How is penile cancer diagnosed?
Certain signs and symptoms might suggest that a man may have penile cancer, but tests are needed to confirm the diagnosis.
Signs and symptoms of penile cancer
In most cases, the first sign of penile cancer is a change in the skin of the penis. The skin may change color, become thicker, or tissue may build up in one area. Some men may notice an ulcer (sore) or a lump on the penis. These are most likely to be found on the glans (the head of the penis) or foreskin, but may also develop on the shaft. The sore or lump is not usually painful, but it can be in some cases.
Sometimes the cancer appears as a reddish, velvety rash, small crusty bumps, or flat growths that are bluish-brown. It may not be visible unless the foreskin is pulled back. A persistent discharge (drainage), often with a bad smell, may also be present beneath the foreskin.
Swelling at the end of the penis, especially when the foreskin is constricted, is another common sign that penile cancer may be present.
If the cancer spreads from the penis, it most often travels first to lymph nodes in the groin. This can cause those lymph nodes to become swollen. Lymph nodes are bean-sized collections of immune system cells that fight infection. Normally, they can barely be felt at all. If they are swollen, the lymph nodes may be easy to feel as lumps under the skin.
These signs and symptoms don't always mean cancer -- they can also be caused by benign conditions. For example, infection can cause swollen lymph nodes in the groin area. Still, if you have any of these signs or symptoms, go see your doctor right away. Remember, the sooner you receive a correct diagnosis, the sooner you can start treatment and the more effective your treatment is likely to be.
Medical history and physical exam
If you have symptoms that suggest you might have penile cancer, your doctor will want to take a complete medical history to get details about your symptoms and any possible risk factors you may have.
Your doctor will also look at the genital region 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 may have penile cancer, other tests will likely be done. These might include a biopsy and imaging tests.
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.
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).
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 may be done in a hospital or outpatient surgical center. Local anesthesia (numbing medicine) or general anesthesia (where you are asleep) may be used.
Fine needle aspiration
For a 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.
FNA is not used in every case, but it is one alternative to a more extensive procedure, called a lymph node dissection, for some patients.
Surgery to check lymph nodes
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 has been made.
If the biopsy is not done with FNA, it will require some type of surgery. These surgical lymph node biopsies are described in the section called "How is penile cancer treated?"
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.
CT scans are helpful in staging the cancer. They help tell if your cancer has spread into your lungs, liver, or other organs.
Prior to the scan, you may be asked to drink a contrast solution 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 scans take longer than regular x-rays. You need to lie still on a table while they are being done. During the test, the table moves in and out of the scanner, a ring-shaped machine that completely surrounds the table. You might feel a bit confined by the ring you have to lie in while the pictures are being taken.
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 out. MRIs are not safe for people with pacemakers or certain implants containing metals that are strongly attracted to magnets.
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 spot enlarged lymph nodes in the groin.
Last Medical Review: 05/02/2012
Last Revised: 01/17/2013