The stage and grade of penile cancer describes its size, whether it has spread and how quickly it may develop.

Staging of penile cancer

The stage of penile cancer (cancer of the penis) describes:

  • where it is
  • how far it has grown into the penis
  • if it has spread.

Sometimes it also includes the grade of the tumour. The grade describes how the cancer cells look under a microscope.

Knowing the stage and grade of the cancer helps you and your specialist doctor decide on the best treatment for you.

TNM staging

The most commonly used staging system is the TNM system:

  • T describes where the tumour (cancer) is on the penis and how far it has grown.
  • 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).

Tumour

The T stages are sometimes split further to give more detailed information, or to include the grade:

  • Tis or carcinoma in situ (CIS) means the cancer cells are only in the top layer of skin.
  • Ta means the cancer looks like a wart, but is still only in the top layer of skin.
  • T1a means the tumour has grown into tissue just below the top layer of skin, but not any further. It is also a grade 1 or 2 tumour (see below).
  • T1b means the tumour has grown into blood vessels, lymph vessels or nerves, or it is a grade 3 tumour (see below).
  • T2 means the tumour has grown into the spongy tissue of the penis. It may also have grown into the urethra.
  • T3 means the tumour has grown more deeply into the penis. It may also have grown into the urethra.
  • T4 means the tumour has spread more deeply into the penis and into nearby areas such as the scrotum.

Nodes

There are four N stages:

  • N0 means there is no cancer in the lymph nodes.
  • N1 means there is cancer in one lymph node in the groin.
  • N2 means the cancer is in at least two lymph nodes in the groin, or in lymph nodes on both sides of the groin.
  • N3 means the cancer has spread into the tissue around the groin lymph nodes or has spread to lymph nodes in the pelvis.

Metastasis

There are two M stages:

  • M0 means the cancer has not spread to other parts of the body.
  • M1 means the cancer has spread to other parts of the body, such as the liver or the lungs.

Sometimes the TNM stage is combined to give the cancer a number stage from 0 (Tis) to 4. The higher the number, the more advanced the cancer is.

Other terms used

Your doctor may use other terms to describe the cancer:

  • Early means a cancer that has not spread outside the penis.
  • Locally advanced means the cancer has spread more deeply into the penis and the lymph nodes in the groin.
  • Secondary cancer means the cancer has spread to other parts of the body.

Grading of penile cancer

The grade of a cancer is based on how the cancer cells look under a microscope. It gives an idea of how quickly the cancer might grow and how likely it is to spread.

Cancer of the penis is graded from 1 to 4. It can also be described as low-grade or high-grade:

  • Low-grade (grade 1 and 2) means the cancer cells look similar to normal cells. They are slow-growing and less likely to spread.
  • High-grade (grade 3 and 4)means the cancer cells do not look like normal cells. They are likely to grow more quickly and spread.