands) in the groin.

Lymph nodes are part of the lymphatic system, which helps defend us against infection and disease. There are lymph nodes throughout the body. They are linked by fine channels, which circulate a fluid called lymph around the body. If the cancer has spread, the lymph nodes in the groin may be bigger than normal. But this can also happen as a result of infection. Your doctor may arrange for you to have tests on the lymph nodes.

Sometimes the doctor puts a needle into the node and withdraws a sample of cells into the syringe. The cells are examined under a microscope to see if there are any cancer cells. This is called a fine needle aspiration.

Your doctor may recommend you have one or more lymph nodes removed. This may be done at the same time as surgery to remove the cancer in the penis. There are different ways of doing it: 

Removing a sample of lymph nodes

During this operation the surgeon removes a sample of lymph nodes from one or both groins. They remove the nodes through a small cut in each groin.

Sentinel lymph node biopsy (SLNB)

SLNB checks the smallest possible number of lymph nodes in the groin to see if they contain cancer cells. The sentinel node is the first node that lymph fluid from the penis drains to. This means it is the node most likely to contain any cancer cells. There may be more than one sentinel node.

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 handheld instrument to find the lymph nodes that have picked up the radioactive liquid. They remove any blue or radioactive nodes (sentinel nodes) through a small cut in the groin.

If the sentinel nodes don’t contain cancer, it is very unlikely that any other lymph nodes are affected. This means you won’t need any more lymph nodes removed. If there are cancer cells in any sentinel nodes, you’ll need more surgery to remove the rest of the lymph nodes.

The stage of a cancer describes its size and whether or not it has spread from where it started.

TNM staging

The most commonly used staging system is the TNM system:

T describes the size or position of the primary tumour (where the cancer first started)

N describes if the cancer has spread to any lymph nodes

M describes if the cancer has spread to other parts of the body (metastases or secondary cancer)

There are also numbers attached to these letters to describe the cancer in detail. There are four T stages from T1 to T4. A T1 tumour is small and on or just below the surface of the penis. A T4 tumour has spread more deeply into the penis and into areas close by.

There are three N stages from N0 to N2. If the cancer is not in any lymph nodes it’s described as N0. If there are cancer cells in one lymph node in the groin it’s N1, while N2 means the cancer is in at least two nodes in the groin.

There are two M stages – M0 and M1. When the cancer has not spread to other parts of the body, it’s M0. But if it has spread to other parts of the body, such as the liver or the lungs, it’s M1.

Other terms used

Your doctor may use other terms used to describe cancer:

• Early may be used to describe a cancer of the penis that that hasn’t spread outside the penis.
• Locally advanced is when the cancer has spread more deeply into the penis and the lymph nodes close by.
• Secondary cancer means the cancer has spread to other parts of the body.

Grading

The grade of a cancer is how the cancer cells look under the microscope. It gives an idea of how slowly or quickly the cancer may grow and how likely it is to spread. Knowing the grade helps your specialist when deciding on the best treatments for you. Cancer of the penis is graded from 1-4 and can also be described as low-grade or high-grade:

• Low-grade (grade 1 and 2): the cancer cells look similar to normal cells, and are slow-growing and less likely to spread.
• High-grade (grade 3 and 4): the cancer cells look more or very abnormal, and are likely to grow more quickly and spread.

The treatment you have will depend on a number of things, including the stage and grade of the cancer and your general health.

Your specialist doctor and nurse will explain the treatments and their advantages and disadvantages to you. It’s important to ask them any questions you have and to let them know if you need more information. You and your doctor can then decide on the best treatment plan for you.

Very small early cancers can sometimes be treated with chemotherapy cream called fluorouracil (5FU). You apply the cream to the area of the cancer. Another type of cream called imiquimod (Aldara®) can also be used. It works by stimulating the immune system to destroy the cancer cells. Small early cancers are treated with minor surgery or with treatments that use heat or cold to destroy the cancer.

