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In most cases, the first sign of penile cancer is a change (or
changes) in the skin of the penis. The skin may change color, become
thicker, or tissue may build-up in one area. Later signs are a painless
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 also sometimes
develop on the shaft. Most penile cancers do not cause pain, but some
can cause ulcers (sores) and bleeding.
Sometimes the cancers appear as a reddish, velvety rash, small
crusty bumps, or flat growths that are bluish-brown. They 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.
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 will be.
Biopsy procedures
Penile lesions affect the skin tissue on the surface of the
organ, so a doctor often can find cancers and other abnormalities by
looking closely at the penis. Then, a biopsy is needed to make an
accurate diagnosis of cancer. In this procedure, a small piece of the
abnormal tissue is cut out and sent to a laboratory. There, a
pathologist (a doctor specializing in laboratory diagnosis of diseases)
looks at the tissue under a microscope to see whether cancer cells are
present. 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 (a break in the skin or it appears to have a sore), or
that appear to grow deeply into the tissue. These biopsies are usually
done in a doctor's office, clinic, or outpatient (1 day) surgical
center with the patient under local anesthesia (numbing medication).
The tissue is then sent to a laboratory, where a pathologist examines
it under a microscope. The results may be available within a few days,
but can take a week or more.
Excisional biopsy
In an excisional biopsy, the entire lesion is removed. This is
more common if the abnormal area is small, such as nodules (swollen
lumps) or plaques (raised, flat areas) that are 1 cm (about 3/8 inch)
or less in size.
Fine needle aspiration
For a fine needle aspiration (FNA) the doctor places a thin
needle directly into the abnormal area for about 10 seconds and
withdraws cells and a few drops of fluid. The cells can be viewed under
a microscope to determine if cancer is present. This type of biopsy is
often done to see if enlarged lymph nodes contain cancer. If anesthesia
is needed, 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 mass is deep inside your body and the doctor cannot
feel it, imaging methods such as ultrasound or CT scan can be used to
guide the needle into the enlarged lymph node. FNA is not used in every
case but is one alternative to lymph node dissection for some patients.
Imaging tests
Imaging tests like those listed below are generally not useful
in examining people with early penile cancer. 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 of the part
of the body being studied as it rotates around you. A computer then
combines these pictures into an image of a slice of your body.
CT scans are helpful in staging the cancer. They help tell if
your cancer has spread into your lungs, liver, or other organs.
Often before the first set of pictures is taken you may be
asked to drink 1 or 2 pints of a contrast agent. This helps outline the
intestine so that it certain areas are not mistaken for tumors. You may
also receive an IV (intravenous) line through which a different kind of
contrast dye is injected. This helps better outline structures in your
body.
The injection can cause some flushing (redness and warm
feeling). A few people are allergic to the dye and get hives. Rarely,
more serious reactions like trouble breathing and low blood pressure
can occur. Medication can be given to 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 and you need to lie
still on a table while they are being done. But just like other
computerized devices, they are getting faster and your stay might be
pleasantly short. Also, you might feel a bit confined by the ring you
have to lay in when 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’ll remain on the CT scanning table while a radiologist
advances a biopsy needle toward the location of the mass. CT scans are
repeated until the doctors are confident that the needle is within the
mass. A fine needle biopsy sample (tiny fragment of tissue) or a core
needle biopsy sample (a thin cylinder of tissue about ½-inch
long and less than 1/8 inch in diameter) is removed and examined under
a microscope.
Magnetic resonance imaging (MRI)
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. Not only does this
produce cross-sectional slices of the body like a CT scanner, it can
also produce slices that are parallel with the length of your 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. Also, you have to be placed inside a tube, which can upset
people with a fear of enclosed spaces. The machine also makes a
thumping noise that you may find disturbing. Some places provide
headphones with music to block this out. If you have problems with
close spaces (claustrophobia), you should let your doctor know before
the MRI.
Ultrasound
This test uses sound waves to produce images of internal
organs. A transducer (wand-like equipment) emits the sound waves and
then picks up the echoes as they bounce off the organs. A computer
processes the pattern of echoes to produce an image that is displayed
on a monitor. The echoes from most tumors differ from those of normal
tissue.
This is an easy test to have and it uses no radiation. For
most ultrasound exams, the skin is first lubricated with gel. Then a
technician moves the transducer over the part of your body being
examined.. This test may be useful for determining how deeply the
cancer has penetrated into the penis. It can also spot enlarged lymph
nodes in the groin.
Chest x-ray
A regular x-ray of the chest may be done to look for cancer
spread to the lungs.
Last Medical Review: 07/11/2008 Last Revised: 05/13/2009
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