Penile Cancer

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Early Detection, Diagnosis, and Staging TOPICS

How is penile cancer diagnosed?

If you have symptoms of penile cancer you should go to a doctor, who will do an exam and may order some tests.

Medical history and physical exam

Your doctor will need to take a complete medical history to get details about your symptoms and any possible risk factors you have.

Your doctor will also look at your genital area carefully for possible signs of penile cancer or other health problems. Penile lesions usually affect the skin on the surface of the penis, so a doctor often can find cancers and other abnormalities by looking closely at the penis.

If symptoms and/or the results of the physical exam suggest you have penile cancer, you will need other tests. These might include a biopsy and imaging tests.

Biopsy procedures

A biopsy is needed to make an accurate diagnosis of cancer. In this procedure, a small piece of tissue from the abnormal area is cut out and sent to a pathologist (a doctor specializing in laboratory diagnosis of diseases), who looks at the tissue under a microscope to see if cancer cells are present. The results are usually available in a few days, but may take longer in some cases.

The type of biopsy used depends on the nature of the abnormality.

Incisional biopsy

For an incisional biopsy only a part of the abnormal tissue is removed. This type of biopsy is often done for lesions that are larger, are ulcerated (the top layer of skin is missing or the lesion appears as a sore), or that appear to grow deeply into the tissue.

These biopsies are usually done in a doctor's office, clinic, or outpatient surgical center with local anesthesia (numbing medicine).

Excisional biopsy

In an excisional biopsy, the entire lesion is removed. This type of biopsy is more commonly used if the abnormal area is small, such as a nodule (swollen lump) or plaque (raised, flat area) that is 1 cm (about 3/8 inch) or less. If the abnormal area is only on the foreskin, your doctor may recommend circumcision as a form of excisional biopsy to remove the lesion completely.

These biopsies are usually done in a hospital or outpatient surgical center. Local anesthesia (numbing medicine) or general anesthesia (where you are asleep) may be used.

Lymph node biopsy

Patients with cancers that have invaded deep within the penis usually need to have nearby lymph nodes checked for cancer spread. This is done to help determine the stage (extent) of the cancer after the diagnosis. These lymph nodes may be checked either with fine needle aspiration or with surgery to remove them.

For fine needle aspiration (FNA) the doctor places a thin, hollow needle directly into the abnormal area for about 10 seconds and withdraws cells and a few drops of fluid. This type of biopsy is often done to see if enlarged lymph nodes contain cancer. It is not used to sample lesions on the penis itself.

Local anesthesia may be injected into the skin over the mass to numb the area. This procedure can be done in a doctor's office or clinic.

If the enlarged lymph node is deep inside your body and the doctor cannot feel it, imaging methods such as ultrasound or CT scans can be used to guide the needle into the node.

In some cases, the lymph nodes are not checked with FNA, but instead through surgery to remove one or more lymph nodes. These surgical lymph node biopsies, which include sentinel lymph node biopsies and lymphadenectomy, are described in the section “Surgery for penile cancer.” To learn more about biopsies, see our document, Testing Biopsy and Cytology Specimens for Cancer.

Imaging tests

Imaging tests use x-rays, magnetic fields, or sound waves to create pictures of the inside of your body. If the doctor thinks the cancer is advanced or has spread, then one or more of these tests may be ordered.

Computed tomography (CT)

The CT scan is an x-ray procedure that produces detailed cross-sectional images of your body. Instead of taking one picture, like a conventional x-ray, a CT scanner takes many pictures as it rotates around you while you are lying on a narrow platform. A computer then combines these pictures into images of slices of the part of your body that is being studied.

A CT scanner has been described as a large donut, with a narrow table in the middle opening. You will need to lie still on the table while the scan is being done. CT scans take longer than regular x-rays, and you might feel a bit confined by the ring while the pictures are being taken

CT scans are helpful in staging the cancer. They help tell if your cancer has spread into your lungs, liver, or other organs.

Before the test, you may be asked to drink 1 to 2 pints of a liquid called oral contrast and/or get an intravenous (IV) injection of a contrast dye that helps better outline abnormal areas in the body. The injection can cause some flushing (redness and warm feeling). A few people are allergic to the dye and get hives or, rarely, more serious reactions like trouble breathing and low blood pressure. Medicine can be given to help prevent and treat allergic reactions. Be sure to tell the doctor if you have ever had a reaction to any contrast material used for x-rays or if you have an allergy to shellfish.

CT-guided needle biopsy: CT scans can also be used to guide a biopsy needle precisely into a suspected metastasis. For this procedure, called a CT-guided needle biopsy, you remain on the CT scanning table while a radiologist advances a biopsy needle through the skin and toward the location of the mass. CT scans are repeated until the needle is within the mass. A biopsy sample is then removed and sent to be looked at under a microscope.

Magnetic resonance imaging (MRI)

Like CT scans, MRI scans provide detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases. A computer translates the pattern of radio waves given off by the tissues into a very detailed image of parts of the body. A contrast material might be injected just as with CT scans but is used less often.

MRI scans are most helpful in looking at the brain and spinal cord. When they are used to look at penile tumors, the pictures are better if the penis is erect. The doctor can inject a substance called prostaglandin into the penis to make it erect.

MRI scans are a little more uncomfortable than CT scans. First, they take longer -- often up to an hour. You may be placed inside a large, narrow tube, which can upset people with a fear of enclosed spaces. Special, more open MRI machines can sometimes help with this if needed, but the drawback is that the images may not be as clear. The MRI machine makes buzzing and clicking noises that you may find disturbing. Some places will provide earplugs to help block this noise out. MRIs are not safe for people with pacemakers or certain implants containing metals that are strongly attracted to magnets.

Ultrasound

This test uses sound waves and their echoes to produce a picture of internal organs or masses. A small microphone-like instrument called a transducer emits sound waves and picks up the echoes as they bounce off body tissues. The echoes are converted by a computer into a black and white image that is displayed on a computer screen.

This test is painless and does not expose you to radiation. For most ultrasound exams, the skin is first lubricated with gel. Then a technician moves the transducer over the skin above the part of your body being examined.

Ultrasound may be useful for determining how deeply the cancer has penetrated into the penis. It can also show enlarged lymph nodes in the groin.


Last Medical Review: 12/06/2013
Last Revised: 12/11/2014