Penile Cancer

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Treating Penile Cancer TOPICS

Surgery for penile cancer

Surgery is the most common treatment for all stages of penile cancer. If the cancer is detected early, the tumor can often be treated without having to remove part of the penis. If the cancer is detected at a more advanced stage, part of or all of the penis might have to be removed with the tumor. Your team will discuss with you the treatment options that give you the best chance of curing your cancer while preserving as much of the penis as possible.

Patients with cancers that have grown deep within the penis (stage T2 or higher) usually need to have some nearby lymph nodes removed as well to check for cancer spread. Instead of removing all of the groin lymph nodes to look for cancer, some doctors prefer to do a sentinel lymph node biopsy, which is discussed later in this section.

Several different kinds of surgery are used to treat penile cancers.

Circumcision

This operation removes the foreskin and some nearby skin. This surgery can often cure cancers that are only in the foreskin.

Circumcision is also done to remove the foreskin before radiation therapy to the penis. Radiation can cause swelling and constriction of the foreskin, which could lead to other problems.

Simple excision

In this operation, the tumor is cut out with a surgical knife, along with some surrounding normal skin. If the tumor is small, the remaining skin can then be stitched back together. This is the same as an excisional biopsy.

In a wide local excision, the cancer is removed along with a large amount of normal tissue around it (called wide margins). Removing healthy tissue makes it less likely that any cancer cells are left behind. If not enough skin remains to cover the area, a skin graft may be taken from another part of the body and placed over the area.

Mohs surgery (microscopically controlled surgery)

Using the Mohs technique, the surgeon removes a layer of the skin that the tumor may have invaded and then checks the sample under a microscope right away. If it contains cancer, another layer is removed and examined. This process is repeated until the skin samples are found to be free of cancer cells.

This process is slow, but it means that more normal tissue near the tumor can be saved. This creates a better appearance and function after surgery. This is a highly specialized technique that should be used only by doctors who have been trained in this specific type of surgery. It is used for carcinoma in situ and for some cancers that have not grown deeply into the penis

Laser surgery

This approach uses a beam of laser light to vaporize cancer cells. It is useful for squamous cell carcinoma in situ (cancer cells in only the outer layer of the skin) and for very thin or shallow basal cell cancers.

Cryosurgery

This approach freezes the cancer cells with a probe cooled with liquid nitrogen. It is useful for some verrucous penile cancers and carcinoma in situ of the glans.

Partial or total penectomy

This operation removes part of or all of the penis. It is the most common and most effective way to treat a penile cancer that has grown deeply inside the penis. The goal is to remove all of the cancer. To do this the surgeon needs to remove some of the normal looking penis as well. The surgeon will try to leave as much of the shaft as possible.

The operation is called a partial penectomy if only the end of the penis is removed (and some shaft remains).

If not enough of the shaft can be saved for the man to urinate standing upright without dribbling, a total penectomy will be done. This operation removes the entire penis, including the roots that extend into the pelvis. The surgeon creates a new opening for urine to drain from the perineum, which is the area between the scrotum (sac for the testicles) and the anus. This is known as a perineal urethrostomy. Urination can still be controlled because the sphincter (the "on-off" valve) in the urethra is left behind, but the man will have to sit down to urinate.

For advanced tumors, sometimes the penis is removed along with the scrotum (and testicles). This operation is called emasculation. Since this operation removes the main natural source of the male hormone testosterone, men who have this procedure must take a man-made version of this hormone for the rest of their life.

Any of these operations can affect a man's self image, as well as his ability to have sexual intercourse. For more information, see the section "What happens after treatment for penile cancer?"

Surgery to remove lymph nodes

Patients with cancers that have grown deep within the penis (stage T2 or higher) usually need to have some nearby lymph nodes removed to check for cancer spread.

Sentinel lymph node biopsy: This operation can sometimes help the surgeon see if the groin lymph nodes contain cancer without having to remove all of them. It is most often done when lymph nodes are not enlarged but there is a chance that the cancer may have reached them.

The surgeon finds the first lymph node that drains the tumor (called the sentinel node) and removes it. If the cancer has spread outside the penis, this lymph node is the one most likely to contain cancer cells. If the sentinel node contains cancer, a more extensive operation, known as a lymph node dissection or inguinal lymphadenectomy, is done (see below). If the sentinel node does not have cancer cells, the surgeon doesn't have to remove any more lymph nodes.

To find the right lymph node, a radioactive tracer is injected into the region around the tumor the day before surgery. A radiation detection device is used to determine whether the lymphatic channels around the cancer drain into the left groin or right groin. This tells the doctor which side is likely to have cancer if it has spread. On the day of surgery, a blue dye is injected into the region of the tumor.

The lymphatic vessels will carry the dye and radioactive material to the sentinel node. The surgeon finds this node during the operation either by seeing the blue dye or with a Geiger counter (radiation detector) and removes it.

Using this approach, fewer patients need to have as many lymph nodes removed. The more lymph nodes that are removed, the higher the risk of side effects such as lymphedema (swelling in the groin and legs caused by the buildup of fluid) and problems with wound healing.

Not all doctors agree on how useful this type of operation is for penile cancer. Early studies showed that a sentinel lymph node procedure was helpful in finding those men whose cancer had spread to their lymph nodes, but later studies did not show that it was very accurate, and some men with lymph node spread could be missed if the sentinel lymph node procedure was used.

Also, if your doctor is considering a sentinel lymph node biopsy, it might be useful to determine how many sentinel node biopsies he/she has done. Experience is very important to the success of this procedure. Discuss the procedure with your doctor.

Inguinal lymphadenectomy (groin lymph node dissection): Many men with penile cancer have swollen groin lymph nodes when they are first diagnosed. These lymph nodes only need to be removed if they contain cancer cells. About half of the time, the swelling is from infection or inflammation -- not from cancer. If the lymph nodes are swollen, doctors routinely give a course of antibiotics and wait 4 to 6 weeks after the main penile tumor is removed. If the swelling doesn't go away over time, then a second operation, called an inguinal lymphadenectomy, is done to remove the lymph nodes.

This operation may also be done if cancer is found during a sentinel lymph node biopsy. In this procedure, the surgeon makes a 4-inch incision in your groin and carefully removes the tissues containing lymph nodes. This must be done with care because important muscles, nerves, and blood vessels run through this area. The nodes are then sent to a lab, where a pathologist looks at them under a microscope to see if they have cancer.

Side effects of lymph node surgery: The groin lymph nodes are part of the system that normally helps excess fluid drain out of the legs and back into the bloodstream. Removing many lymph nodes in an area can lead to problems with fluid drainage, causing abnormal swelling. This condition is called lymphedema. In the past, this was a common problem after treatment for penile cancer because the lymph nodes from groin areas on both sides were removed to check for cancer spread. Up to half of the patients who had this surgery developed severe lymphedema in both legs. Now fewer lymph nodes are usually removed, which lowers the chance that lymphedema will occur. Still, lymphedema can occur even when only one lymph node or the lymph nodes from only one groin area are removed. For more on this, see our document, Understanding Lymphedema: For Cancers Other than Breast Cancer.

Other side effects can occur after lymph node surgery, and can include problems with wound healing, infection, and skin breakdown (necrosis). These are not common.


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