Surgery is the main treatment for cancers that affect a wider area. Surgical techniques have improved over time and it is usually possible to preserve the appearance of the penis. Some men do need to have surgery to remove part or all of the penis. They can often have surgery to reconstruct the penis later.

Radiotherapy can sometimes be used instead of surgery. It may be given to lymph nodes in the groin after surgery.

Chemotherapy can be given in combination with radiotherapy. It is sometimes given before or after surgery. It can also be used when the cancer has spread to other parts of the body.

Surgery

The type of surgery you have depends on the size and position of the cancer. There are different types of operation. Your surgeon and specialist nurse will explain what is involved. It’s important to ask them any questions you have and talk about any concerns.

Some operations may cause changes in how your penis looks and affect your sex life. This can be difficult to come to terms with. Your team will explain any possible changes and give you support to help you cope.

If you are having a general anaesthetic, you may need tests before it to make sure you are well enough. You usually have these at a pre-surgery assessment clinic. If you smoke, you’ll be advised to stop or cut down before your operation. We have more information on giving up smoking. You’re usually admitted to hospital on the day of your operation.

Removing a small cancer

If you have a small cancer that is only on the surface of the penis, it can be treated in different ways:

• using lasers (heat) to cut away the cancer
• removing the cancer by freezing it with a cold probe (cryotherapy)
• with an operation to remove only the affected area and a small area around it
• with an operation to remove the foreskin (circumcision), if the cancer is only affecting the foreskin.

These treatments can be done under local or general anaesthetic. You may be able to go home on the same day. Your doctor and nurse will give you more information.

Wide local excision

If the cancer has spread over a wider area, you will usually need an operation called a wide local excision. This means removing the cancer and an area (margin) of healthy-looking tissue around it to reduce the risk of the cancer coming back. You usually have this operation under a general anaesthetic and will need a short stay in hospital.

Surgery to preserve the penis

If you have a larger cancer on the head of the penis (the glans), you usually need an operation to completely remove the head of the penis. The surgeon can take skin from somewhere else in the body (a skin graft) to give you back a normal appearance. You need to stay in hospital for a few days to have this operation.

Removing part or all of the penis

If the cancer is large, or affecting too much of the penis, your surgeon may advise you to have part or, occasionally, all of the penis removed. This type of surgery is only carried out by expert surgeons. They will explain what’s involved and how the operation is likely to affect you. Having surgery to remove part or all of the penis may be distressing, but the team looking after you will support you.

If you have all of the penis removed, the surgeon will divert the tube that carries urine outside the body (urethra) to behind your scrotum. This means you pass urine when you are sitting down.

Reconstructive surgery

It may be possible to have an operation to form a new penis (reconstructive surgery) if the cancer has not spread anywhere else in the body. This is only done in a few hospitals in the UK. You won’t have reconstructive surgery until you have fully recovered from your operation and completed all your cancer treatment.

The surgeon performing the reconstruction can use techniques that include taking skin and muscle from your arm to make a new penis. It may be possible for the surgeon to reconnect some of the nerves to allow you to get an erection in the reconstructed penis.

Your surgeon will explain what the operation involves so you know what to expect.

Surgery to remove the lymph nodes

You may be advised to have an operation to have all the lymph nodes removed from one or both groins. This is called a radical groin dissection. The surgeon makes a long cut in the groin to remove the lymph nodes.

After this operation there is a risk of developing swelling in the leg(s). This is called lymphoedema. The risk is higher if you also have radiotherapy to your groin. 

Lymphoedema

You can do the following things to help lower your risk of getting lymphoedema:

• Protect the skin on your legs and feet

Keep skin clean and prevent it from getting too dry with moisturising creams, such as E45. Wear long trousers if gardening to avoid being scratched and don’t get sunburnt. Treat any cuts or grazes on your feet or legs with antiseptic cream and cover them up. See a doctor immediately if the area becomes red, warm or swollen.

• Look after your feet

Wear well-fitting footwear and don’t walk around barefoot. Use nail clippers instead of scissors. Avoid standing for long periods and put your feet up if you’re sitting down.

