Staging and grading 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.

We understand that waiting to know the stage and grade of your cancer can be a worrying time. We're here if you need someone to talk to. You can:

• Call the Macmillan Support Line on 0808 808 00 00.
• Chat to our specialists online.

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).

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.

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.

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.

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.

Due to the pandemic, there have been delays in us updating this information as quickly as we would have wanted. Our team is working hard to put this right.

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

We try to make sure our information is as clear as possible. We use plain English, avoid jargon, explain any medical words, use illustrations to explain text, and make sure important points are highlighted clearly.

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. Our aims are for our information to be as clear and relevant as possible for everyone.

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