Penile cancer

What is penile cancer?

Penile cancer is also known as cancer of the penis. Penile cancer is rare. Around 700 people are diagnosed each year in the UK. Almost all cancers of the penis are squamous cell cancers. Squamous cells are found in the skin. They cover the surface of most parts of the body.

Rarely, other types of cancer can affect the penis. These include types of skin cancer such as basal cell carcinomas and malignant melanomas.

Most penile cancer is diagnosed over the age of 50. But it can also affect those who are younger.

The penis

The penis is one of the male urinary and sex organs. It is made of different types of tissue, such as skin, muscle and nerves. The penis has 3 main areas:

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

During sexual arousal, blood flow to the penis increases. This makes it hard and erect. The penis also contains a tube called the urethra. The urethra carries semen (sperm) from the testicles and urine (pee) from the bladder out of the body.

The illustration shows a male body from the side. The lower abdomen, pelvis and upper part of the thigh are shown. The penis is shown hanging down outside the front of the body. At the end of the penis is a rounded structure called the glans or the head of the penis. There is a layer of skin covering the glans. This is called the foreskin. The main part of the penis, between the glans and where it joins the lower abdomen, is called the shaft. Behind the penis, a small solid oval organ is shown hanging below the body in a pocket of skin. This is the testicle in the scrotum. Inside the body a rounded hollow organ is shown. This is the bladder. It is behind and above the penis. Below the bladder is a smaller, rounded hollow organ. This is the prostate. A thin tube leaves the lower end of the bladder. This is the urethra. It travels through the prostate, down the centre of the penis to an opening at the tip of the penis. — Image: MACD045 The penis and surrounding organs

If you are transgender or non-binary

The information on this page may be helpful to you if:

you are a transgender (trans) woman or a non-binary person assigned male at birth
you have a penis.

It is not written for people who have had:

genital gender-affirming surgery to make a penis
surgery to make a vagina using tissue from the penis.

We have more information for transgender and non-binary people, including cancer risk, symptoms and screening, and what to expect from your healthcare team.

Related pages

What is cancer?

Symptoms of penile cancer

Signs and symptoms of penile cancer can include:

a growth or sore (ulcer) anywhere on the penis
thickening or raised areas anywhere on the penis
changes in the colour of the skin, such as 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. You should always see your GP straight away if you have any of these symptoms or any other changes. Penile cancer is easier to treat if it is diagnosed early.

Causes of 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.

We have more information about the causes and risk factors of penile cancer.

How penile cancer is diagnosed

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

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.

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

This is a rare type of cancer. So 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:

CT scan

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

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 us 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.

Ultrasound scan

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.
Fine needle aspiration (FNA)

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.
Removing a sample of lymph nodes

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 1 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.
Sentinel lymph node biopsy (SLNB)

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 are 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 do not contain cancer, it is very unlikely that any other lymph nodes will. This means you will not need to have any more lymph nodes removed. If there are cancer cells in any sentinel nodes, you will need more surgery. This will remove all the lymph nodes in the affected area.

Waiting for test results can be a difficult time, we 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 the 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.

Penile cancer treatment

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

Your doctor, cancer specialist or nurse will explain the different treatments and their side effects. They will also talk to you about things to consider 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 than penile cancer. We have more information about treatment for Tis.

The main treatments for penile cancer include:

Surgery

Surgery is the main treatment for larger cancers of the penis. Depending on their position, small early cancers can also be treated with minor surgery.
Chemotherapy
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 to make it easier to remove

after surgery, to reduce the risks of cancer coming back

to treat cancer that has spread to other parts of the body.
Radiotherapy

Radiotherapy uses high-energy rays to destroy cancer cells. It is sometimes used instead of chemotherapy. Not everyone who has penile cancer will have radiotherapy. Sometimes, it is used instead of chemotherapy or surgery. This is usually if the cancer has spread to other parts of the body.

Radiotherapy may be given after surgery to remove lymph nodes in the groin. This is to reduce the risk of cancer coming back in this area.

We have more information about how radiotherapy is used to treat penile cancer.
Chemoradiation

You may have chemotherapy at the same time as radiotherapy to make it work better. This is called chemoradiation.

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

We have more information about how different treatments are used to treat penile cancer.

After penile cancer treatment

After your treatment, you will have regular follow-up appointments with your surgeon or cancer specialist. They will 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. This 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 is also here to support you. If you would like to talk, you can:

Call the Macmillan Support Line on 0808 808 00 00.
Chat to our specialists online.
Visit our penile cancer forum to talk with people who have been affected by penile cancer, share your experience, and ask an expert your questions.

Relationships and sex

Your doctor or nurse will explain any possible effects your treatment may have on your sex life. If you have an early-stage cancer, treatment is unlikely to directly affect your sex life.

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

After surgery
Sometimes surgery for penile cancer can affect your sex life. This may depend on:

the type of surgery you’ve had

how this has impacted your physical and emotional well-being.

We have more information about penile cancer surgery and how this may affect your sex life.
After radiotherapy

It can take time to recover from the side effects of radiotherapy before you feel ready to have sex. 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.
After chemotherapy

If you are having chemotherapy into a vein, it will not have a direct effect on your sex life. But side effects, such as tiredness, may mean you do not feel like having sex. You may find this slowly improves after treatment finishes.

Your doctor will advise you not to make someone pregnant while having chemotherapy. The drugs may harm the developing baby. It is important to use effective contraception during your treatment.

Late effects after radiotherapy

Some people may get side effects months or years after radiotherapy treatment. These are called late effects.

After radiotherapy, the healthy tissue in the penis may get thicker. This can cause narrowing of the tube that carries urine through the penis. This tube is called the urethra. If this happens, you may find it difficult to pass urine. This can be treated with a simple operation to stretch the urethra. If you have difficulty passing urine, tell your doctor straight away.

We have more information about the late effects of pelvic radiotherapy.

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

Well-being and recovery

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

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

Related pages

Finishing treatment

About our information

References

Below is a sample of the sources used in our penile cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

EAU Guidelines: Penile Cancer. Available from: uroweb.org/guideline/penile-cancer (accessed May 2022).

Penile cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow up. Available from: www.annalsofoncology.org/article/S0923-7534(19)31556-X/pdf (accessed May 2022).

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Ursula McGovern, Consultant Medical Oncologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

use plain English
explain medical words
use short sentences
use illustrations to explain text
structure the information clearly
make sure important points are clear.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.