Penile Cancer

Overview

What is penile cancer?

Penile cancer develops when malignant cells in your penis grow out of control. Your penis is a rod-shaped reproductive organ that allows you to pee and have sex. Its main parts include the rod-like part (shaft) that extends from your low belly to the tip of your penis, called the head, or glans. If you’re uncircumcised, a layer of skin called the foreskin covers the head. If you’re not circumcised, the head of your penis is exposed.

Cancer can form anywhere in your penis, but it most commonly starts on the head or foreskin (if you’re uncircumcised).

What are the types of penile cancer?

Ninety-five percent of penile cancers are squamous cell carcinoma (SCC). This type of cancer forms in the top part of your skin layer called the epithelium. Other, less common types of penile cancer form in different types of tissue:

  • Basal cell carcinoma (BCC): Cancer begins in the bottom layer of your epithelium. BCC is a slow-growing form of penile cancer.
  • Melanoma: This cancer begins in cells that control how dark or light your skin is, called melanocytes. Melanoma is a more aggressive form of cancer.
  • Sarcoma: Cancer develops in muscle or connective tissue. It’s an extremely rare form of penile cancer.

How common is penile cancer?

Penile cancer is rare in the United States, accounting for less than 1% of cancers among people with penises. However, it’s more common in other countries. Penile cancer accounts for more than 10% of cancers among people assigned male at birth (AMAB) in Africa, Asia and South America.

At what age does penile cancer usually occur?

Cancer is most commonly diagnosed in people over 55, but people under 40 can also get it. The average age of diagnosis is 60.

Symptoms and Causes

What are the symptoms of penile cancer?

Not all cancers cause changes you can see, but penile cancer usually causes your penis to look different. The skin on your penis may become discolored, and you may notice a lump.

Signs and symptoms of penile cancer include:

  • A painless lump or sore (that may bleed).
  • Swelling and irritation, especially in the head of your penis (balanitis).
  • Skin thickening or changing skin color.
  • Flat growths that look blueish-brown.
  • Foul-smelling fluid underneath your foreskin.
  • Small, crusty bumps.
  • Rash.

Less serious conditions like infections and allergic reactions also cause these symptoms. Still, don’t leave things to chance. It’s better to have your healthcare provider take a look so early-stage cancer doesn’t go untreated.

What causes penile cancer?

With penile cancer, a healthy cell in your skin changes to become a cancer cell. Cancer cells multiply out of control, forming a mass called a tumor. These cells can crowd out healthy cells. Over time, cancer cells can spread to other parts of your body, damaging healthy tissue and organs.

Researchers don’t know what causes the change that transforms a healthy cell into a cancer cell, but they’ve discovered several risk factors. A risk factor doesn’t cause penile cancer, but it increases the possibility.

What are the risk factors for penile cancer?

The most significant risk factor for penile cancer is age. About 80% of penile cancer diagnoses in the U.S. occur in people 55 or older. Not being circumcised when you were an infant may also increase your risk. Circumcision removes the foreskin of your penis, exposing the head. Many risk factors related to penile cancer are likely related to having a foreskin.

Phimosis

Phimosis is common in uncircumcised infants but rare in uncircumcised adults. It’s a condition that causes your foreskin to become so tight that you can’t retract it (pull it back) to access the head of your penis. It’s possible that phimosis lasting into your adulthood increases the risk of infection and inflammation beneath your foreskin. Both may increase your cancer risk.

HPV

Many of the same high-risk strains of the human papillomavirus (HPV) that cause cervical cancer have been found in people with penile cancer. The HPV associated with cervical and penile cancer is a sexually transmitted virus (STI). Although HPV is present in nearly all instances of cervical cancer, it’s present about half the time in people with penile cancer. Still, HPV infection is a significant risk factor for penile cancer.

HIV

Penile cancer is more common in people with HIV (human immunodeficiency virus). Researchers aren’t sure why. It’s possible that the same sexual behaviors that increase a person’s risk of HPV (for example, unprotected sex, multiple partners, etc.) also increase the risk of HIV infection. It’s possible, too, that HIV infection alone increases cancer risk. Research is ongoing.

Tobacco use

Smoking cigarettes, chewing tobacco or using snuff increases your penile cancer risk. Tobacco may slow your body’s ability to fight infection, raising your risk. Tobacco use may damage cells, causing changes that lead to cancer.

PUVA treatment

PUVA stands for psoralen and ultraviolet A photochemotherapy. It’s a type of treatment for psoriasis that uses radiation. Receiving this treatment can increase your risk of penile cancer. More radiation exposure means greater risk.

Lichen sclerosus

Lichen sclerosis (LS) is an inflammatory disorder that may cause the head of your penis or your foreskin to feel painful, irritated or itchy. If you have LS, you’re at an increased risk of penile cancer. Lichen sclerosus may also increase your risk of HPV infection.

