Cancer of the penis (penile cancer)

Cancer of the penis is rare in Europe and the USA, but is more common in South East Asia, parts of Africa, and India. Approximately 400 men are diagnosed with this type of cancer in the UK each year. It is most often diagnosed in men over the age of 60 years.

Causes

The exact cause of cancer of the penis is unknown. It is thought to be related to general hygiene and is much less common in men who have had all or part of their foreskin removed (been cirumcised) soon after birth. This is because men who have not been circumcised may find it more difficult to pull back the foreskin enough to clean thoroughly underneath. The human papilloma virus (HPV) that causes penile warts also increases the risk of cancer of the penis.

Some skin conditions that affect the penis can go on to develop into cancer if they are left untreated. If you notice white patches, red scaly patches, or red moist patches of skin on your penis, it is important to see your doctor so that you can get any treatment that you need.

Cancer of the penis is not infectious and cannot be passed on to other people. It is not caused by an inherited faulty gene and so other members of your family are not likely to develop it.

Signs and symptoms

The first signs of a penile cancer are often a change in colour of the skin and skin thickening. Later symptoms include a growth or sore on the penis, especially on the glans (head of the penis) or foreskin, but also sometimes on the shaft of the penis. There may be a discharge or bleeding. Most penile cancers are painless.

Sometimes the cancers appear as flat growths that are bluish-brown in colour, or as a red rash, or small crusty bumps. Often the cancers are only visible when the foreskin is pulled back.

These symptoms may occur with conditions other than cancer. Like most cancers, cancer of the penis is easiest to treat if it is diagnosed early, so if you have any worries it is best to go to your doctor straight away.

How it is diagnosed

Your GP will examine you and may then refer you to a hospital specialist for advice and treatment.

The specialist will examine the whole of the penis and the lymph nodes in your groin. If the cancer has spread to the lymph nodes they may be enlarged. To make a firm diagnosis, the doctor will take a sample of tissue (a biopsy) from any sore or abnormal areas on the penis. This will usually be done under a local anaesthetic so that the area is numb. The biopsies will be examined under a microscope.

Further tests

If the biopsy shows that you have cancer, your doctor may want to do some further tests to check whether or not the cancer has spread. Cancer can spread in the body, either in the bloodstream or through the lymphatic system. The lymphatic system is part of the body's defence against infection and disease. The system is made up of a network of lymph glands (also known as lymph nodes) that are linked by fine ducts containing lymph fluid. The results of these tests will help the specialist to decide on the best type of treatment for you.

Chest x-ray A chest x-ray is usually done to check whether or not the cancer has spread to the lungs.

CT (computerised tomography) scan A CT scan is a specialised type of x-ray. A series of pictures is taken and fed into a computer to build up a detailed picture of the inside of the body. The scan can show whether or not the cancer has spread to other parts of the body. It is painless and takes 10–30 minutes.

Lymph node biopsy If you have any enlarged lymph nodes in the groin, your doctor may put a needle into the node to get a sample of cells. This is to see whether or not the enlargement is due to cancer. Enlarged lymph nodes are often due to infection and not cancer, so your doctor may also give you a course of antibiotics to see whether or not the swollen nodes shrink.

Staging and grading

Staging

The stage of a cancer is a term used to describe its size and whether or not it has spread beyond its original site. Knowing the particular type and the stage of the cancer helps the doctors to decide on the best treatment for you.

• Stage 1 The cancer only affects the skin covering the penis, the head of the penis (glans) or the foreskin.
• Stage 2 The cancer has begun to spread into the shaft of the penis or into one of the lymph nodes in the groin.
• Stage 3 The cancer has spread deep into the shaft of the penis or to many lymph nodes in the groin.
• Stage 4 The cancer has spread to lymph nodes deep in the pelvis, or to other parts of the body.

If your cancer comes back after initial treatment, this is known as recurrent cancer.

Grading

Grading refers to the appearance of the cancer cells under the microscope and gives an idea of how quickly the cancer may develop. Low-grade means that the cancer cells look very like normal cells; they are usually slow-growing and are less likely to spread. In high-grade tumours, the cells look very abnormal, are likely to grow more quickly, and are more likely to spread.