Penile Cancer

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Early Detection, Diagnosis, and Staging TOPICS

How is penile cancer diagnosed?

If you have possible symptoms of penile cancer you should go to a doctor, who will examine you and might 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 penis, so a doctor often can find cancers and other abnormalities by looking closely at the penis. The doctor may look at and feel the lymph nodes in the groin area as well to see if they are swollen.

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

Biopsy

A biopsy is needed to diagnose penile cancer. In this procedure, a small piece of tissue from the abnormal area is removed and sent to a lab, where it is looked at under a microscope to see if it contains cancer cells. 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 area 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 penis.

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

Excisional biopsy

In an excisional biopsy, the entire lesion is removed. This type of biopsy is more often used if the abnormal area is small, such as a nodule (lump) or plaque (raised, flat area). If the abnormal area is only on the foreskin, your doctor might recommend circumcision (removal of the foreskin) as a form of excisional biopsy.

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

If the cancer has invaded deep within the penis, nearby lymph nodes usually will need to be checked for cancer spread. This is done to help determine the stage (extent) of the cancer after the diagnosis. These lymph nodes can be checked either with fine needle aspiration or with surgery to remove them.

Fine needle aspiration (FNA): For this type of biopsy, the doctor places a thin, hollow needle directly into the lymph node and withdraws cells and a few drops of fluid. Local anesthesia may be injected into the skin over the node to numb the area.

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

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. This procedure can be done in a doctor’s office or clinic.

Surgical biopsy: 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 biopsy 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 to help determine the stage of the cancer.

Computed tomography (CT)

The CT scan uses x-rays to make detailed cross-sectional images of your body. Instead of taking one picture, like a standard x-ray, a CT scanner takes many pictures as it rotates around you. A computer then combines these pictures into images of slices of part of your body.

A CT scanner has been described as a large donut, with a narrow table that slides in and out of 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

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 any allergies (especially to iodine or shellfish) or if you have ever had a reaction to any contrast material used for x-rays.

CT-guided needle biopsy: CT scans can be used to guide a biopsy needle into an enlarged lymph node or other area of possible cancer spread. For this procedure, you remain on the CT scanning table while a doctor moves a biopsy needle through the skin and toward 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 to create the images. A contrast material might be injected just as with CT scans, but this is used less often.

When MRI scans 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 take longer than CT scans – often up to an hour – and are a little more uncomfortable. You may have to lie on a table that slides inside a 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 to make pictures of internal organs or masses. It can be useful for determining how deeply the cancer has penetrated into the penis. It can also show enlarged lymph nodes in the groin.

For this test, a small microphone-like instrument called a transducer gives off sound waves and picks up the echoes as they bounce off body tissues. The echoes are converted by a computer into an image 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.


Last Medical Review: 03/30/2015
Last Revised: 04/20/2015