Penile Cancer

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Treating Penile Cancer TOPICS

Treatment options for penile cancer, by stage

The type of treatment your cancer care team will recommend depends on how far the cancer has spread. This section summarizes the choices available according to the stage of the cancer.

Stage 0

Stage 0 includes 2 types of tumors: carcinoma in situ and verrucous carcinoma. They are treated differently.

Patients with carcinoma in situ that is only in the foreskin can often be treated with circumcision. If the tumor developed in the glans and does not affect other tissues, it may be possible to treat it with topical therapy (such as 5-FU cream or imiquimod) or Mohs (microscopically directed) surgery. Laser treatment, cryotherapy, and radiation therapy are also possible options. Penectomy is not often needed.

Verrucous carcinoma can often be treated with laser therapy, cryotherapy, or Mohs surgery. Only rarely will penectomy be needed. Radiation is not used for this type of tumor, because it can make it more likely to spread.

Stage I

These tumors have grown below the skin of the penis but not into deeper layers. Options for treatment may include circumcision (for tumors confined to the foreskin), surgical removal of part of the penis (partial penectomy), radiation therapy, and Mohs surgery. Laser surgery may also be an option.

Stage II

Stage II penile cancer includes tumors that have grown into the tissues of the penis (such as the corpus spongiosum or cavernosum) or the urethra, but have not spread to nearby lymph nodes. These cancers are usually treated with a partial or total penectomy, with or without radiation therapy. A less common approach is to use radiation therapy as the first treatment with surgery remaining as an option if the cancer is not completely destroyed by the radiation. Radiation may also be used as the main treatment in men who cannot have surgery due to severe medical problems.

Some doctors recommend checking groin lymph nodes, even if they are not enlarged. This may be done with a sentinel lymph node biopsy or with a more extensive lymph node dissection. If the lymph nodes show cancer spread, then the cancer is not really a stage II. It is a stage III or IV.

Stage III

Stage III penile cancers include T1, T2, and T3 tumors that have spread to nearby lymph nodes (N1 or N2). Stage III includes tumors that have grown into the corpus spongiosum, corpus cavarnosum, or urethra, but not tumors that have grown into nearby structures like the bladder or prostate.

Stage III cancers are treated with a partial or total penectomy. In a few cases, chemotherapy (chemo) or chemo plus radiation may be used first to shrink the tumor so that it can be more easily removed with surgery.

These cancers require an inguinal lymphadenectomy to remove lymph nodes in the groin. Radiation therapy to the groin may be used as well, either after surgery or instead of surgery in selected cases.

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

Stage IV

Stage IV penile cancer includes cancers that have spread to nearby tissues, like the prostate, bladder, scrotum, or abdominal wall (T4). Treatment may include surgery to remove the main tumor, such as penectomy. If the tumor is in the scrotum or parts of the abdominal wall, it may also be necessary to remove the testicles and/or the scrotum. A new opening can be made in the abdomen or the perineum to allow urination. If the tumor has grown into the prostate or bladder, these may need to be removed, as well. Chemo (sometimes with radiation) may be given before surgery (this is called neoadjuvant treatment) 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. This area may also be treated with radiation after surgery (unless it was given before surgery).

Stage IV also includes smaller cancers with more extensive spread to the lymph nodes (N3), such as cancer in groin lymph nodes that has grown through the lymph nodes’ outer covering and into surrounding tissue or cancer spread to lymph nodes inside the pelvis. This stage is treated with surgery to remove the main tumor in the penis, such as penectomy. The lymph nodes in both groins are also removed. The lymph nodes inside the pelvis will also be removed if they are thought to contain cancer spread (if they are enlarged, for example). After the lymph nodes are removed, those areas are often treated with radiation to try to kill any cancer cells that may be have left behind (but are too small to see).

Penile cancer that has spread to distant organs and tissues is also considered stage IV. This is usually not considered curable by current methods. Treatment is designed to try to keep the cancer in check and to prevent or relieve symptoms to the best extent possible. Choices to treat the penile tumor usually include wide local excision, penectomy, or radiation therapy. Surgery or radiation therapy may also be considered to treat nearby lymph nodes. Radiation may also be used to treat areas of cancer spread in the bones or in the brain or spinal cord.

Chemo may be used to treat cancer that has spread to other areas, like the lungs or liver. Studies are under way to determine the value of chemotherapy combined with surgery or radiation therapy.

Stage IV cancers are hard to treat, so men may want to think about taking part in clinical trials of new treatments.

Recurrent cancer

The treatment of recurrent cancer depends on where the cancer comes back and what treatments were used before. If penectomy was not done before, a recurrent penile cancer may be treated with surgical removal of the penis. Radiation therapy may also be an option. Surgery and/or radiation may also be options for some cancers that recur in the lymph nodes. Chemotherapy may be helpful in treating more advanced recurrent penile cancers. These tumors can be hard to treat, so men may want to think about taking part in a clinical trial of a newer treatment.

Last Medical Review: 12/06/2013
Last Revised: 01/09/2015