Cancer of the penis

Penis cancer is uncommon. It usually affects men aged over 65. The most common type is squamous cell cancer.

Symptoms include:

  • a thickening or change in colour of the skin
  • a flat growth or sore on the penis
  • discharge or bleeding from the growth or sore.

These symptoms can be caused by other conditions, but it is best to get them checked by your GP.

If they think your symptoms may be caused by cancer, you will be referred to a hospital specialist. The specialist will examine your penis and groin. They may take a tissue sample (biopsy) to be tested. You may also have tests such as a CT or MRI scan.

Small, early cancers are sometimes treated with chemotherapy cream. Or you may be offered minor surgery or treatments that use heat or cold to destroy the cancer.

Large cancers may need surgery to remove them. It is usually possible to preserve the appearance of the penis. But sometimes part or all of the penis needs to be removed.

You may have radiotherapy instead of, or after, surgery. Chemotherapy is sometimes given before or after surgery, or if the cancer has spread.

The penis


What is penis cancer?

Penis cancer is rare. Almost all penis cancers are squamous cell cancers. Squamous cells are found in the skin and cover the surface of many parts of the body.

Very rarely, other types of cancer can affect the penis. These include basal cell carcinomas and malignant melanomas.

Most men diagnosed with penis cancer are aged over 65, but it can also affect younger men.

We hope this information answers your questions. If you have more questions, you can ask your doctor or nurse at the hospital where you are having your treatment.


Causes and risk factors of penis cancer

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 have been exposed to. Some types of HPV increase the risk of certain cancers. But most people with HPV do not develop cancer. HPV infection is often found in cancer of the penis. Some types of HPV cause genital warts, which increases the risk of penis cancer.

Having a tight foreskin that does not pull back easily (phimosis) is more common in men who have penis cancer. Cancer of the penis is less common in men who are circumcised (have all or part of their foreskin removed). The reason for this is not clear.

Smoking increases the risk of cancer of the penis.

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 moist red patches of skin on your penis.

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


Signs and symptoms of penis cancer

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 (ulcer) 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 is diagnosed early.


Diagnosing penis cancer

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 it won’t be painful at the time. You can take painkillers afterwards if you need to. The biopsy is examined under a microscope to look for signs of cancer.


Further tests for 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 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.

CT scan
CT scan

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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 (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 because of infection. Your doctor may arrange for you to have tests on the lymph nodes.

If a lymph node is bigger than normal, the doctor may put a needle into the node and withdraw some fluid into a syringe. This fluid is 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

This operation is usually done while you are asleep under a general anaesthetic.

The surgeon removes a sample of lymph nodes from one or both sides of the groin. They remove the nodes through a small cut in each side of the groin.

Sentinel lymph node biopsy (SLNB)

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


Staging and grading of penis cancer

The stage of a cancer describes its size and if 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 four N stages from N0 to N3:

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

There are two M stages – M0 and M1:

  • When the cancer has not spread to other parts of the body, it is M0.
  • If the cancer 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 means a cancer of the penis that that has not 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 based on how the cancer cells look under a 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 decide on the best treatments for you.

Cancer of the penis is graded from 1 to 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. They are slow-growing and less likely to spread.
  • High-grade (grade 3 and 4) – the cancer cells look more or very abnormal. They are likely to grow more quickly and spread.


Treatment for penis cancer

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 treatment options and their advantages and disadvantages to you. It is 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 cream containing chemotherapy called fluorouracil (5FU). Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. 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 will need to have surgery to remove part, or all, of the penis. It may be possible to 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 for penis cancer

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 is important to ask them any questions you have and talk about any concerns.

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 will be advised to stop or cut down before your operation. We have more information on giving up smoking. You are usually admitted to hospital on the day of your operation.

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.

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. It might be treated:

  • using lasers (heat) to cut away the cancer
  • by 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 is involved and how the operation is likely to affect 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 will pass urine when you are sitting down.

Having surgery to remove part or all of the penis may be distressing, but the team looking after you will support you. 

Changes in your appearance and how your body works can be difficult to cope with. It can affect your sexuality and how you see and feel about your body (your body image).  It is important to tell your doctor and specialist nurse how you feel, so that you can get the support you need. We have more information about sexuality and body image.

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 may take skin and muscle from your arm to make a new penis. They may be able to reconnect some of the nerves to allow you to get an erection in the new 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 sides of the groin. 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. There is more information about lymphoedema below.

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 after 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 will have a tube going into your groin to drain away extra fluid. It is connected to a small bottle. The nurses will remove it when there is 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 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, through 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 have 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 for penis cancer

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

  • if you are not well enough to have an operation, or you do not 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 person that operates the machine (the radiographer) will position you carefully on the couch and make sure you are 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 to 15 minutes. Treatments are usually given Monday to 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 is 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.

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 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 has finished.

The penis and scrotum may become swollen during treatment. This will gradually improve when treatment has finished.

Late effects

Side effects sometimes develop months or years later after radiotherapy.

The healthy tissues in the penis may become less flexible (fibrosis) after radiotherapy. 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.

Some men may develop ulcers on their penis because of changes in blood-flow. Tell your doctor if you notice any changes in the skin of your penis.

We have more information about radiotherapy.

Lymphoedema

Lymphoedema is swelling that develops because of a build-up of fluid in the body’s tissues. Lymphoedema develops when lymph nodes or vessels are damaged or if the lymph nodes have been removed by surgery.

Surgery to remove lymph nodes or radiotherapy to the lymph nodes can cause lymphoedema. If you have both treatments, the risk is greater.

Being active and keeping to a healthy weight can lower your risk of getting lymphoedema. There are other things that may also help:

  • Protect the skin on your legs and feet. Keep skin clean and use moisturising creams, such as E45 Cream, to stop it getting too dry. Wear long trousers if you are gardening to avoid being scratched, and do not get sunburnt. If you get any cuts or grazes on your feet or legs, use antiseptic cream and cover them up. See a doctor immediately if the area becomes red, warm or swollen.
  • Look after your feet. Wear footwear that fits well and do not walk around barefoot. Use nail clippers instead of scissors. Avoid standing for long periods, and put your feet up if you are sitting down.
  • Avoid temperature extremes. Do not 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.

Chemotherapy for penis cancer

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

Chemotherapy is usually given into a vein (intravenously). Some drugs may be given as tablets. It may be given:

  • to control the cancer and improve symptoms if it has spread to other parts of the body
  • 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.

You usually have chemotherapy drugs given into a vein (intravenously) at a chemotherapy day unit or clinic. A nurse will tell you what to expect and give you the chemotherapy. You may be there for a few hours, so take some things with you to help pass the time.

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 does not cause the side effects you may get with chemotherapy into a vein. Your nurse will explain more about this.

We have more information about chemotherapy.

Clinical trials for penis cancer

Cancer research trials are carried out to try to find new and better treatments for cancer. You may be asked 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 means to take part. Our information about clinical trials may help you decide.


Sex after cancer of the penis

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

Treatment for early penis 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.

Not having a penis can be very difficult to come to terms with. But you may find new ways to enjoy sexual activity. The areas around your scrotum and testicles will still be sensitive. You may still be able to have orgasms through stroking and other stimulation.

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. If you have a partner, it is important to try to talk openly with them about your feelings. A specialist nurse or counsellor can help you 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 a support organisation such as Orchid or the College of Sexual Relationship Therapists.

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


Follow-up

After your treatment is finished, you will have regular check-ups. These will involve visits to the hospital, examinations by your surgeon or cancer specialist, and possibly scans or blood tests. 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.


Your feelings

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.

Our online community is also a good place to meet people who may be in a similar situation.