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