Poor hygiene

Not washing your penis frequently or thoroughly may increase your risk of smegma. Smegma is a build-up of fluids your body secretes naturally. If you’re uncircumcised, smegma can collect beneath your foreskin and become thick and smelly. Researchers once thought that smegma had cancer-causing properties, but this isn’t the case. It’s more likely that smegma leads to irritation and inflammation that may increase cancer risk.

Is penile cancer contagious?

Penile cancer isn’t contagious. However, HPV — one of the risk factors for penile cancer — is transmitted through skin-to-skin contact (most often) during unprotected sex. HPV spreads through vaginal sex, oral sex and anal sex.

Diagnosis and Tests

How is penile cancer diagnosed?

Your healthcare provider may perform the following to determine whether you have cancer:

  • Physical exam and history: Your healthcare provider will examine you to check for unusual skin changes, like a lump or discoloration on your penis. They’ll also ask about your symptoms, habits and past illnesses. This information can help your healthcare provider determine whether the changes likely result from cancer or a more common cause like an infection or allergic reaction.
  • Biopsy: A biopsy is the only way to confirm a cancer diagnosis. During the procedure, your healthcare provider removes suspicious-looking cells or tissues. A specialist who works in a lab (pathologist) views the cells under a microscope to check for signs of cancer.
  • Imaging: You may need imaging to see how much the cancer’s spread. Depending on your cancer, your healthcare provider may order a CT scan, MRI, ultrasound, PET scan, or chest X-ray.

What are the stages of penile cancer?

Imaging helps your healthcare provider stage your cancer. Cancer staging allows them to classify how serious cancer is, based on the size of a tumor and how much it’s spread throughout your body. This information guides treatment decisions.

Penile cancer is staged using the TNM staging system. Each letter provides unique information about your cancer.

  • T (Tumor): “T” provides information about your tumor, including whether the cancer cells have formed a tumor and (if so) how much it’s grown into your penis.
  • N (Lymph nodes): “N” provides information about whether the cancer has spread to your lymph nodes. If it has, your healthcare provider can note which lymph nodes are affected.
  • M (Metastasize): “M” provides information about whether the cancer has spread to other organs in your body. If it has, your healthcare provider can note which organs are affected.

Numbers following the letters (TNM) provide additional information about the tumor, lymph nodes affected and whether the cancer has metastasized. The numbers range from 1 to 4, with 1 meaning less cancer spread and 4 meaning the most spread (metastasis).

Cancer staging can be complex, but it communicates important information about how serious your condition is. Talk to your healthcare provider about what stage of cancer you have. Ask about what your cancer stage means for your treatment and likely outcomes.

Management and Treatment

How is penile cancer treated?

Your treatment will depend on the size of the tumor, whether it’s spread and how likely it is that the cancer will return (recur) after treatment. Treatment may involve a care team that includes your primary care provider, a cancer specialist (oncologist), a urinary tract specialist (urologist) and a skin specialist (dermatologist).

For cancer that’s in earlier stages, your healthcare provider may recommend one or a combination of the following treatments:

  • Medicated creams: Your healthcare provider may recommend a cream that you regularly apply to your penis. Common medicines include fluorouracil and imiquimod.
  • Circumcision: If the cancer is only on your foreskin, your healthcare provider may remove the tissue.
  • Laser ablation: This procedure uses lasers that create extreme heat to destroy the tumor.
  • Cryotherapy: This procedure uses extreme cold to destroy the tumor.
  • Mohs surgery: During this procedure, your healthcare provider removes cancerous skin layer by layer until arriving at the healthy tissue underneath.
  • Excision: Your healthcare provider may cut the cancer cells or tumor from your penis.
  • Radiation therapy: Your healthcare provider may use energy beams, like X-rays, to destroy cancer cells or shrink a tumor before surgery.

For cancer that’s more advanced, your healthcare provider may recommend:

  • Penectomy: A partial penectomy removes part of your penis. A total penectomy removes your entire penis. For a total penectomy, your healthcare provider will create an opening in your abdomen or the skin between your anus and scrotum (perineum) so you can pee.
  • Lymphadenectomy: Your healthcare provider may remove your lymph nodes (most commonly in your groin area) if the cancer’s spread there.

Your healthcare provider may use radiation, chemotherapy or both to shrink cancer cells before performing surgery.

Prevention

How can I reduce my risk of penile cancer?

