Treating Penile Cancer

Stage 0 cancers are only in the top layer of skin (the epithelium). They include:

• Carcinoma in situ (CIS), also known as penile intraepithelial neoplasia (PeIN) (tumor category Tis)
• Noninvasive (papillary) squamous cell carcinoma (tumor category Ta)

Treatment options depend on where the tumor is on the penis and on other factors. Options might include:

• Circumcision, if the tumor is only on the foreskin
• Total glans resurfacing, if the tumor is on the glans (head of the penis)
• Topical treatments (drugs applied directly to the skin, such as 5-FU or imiquimod)
• Laser ablation
• Radiation therapy
• Mohs surgery
• More extensive types of surgery, such as glansectomy (removal of the glans, if the tumor is there) or wide excision

These cancers have grown below the skin of the penis but not into deeper layers.

Treatment options depend on where the tumor is and might include:

• Circumcision, if the tumor is only on the foreskin
• Mohs surgery, in certain cases
• More extensive types of surgery, such as glansectomy (removal of the glans, if the tumor is there), wide excision, or partial penectomy (removal of part of the penis)
• Laser ablation, in certain cases
• Radiation therapy, especially in men who can’t or refuse to have surgery

In stage II penile cancer, the tumor has grown deep into the tissues of the penis, but the cancer hasn’t spread to nearby lymph nodes or other parts of the body.

Depending on the location of the main tumor and how deeply it has grown into the penis, different types of surgery might be used, but it is most often treated with a partial or total penectomy (removal of part or all of the penis).  

A less common approach is to use radiation therapy as the first treatment, followed by surgery.

Radiation may also be used as the main treatment in men who can’t have or refuse surgery.

The inguinal (groin) lymph nodes are also typically checked for cancer, even if they’re not enlarged on exams or imaging tests. This may be done with a sentinel lymph node biopsy (SLNB) or with a more extensive inguinal lymph node dissection (ILND).

If cancer is found in the lymph nodes, then it’s not really a stage II cancer. It’s a stage III or IV cancer, and it’s treated as such (see below).

Stage III penile cancers have spread to nearby lymph nodes in the groin (inguinal lymph nodes). The main tumor may have grown into the deeper tissues of the penis, but it hasn’t grown into nearby structures like the scrotum, bladder, or prostate.

Treating the main tumor

Depending on the location of the main tumor and how deeply it has grown into the penis, different types of surgery might be used, but it is most often treated with a partial or total penectomy (removal of part or all of the penis). If surgery can’t be done for some reason, radiation therapy might be another option.

In some cases, chemotherapy (chemo) or chemo plus radiation therapy (chemoradiation) may be used first to shrink the tumor so that it’s easier to remove. This might allow a less extensive operation to be done.

Treating the lymph nodes

Because the cancer has reached the inguinal lymph nodes, they need to be treated as well. Most often this is with surgery (an inguinal lymph node dissection, or ILND).

Chemotherapy might be given either before or after lymph node surgery.

Radiation therapy to the groin and/or pelvis may be used, too, usually after surgery or sometimes instead of surgery.

These cancers can be hard to cure, so men may want to consider taking part in clinical trials of new treatments.

Stage IV penile cancer includes different groups of more advanced cancers:

• The main tumor has grown into nearby structures like the prostate, bladder, scrotum, or abdominal (belly) wall.
• The cancer has spread to the pelvic lymph nodes, or it has spread to the inguinal (groin) lymph nodes and has grown outside of one of them.
• The cancer has spread to distant parts of the body.

If the main tumor has grown into nearby structures

Treatment for these cancers typically includes surgery, which is often a total penectomy (removal of the penis), if it can be done.

If the tumor is in the scrotum or parts of the abdominal wall, the testicles and/or the scrotum may also need to be removed. A new opening can be made in the abdomen or the perineum (space between the scrotum and anus) to allow urine to pass out of the body. If the tumor has grown into the prostate or bladder, these may need to be removed, too.

Chemo (sometimes with radiation) may be given before surgery to try to shrink the tumor and make it easier to remove.

The inguinal (groin) lymph nodes on both sides will be removed as well (an inguinal lymph node dissection, or ILND). Again, chemo (sometimes with radiation) might be used before or after surgery. This area may also be treated with radiation after surgery (unless it was given before surgery).

If the cancer has spread more extensively in the lymph nodes

For these cancers, the main tumor on the penis is typically removed with surgery, such as a partial or total penectomy (removal of part or all of the penis).

Because these cancers have spread extensively in the lymph nodes, the nodes on both sides of the groin will be removed (during an inguinal lymph node dissection, or ILND). If the lymph nodes inside the pelvis are thought to contain cancer, they will be removed as well (during a pelvic lymph node dissection, or PLND). Chemotherapy (sometimes along with radiation) might be part of the treatment as well, either before or after the surgery.

After the lymph nodes are removed, these areas may be treated with radiation if it hasn’t been given to the areas already.

If surgery to remove the lymph nodes can’t be done for some reason, chemotherapy and radiation therapy are usually given.

The treatment of cancer that comes back after treatment (recurrent cancer) depends on where the cancer comes back, which treatments were used before, and other factors.

If the cancer comes back on the penis, a more extensive surgery, such as a partial or total penectomy (removal of part or all of the penis), may be an option. Radiation therapy may also be an option if surgery is not.

If the cancer comes back in the lymph nodes, surgery (lymph node dissection), radiation therapy, and/or chemotherapy may be options, depending on which treatments a person has had before.

If the cancer comes back in another part of the body, chemotherapy is usually the main treatment. Immunotherapy with a checkpoint inhibitor might be another option for some people. Radiation therapy may also be helpful in treating specific parts of the body.

These cancers can be hard to treat, so men may want to think about taking part in a clinical trial of a newer treatment.