• Avoid temperature extremes

Don’t have hot baths and avoid using saunas or hot tubs.

Always tell your doctor or specialist nurse if you have any swelling in your feet or legs. The earlier lymphoedema is diagnosed the easier it is to manage.

We have more information on lymphoedema.

After your operation

How long it takes you to recover depends on the surgery you have. If the cancer is very small, and only a small amount of skin is removed, your wound is likely to heal quickly. If the surgeon removes your lymph nodes, healing and recovery will take longer. This is also true if you have a bigger operation. Your penis may be swollen and bruised immediately after surgery, but this will settle down in a few days. The nurses will give you regular painkillers until any pain or discomfort goes away.

If you had your lymph nodes removed, you’ll have a tube going into your groin to drain away extra fluid. It’s connected to a small bottle. The nurses will remove it when there’s only a small amount of fluid draining. This can take a few days. You may also have a drain coming from the wound if you had part or all of the penis removed.

The nurses will encourage you to start moving about as soon as possible after your operation. This is important for your recovery, as it helps to prevent problems such as chest infections and blood clots.

If you had a bigger operation, you may have a tube (catheter) going into your bladder, via your urethra, to drain urine. This will be removed after a few days.

The nurses will check your wound(s) regularly. They will change the dressings to keep the area clean and help the skin to heal. Stitches are usually designed to slowly dissolve and disappear as the wound heals.

If you’ve had a skin graft, you may need dressings on the area the skin was taken from (the donor site). These dressings usually stay in place until new skin has formed. Your nurse will explain more about this to you.

Your surgeon will talk to you about your results once they have them. This will usually happen during your stay in hospital, or at your first outpatient visit after your operation.

Radiotherapy

Radiotherapy treats cancer using high-energy rays to destroy cancer cells. It can be used to treat cancer of the penis in the following situations:

• if you’re not well enough to have an operation, or you don’t want to have surgery
• after surgery to treat lymph nodes in the groin to reduce the risk of the cancer coming back
• instead of surgery, if the cancer is in the lymph nodes in the groin or in the pelvis.

Radiotherapy may also be used to control pain if the cancer has spread to the bones.

Your cancer doctor or nurse will talk over the treatment with you. They will explain the side effects and answer any questions you have.

You usually have a series of short daily treatments in the hospital's radiotherapy department. The high-energy x-rays are directed from a machine to the area of the cancer. Before each session of radiotherapy, the radiographer (the person that operates the machine) will position you carefully on the couch and make sure that you’re comfortable. Radiotherapy is not painful, but you do have to lie still for a few minutes while your treatment is being given.

Each treatment takes about 10-15 minutes. Treatments are usually given Monday-Friday, with a rest at the weekend. The whole course may take up to six weeks depending on your situation.

The treatment does not make you radioactive and it’s perfectly safe for you to be around other people, including children, after your treatment.

Side effects of radiotherapy

Most side effects are temporary and start a week or two into your treatment. Side effects usually start to improve a couple of weeks after treatment finishes.

The side effects of radiotherapy are made worse by smoking. If you can cut down or stop smoking during and after your treatment this will help. We have information on giving up smoking that we can send you.

• Tiredness

This is a common side effect. It may last for weeks or months after radiotherapy is over. Pace yourself so you don’t overdo it and take regular rests. Try to balance this with some physical activity, such as short walks. This will help to build up your energy levels.

• Effects on the skin

The skin on your penis and your groin may redden or get darker, and become dry, flaky and itchy. Towards the end of treatment, it may become moist and sore. Your radiographer or nurse will give you advice on how to care for your skin. Tell them if it becomes sore or you have any other changes. They can prescribe cream or dressings to help and give you painkillers. The hair around your genital area will fall out. It usually grows back a few weeks after radiotherapy is finished.

The penis and scrotum may become swollen during treatment. This will gradually go away when treatment is finished.

• Late effects

Side effects occasionally develop months or years later after radiotherapy. Or some, such as tiredness, may not completely go away.

