Penile cancer

Overview

Penile tumors are either benign (noncancerous) or malignant (cancerous). If cancer develops, it’s almost always in the penis’ skin cells. There are four types of malignant penile tumors:

  • Squamous cell carcinoma - these tumors account for 95 percent of all malignant penile tumors. They develop in flat skin cells called squamous cells and are slow growing, meaning a cure is usually possible if caught soon enough. In the earliest stage, the cancer is called carcinoma in situ (CIS), or Erythroplasia of Queyrat when located on the tip (glans) of the penis. A more rare type of carcinoma is called verrucous carcinoma, or a Buschke-Lowenstein tumor.
  • Melanoma - a type of skin cancer, melanoma represents less than 2 percent of penile cancers.
  • Basal cell cancer - another type of skin cancer, basal cell cancer also makes up less than 2 percent of penile cancers. It’s slow growing and rarely spreads.
  • Adenocarcinoma (Paget disease of the penis) - adenocarcinoma is a very rare form of penile cancer that develops in sweat glands.
  • Sarcoma - occasionally, cancer can develop in the blood vessels, smooth muscle or connective tissue of the penis.

Given the different types of tumors, proper penile care cancer is best handled by an experienced medical team. 

Our approach

Penile cancer is rare and usually found in uncircumcised men when it does occur. But advances in care mean successful treatment is likely without lifestyle sacrifices — provided that the patient sees a doctor when warning signs first emerge.

A team approach to penile cancer care

Northwell Health brings together a diverse group of physicians specializing in the care of the urinary system and male genitals. This multidisciplinary team works closely together, constantly advising one another and meeting weekly to discuss the best treatment approaches for individual patients. 

Risk factors

The cause of most penile cancers is still unknown, though doctors and researchers are working to find answers. For now, they have identified several risk factors that can increase chances for developing penile cancer. These include:

  • Human papillomavirus (HPV) infection - sexual activity is the main way HPV gets passed on. Some strains are associated with penile cancer, and represent the greatest risk factor for developing the disease.
  • Smoking - smoking is thought to increase the change of getting penile cancer, especially when combined with an HPV infection.
  • Age - most patients diagnosed with penile cancer are older than 50. In approximately 20 percent of cases, the patient is younger than 40.
  • Smegma buildup - the thick substance that can build up under the foreskin and cause irritation for uncircumcised men is considered a risk factor for penile cancer. Careful and regular washing can prevent problems, though that’s a challenge for men with phimosis — a condition where the foreskin is difficult to pull back.
  • HIV/AIDS infection - HIV weakens the immune system and its ability to fight off cancer.
  • Psoriasis treatment - receiving the drug psoralen with UV (ultraviolet) light therapy raises the risk of developing penile cancer.

Symptoms

Penile cancer is usually diagnosed after a patient has noticed changes to the skin of the penis, though the disease may draw less notice if it starts under intact foreskin. Penile cancer symptoms include these possible changes to the penis:

  • Growths or sores
  • Thickened skin
  • Blood
  • Unexplained pain
  • Abnormal marks
  • Unusual swelling at the tip
  • Continued, odorous discharge under the foreskin
  • Rash beneath the foreskin
  • Bumps beneath the foreskin
  • Swollen lymph nodes in the groin

Some men with penile cancer might not have any of these symptoms, while in others a different condition could cause the changes. It’s important to see a doctor to determine what is causing symptoms.

Penile warts versus cancer

One of the risk factors for penile cancers is human papillomavirus (HPV), an infection that is typically caught through sexual activity. But not all strains of HPV cause serious disease. For example, those strains tied to genital warts do not cause cancer.

Diagnosis

If penile cancer seems like a possibility, a doctor will take all the steps necessary to ensure an accurate diagnosis. Tests could include: 

  • Physical exam - a doctor will look for unusual changes to the penis, such as growths.
  • Biopsy - a team member will remove cells or tissue so a pathologist can examine them under the microscope and confirm a diagnosis. The procedure could involve a thin needle, or cutting out all or part of a lump. In either case, the doctor is careful to take only the smallest sample necessary.

Other tests determine whether the cancer has spread:

  • X-ray - taking an image of the body so the physician can see certain structures
  • Ultrasound - bouncing sound waves off organs and tissues to make a picture from the echoes
  • CT (CAT) scan - overlapping X-rays from different angles, with dye sometimes injected into veins or swallowed to allow doctors to see delicate, tiny structures
  • MRI (magnetic resonance imaging) - using a magnet, radio waves and a computer to take detailed pictures of the inside of the body
  • Further biopsy - removing one or more lymph nodes in the groin

If penile cancer is diagnosed, there are a range of advanced treatment options available, all designed to preserve the look and use of the penis as much as is safely possible. 

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