To reduce your risk of penile cancer, consider the following:

  • Weigh the benefits of circumcision. Circumcising an infant reduces their risk of penile cancer as an adult. Research suggests less benefit if circumcision takes place after a person has become sexually active. It’s important to weigh the medical benefits of circumcision against other deciding factors, like religious beliefs and cultural and individual preferences. Talk through the benefits with your healthcare provider as you consider the best options for yourself or your newborn.
  • Get treated for phimosis. Phimosis in uncircumcised adults has many potential causes, ranging from infections to poor hygiene. Identifying the cause and receiving prompt treatment can reduce your risk of penile cancer.
  • Get the HPV vaccine. The Food and Drug Administration (FDA) has approved three vaccines for preventing high-risk HPV: Gardasil, Gardasil-9 and Cervarix. Ideally, you should get vaccinated between ages 9 and 26 or before you become sexually active. If you’re older than 26, speak to your healthcare provider about the potential benefits of vaccination.
  • Practice safer sex. Condoms and dental dams can’t fully protect you from HPV infection. Still, using them consistently and correctly and limiting your number of sexual partners can reduce your risk of HPV infection.
  • Don’t use tobacco products. Choosing not to smoke, dip, etc., reduces your risk of penile cancer and many other types of cancer.
  • Practice good hygiene. Good hygiene is an important part of having a healthy penis. Cleaning your penis regularly with mild soap and warm water can wash away germs that can cause inflammation or infection. If you’re uncircumcised, pull back your foreskin and clean the head of your penis to prevent smegma build-up.

Outlook / Prognosis

What can I expect if I have penile cancer?

Your chance of recovery and care plan depend on the following:

  • The stage of cancer.
  • The location and size of the tumor.
  • Whether the cancer has just been diagnosed or has recurred (come back).

Catching cancer early means that it’s easier to treat and cure. Catching it later means there’s a greater chance that it’s spread beyond your penis. At this point, penile cancer becomes much harder to treat.

Is penile cancer fatal?

Penile cancer can be fatal, especially if it’s spread beyond your penis. You can reduce your risk by putting good habits into place, like practicing safer sex and avoiding tobacco products. See your healthcare provider at the first sign of a change in your penis, like a lump or discoloration.

Living With

How do I take care of myself?

Talk to your healthcare provider about how your cancer and treatment plan may impact your everyday life. Many cancer treatments preserve the penile tissue. This means that your penis eventually heals to look the same after treatment, or very similar, as it did before. You can still pee standing. You can still get an erection, have sex and orgasm.

Surgery to remove part or all of your penis may change the way you pee and your experience of sex.

Penile cancer and penile cancer treatment can unfold in various ways. Knowing what to expect can help you prepare for various potential scenarios. Speak openly with your healthcare provider about any questions you have.

What questions should I ask my doctor?

  • What stage is my cancer?
  • Would you suggest getting a second opinion?
  • What treatment would you recommend?
  • What are the potential benefits/risks associated with this treatment?
  • What should I expect during the recovery period?
  • What lifestyle changes should I expect following treatment?
  • Which specialists will I need to see for treatment?
  • How likely is it that my cancer will return after treatment?

A note from Cleveland Clinic

Penile cancer develops when malignant cells in your penis grow out of control. If you notice changes in your penis, schedule a visit with your healthcare provider. It’s easy to postpone making an appointment when you know the visit will involve a close examination of your genitals. But delays only give cancer time to progress. Catching cancer early means there’s a much better chance that your healthcare provider can treat it. There’s also a much better chance that these treatments won’t change how your penis looks and functions. If the changes aren’t related to cancer, your healthcare provider can put your mind at ease.

Last reviewed by a Cleveland Clinic medical professional on 05/19/2022.

References

  • Catalfamo CJ, Brown HE, Dennis LK. Evaluating the strength of association of human papillomavirus infection with penile carcinoma: a meta-analysis (https://pubmed.ncbi.nlm.nih.gov/35082241/) [published online ahead of print, 2022 Jan 25]. Sex Transm Dis. 2022;10.1097/OLQ.0000000000001606. Accessed 5/19/2022.
  • Coba G, Patel T. Penile Cancer: Managing sexual dysfunction and improving quality of life after therapy. (https://pubmed.ncbi.nlm.nih.gov/33420966/) Curr Urol Rep. 2021 Jan 9;22(2):8. Accessed 5/19/2022.
  • Marchioni M, Berardinelli F, De Nunzio C, et al. New insight in penile cancer. (https://pubmed.ncbi.nlm.nih.gov/30230297/) Minerva Urol Nefrol. 2018 Dec;70(6):559-569. Accessed 5/19/2022.
  • Morris BJ, Kennedy SE, Wodak AD, et al. Early infant male circumcision: Systematic review, risk-benefit analysis, and progress in policy. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5296634/) World J Clin Pediatr. 2017;6(1):89-102. Published 2017 Feb 8. Accessed 5/19/2022.
  • National Cancer Institute. Penile Cancer. (https://www.cancer.gov/types/penile) Accessed 5/19/2022.

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