Radiotherapy to the lymph nodes increases the risk of developing swelling in one or both legs. This is called lymphoedema. You have more risk of lymphoedema if you have also had surgery to the lymph nodes. It can develop weeks, months or even years after treatment.

Look at the section above on removing the lymph nodes for information on reducing the risk of lymphoedema.

Always tell your doctor or specialist nurse if you have any swelling in your feet or legs. The earlier lymphoedema is diagnosed, the easier it is to manage.

Radiotherapy may cause thickening of healthy tissues (fibrosis). This may make the tube that carries urine through the penis (the urethra) narrower and make it difficult to pass urine. This can be treated with a simple operation to stretch (dilate) the urethra. Let your doctor know straight away if you have difficulty passing urine. We have more information about radiotherapy we can send you.

Chemotherapy 

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells.

Chemotherapy is most often given as tablets or into a vein.

It may be given:

• to control the cancer and improve symptoms if it has spread to other parts of the body
• along with radiotherapy (chemoradiation) to help it work better 
• before surgery to make it easier to remove the cancer
• after surgery to reduce the risk of the cancer coming back.

Usually a chemotherapy nurse will give you chemotherapy by injection into a vein (intravenously). You have it in a chemotherapy day unit. You might be given one drug or several drugs used together.

Chemotherapy can make you more likely to get an infection. Your chemotherapy nurse will give you advice about this. Some other possible side effects include tiredness, feeling sick, hair loss and a sore mouth. Your nurse will explain more about the side effects and how they can be managed. 

Chemotherapy may be given as a cream to treat very small, early cancers on the foreskin or on the head of the penis (glans). This doesn’t cause the side effects you get with chemotherapy into a vein. Your nurse will explain more about this.

Clinical trials

Research is going on all the time to try to find the best way of treating cancer of the penis. Cancer specialists compare different treatments or assess new ones to know which treatment is best. This is called a clinical trial. 

Before any trial takes place it’s discussed and approved by several committees. This is to make sure that the trials are safe and that everyone receives the same standard of treatment.

You may be invited to take part in a clinical trial. Your doctor must discuss the treatment with you so that you have a full understanding of the trial and what it involves. If you decide not to take part, or decide to withdraw from the trial at a later stage, you will still be given the best standard treatment available.

The effects on your sex life will depend on the treatment you have. Most treatments for cancer of the penis don’t affect being able to have sex. 

Treatment for early cancer is unlikely to affect your sex life. Men who have part of the penis removed may still get erections. This will depend on how much tissue has been taken away. Men who have had the whole penis removed will find their sex life is affected. But it is still possible to find different ways of being sexual with your partner. Some men are still able to get an erection after reconstructive surgery.

It can take time to recover from the side effects of radiotherapy or chemotherapy before you feel ready to have sex. Radiotherapy may cause difficulties getting an erection, but this is usually temporary.

Coping with changes to your sex life and how you feel about your body (body image) can be distressing. It often takes time to adjust. It’s important to try to talk openly with your partner, if you have one, about your feelings. A specialist nurse or counsellor can help you to talk things over.

Talk to your doctor or specialist nurse if you are having difficulties. They can give you support or refer you to a counsellor or sexual therapist. You can also get in touch with one of the organisations we mention below.

We have more information about sexuality and cancer for men. We also have information on body image and cancer.

After your treatment is finished, you’ll have regular check-ups. These will involve visits to the hospital, examinations by your surgeon or cancer specialist, and possibly scans or x-rays. These usually continue for several years. If you have any problems, or notice any new symptoms between these appointments, let your doctor know as soon as possible.

You may have many different emotions, including anger, resentment, guilt, anxiety and fear. These are all normal reactions and are part of the process many people go through in trying to come to terms with their condition.

Everyone has their own way of coping with difficult situations. Some people find it helpful to talk to family or friends, while others prefer to seek help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope, but help is there if you need it. Our cancer support specialists can give you information about counselling in your area.