Penis

This information should not be used for self-diagnosis or in place of a qualified physician's care.

Reviewed Sept 2016

The basics

Guidelines for treating this cancer have been developed by the Genitourinary Tumour Group.
For health professional information on treating this cancer, please see our Cancer Management Guidelines.
Other names for this type of cancer are penile cancer or cancer of the penis.
The penis is the external sexual organ and is part of the urinary system.

What causes it and who gets it?

Listed below are some of the known risk factors for this cancer. Not all of the risk factors below may cause this cancer, but they may be contributing factors.

Penis cancer is rare in Canada and the United States.
People aged 50-70 are at a greater risk of penis cancer.
Risk of penis cancer is greater among people who were never circumcised, compared with those who were circumcised at birth.
Those who do not regularly clean under the foreskin (loose skin covering the head of the uncircumcised penis) are more at risk.
Risk of penis cancer is greater for smokers than non-smokers.
People with a lifetime history of 30 or more sexual partners are more likely to have penis cancer.
People with a history of penile rash or a sexually transmitted disease, such as Human Papillomavirus (HPV) or genital warts, are more at risk.
Sexual intercourse with someone with cervical cancer does not cause penile cancer.
Statistics (Penile cancers are very rare and statistics are not published separately for this cancer. Instead, numbers are included with a group of related cancers under "Genital Cancers":
^{NOTE: Available statistics do not have information about the inclusion of transgender and gender diverse participants. Unless specified, it is unknown how these statistics apply to transgender and gender diverse people. Patients are advised to speak with their primary care provider or specialists about their individual considerations and recommendations.}

Can I help to prevent it?

Uncircumcised individuals should retract (pull back) the foreskin and thoroughly wash the penis on a regular basis, in order to make sure that smegma (a substance that is caused by dead skin cells, bacteria, and oily secretions from the skin) does not cause irritation of the penis.
Routine sexual health screening is recommended for all sexually active adults.
Practice safer sex by using a new condom every time you have vaginal, anal or oral sex.
It's best to get immunized against HPV (human papillomavirus) before becoming sexually active; however, people who are sexually active may still benefit from vaccination. Detailed information is available on the Immunize BC website.
To reduce your risk, don’t smoke, and avoid exposure to tobacco and cigarette smoke. Even if you have been using tobacco for many years, quitting will reduce your cancer risk. Support is available to help you successfully quit. Visit the BC Cancer Agency’s Prevention page on Tobacco for information and resources.

Screening for this cancer

No effective screening program exists for penile cancer yet.

Signs and Symptoms

Sore or ulcer on the tip of the penis that does not heal; any lesion or sore on the penis should be checked by a doctor
Lump in the groin
Discharge from the penis which may irritate and itch
Bleeding upon erection

Diagnosis & staging

Diagnosis

These are tests that may be used to diagnose this type of cancer.

Physical examination
Biopsy (usually done under local anaesthetic)
Circumcision (removal of foreskin) may be necessary to remove the tumour or to expose the lesion for biopsy
CT scan of pelvis
Chest X-ray

For more information on tests used to diagnose cancer, see our Recommended Websites, Diagnostic Tests section.

Types and Stages

Types

95% of penis cancers are squamous cell carcinomas.
Other types of penile cancer include melanomas and sarcomas.

Stages
Staging describes the extent of a cancer. The TNM classification system is used as the standard around the world. In general, a lower number in each category means a better prognosis. The stage of the cancer is used to plan the treatment.

T describes the site and size of the main tumour (primary)

N describes involvement of lymph nodes

M relates to whether the cancer has spread (presence or absence of distant metastases

Stage 0
Carcinoma in-situ. The cancer has not spread below the surface layer of skin, and has not spread to any lymph nodes or distant sites.

Stage I
The cancer has spread to the connective tissue just under the surface layer of skin. It has not spread to any lymph nodes or distant sites.

Stage II
The cancer has spread to blood or lymph vessels and/or into the internal chambers of the penis and/or the urethra. It has not spread to any lymph nodes or distant sites.

Stage III
The cancer has spread to the urethra or prostate.

Stage IV
The cancer has spread to adjacent structures and may have spread to lymph nodes in the groin; the cancer has spread beyond lymph nodes in the groin or to pelvic lymph nodes; or the cancer has spread to distant organs.

Treatment

Cancer therapies can be highly individualized – your treatment may differ from what is described below.

If found and treated in the early stages, penis cancers have a five year survival rate of 85-90%.
If penis cancer has spread to lymph nodes in the groin, the five year survival rate is 30-40%.

Treatment by Stage

Stage 0

In-situ penis cancer can be treated by local excision (removal) alone, without sacrificing the penis.
In selected cases, it may be treated with laser therapy.

Stage I and early Stage II

If the cancer is only in the foreskin, it may be treated by circumcision alone.
A partial penectomy (surgery to remove part of the penis) may be necessary if the cancer is more extensive.
Radiotherapy may be a treatment option that can allow for preservation of the penis.
Brachytherapy may be another option that can allow for preservation of the penis.

This procedure is only available at the Vancouver Centre.

Stage II and early Stage III

Partial penectomy (surgery to remove part of the penis) or radical penectomy (surgery to remove the entire penis).
For patients whose medical condition does not permit surgery or where the patient does not wish to have surgery, radiotherapy to the pelvis is an alternative treatment.

Stage III and Stage IV

Exenterative surgery may be performed in select cases. This is a surgery that removes all organs from the pelvic cavity.
If surgery is not possible, palliative radiotherapy and/or chemotherapy may be used.

Follow-up after Treatment

Guidelines for follow-up after treatment are covered on our website.
You will be returned to the care of your family doctor or your specialist for regular follow-up. If you do not have a family doctor, please discuss this with your BC Cancer oncologist or nurse.
Follow-up testing is based on your type of cancer and your individual circumstances.
Life after Cancer focuses on the issues that cancer survivors can face.

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