Penile Cancer

What is penile cancer?

Penile cancer develops when healthy cells in your penis change and 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 area (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 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).

Like many cancers, penile cancer is most treatable when diagnosed early. In many cases, it’s curable. If you notice something doesn’t seem quite right, tell a healthcare provider right away. Early detection is key.

Types of penile cancer

Some types of penile cancer, listed from most to least common, include:

• Squamous cell carcinoma (SCC). This cancer forms in the top part of your skin layer (epithelium). It makes up 95% of all penile cancers.
• Melanoma. This type of cancer begins in cells that control how dark or light your skin is, called melanocytes. Melanoma is a more aggressive form of cancer.
• Basal cell carcinoma (BCC). The cancer begins in the bottom layer of your epithelium. BCC is a slow-growing form of penile cancer.
• Adenocarcinoma. This cancer starts in your glandular cells (cells that make sweat, mucus or other body fluids).
• Urothelial carcinoma. This cancer forms in your urothelium (the tissue that lines your bladder, kidneys and other parts of your urinary system).
• Sarcoma. This type of 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, making up less than 1% of cancers among males. The condition is more common in Africa, Asia and South America.

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.

Penile cancer symptoms include:

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

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

What causes penile cancer?

Cancer happens when healthy cells change and multiply out of control. But researchers don’t know what causes that change to begin with.

While researchers haven’t found causes, they’ve identified risk factors.

Risk factors

A risk factor doesn’t cause penile cancer, but it may increase the possibility. Penile cancer risk factors are:

• Being 55 or over. About 80% of penile cancer diagnoses in the U.S. occur within this age range.
• Being uncircumcised. Circumcision removes the foreskin of your penis, exposing the head. Many risk factors related to penile cancer are likely related to having a foreskin.
• HPV (human papillomavirus). Many of the same high-risk strains of HPV that cause cervical cancer have been found in men with penile cancer.
• HIV (human immunodeficiency virus). Researchers aren’t sure why, but penile cancer is more common in men with HIV.
• Lichen sclerosus (LS). This is an inflammatory disorder that may cause the head of your penis or your foreskin to feel painful, irritated or itchy.
• Phimosis. This condition causes your foreskin to become so tight that you can’t retract it (pull it back) to access the head of your penis.
• Poor hygiene. Not washing your penis frequently or thoroughly enough may increase your risk of smegma. The resulting irritation and inflammation may increase your cancer risk.
• PUVA treatment. PUVA stands for “psoralen and ultraviolet A photochemotherapy.” It’s a type of treatment for psoriasis that uses radiation.
• Tobacco use. Smoking cigarettes, chewing tobacco or using snuff can slow your body’s ability to fight infection, raising your cancer risk. Tobacco may also damage cells, causing changes that lead to cancer.

How is penile cancer diagnosed?

A healthcare provider may do the following:

• Exam. A 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.
• Imaging test. You may need imaging tests to see if the cancer has spread. Depending on the cancer, your healthcare provider may order a CT scan, MRI, ultrasound, PET scan or chest X-ray.
• Tissue biopsy. This is the only way to confirm a cancer diagnosis. During the procedure, your healthcare provider removes suspicious-looking cells or tissues. A pathologist views the cells under a microscope to check for signs of cancer.

How is penile cancer treated?

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

For early-stage cancer, your healthcare provider may recommend one or more of the following treatments:

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

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

Your healthcare provider may use radiation, chemotherapy or both before or after surgery.

For cancer that has spread outside of your lower belly, chemotherapy or other medicines (systemic treatment) are the main treatment.

How can I reduce my risk of penile cancer?

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

• Don’t use tobacco products.
• Get the HPV vaccine.
• Get treated for phimosis.
• Practice good penis health.
• Practice safer sex to reduce your risk of HPV infections.
• Weigh the benefits of circumcision.

It’s important to consider 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 think about the best options for yourself or your newborn.

What can I expect if I have this condition?

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.

How do I take care of myself?

Talk to your healthcare provider about how your cancer diagnosis 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 several potential scenarios. Speak openly with your healthcare provider about any questions you have.

When should I see my healthcare provider?

Let your healthcare provider know if you develop new, changing or worsening symptoms. They can help determine whether cancer caused them.

What questions should I ask my doctor?

If you have penile cancer, here are some questions you might want to ask your healthcare provider:

• 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?