Staging is the process of finding out how far a cancer has spread. Once penile cancer is diagnosed, your doctor will determine the stage of the cancer using the results of exams, biopsies, and any imaging tests you have had. (These were described in the section, "How is penile cancer diagnosed?") The stage of your cancer is a very important factor in planning your treatment and estimating your prognosis (outlook).

If you have penile cancer, ask your cancer care team to explain staging in a way that you can understand. Knowing all you can about staging will let you take a more active role in making informed decisions about your treatment.

The American Joint Committee on Cancer (AJCC) TNM system

A staging system is a standardized way for the cancer care team to summarize information about how far a cancer has spread. The most common system used to describe the stages of squamous cell penile cancers is the American Joint Committee on Cancer (AJCC) TNM system. This system is based on 3 key pieces of information:

• T stands for tumor (how far it has spread within the penis and to nearby organs).
• N stands for spread to nearby lymph nodes (bean-sized collections of immune system cells that help fight infections and cancers).
• M is for metastasis (spread to distant organs).

Additional letters or numbers appear after T, N, and M to provide more details about each of these factors. The numbers 0 through 4 indicate increasing severity. The letter X means "cannot be assessed because the information is not available." The letters "is" after the T stand for "in situ," which means the cancer is only in the top layers of skin and has not yet invaded (grown into) a deeper layer of tissue.

T categories are:

N categories are:

M categories are:

Using the TNM system, a doctor might describe one case of penile cancer as T2, N0, M0 and another as T4, N1, M0.

Stage groupings

To summarize this information, TNM combinations are grouped together into a simpler set of stages, labeled stage 0 through stage IV. This is known as stage grouping.

Stage 0

Tis or Ta, N0, M0: The cancer has not grown into tissue below the top layers of skin and has not spread to lymph nodes or distant sites.

Stage I

T1, N0, M0: The cancer has grown into tissue just below the superficial layer of skin and has not spread to lymph nodes or distant sites.

Stage II (if either of these applies)

T1, N1, M0: The cancer has grown into tissue just below the superficial layer of skin and has spread to a single superficial groin lymph node, but it has not spread to distant sites

T2, N0 or N1, M0: The cancer has grown deeply into the tissues of the penis (but not into the urethra or prostate) and may or may not have spread to a single groin lymph node. It has not spread to distant sites.

Stage III (if either of these applies)

T1 or T2, N2, M0: The cancer has grown into the tissues of the penis (but not into the urethra or prostate) and has spread to many superficial groin lymph nodes. It has not spread to distant sites

T3, N0-N2, M0: The cancer has grown into the urethra or prostate. It may or may not have spread to superficial groin lymph nodes but has not spread to distant sites.

Stage IV (if any of these applies)

T4, any N, M0: The cancer has grown into nearby structures (other than the urethra or prostate). It may or may not have spread to groin lymph nodes. It has not spread to distant sites.

Any T, N3, M0: The cancer has spread to lymph nodes deep in the groin but not to distant sites.

Any T, any N, M1: the cancer has spread to distant sites.

Recurrent cancer

Recurrent disease means that the cancer went away with treatment, but then later came back. Recurrent penile cancer may return in the penis or in any other part of the body. This isn't a formal stage of the TNM system, but a doctor may note it by putting a small 'r' in front of the stage (for example, rT2N1M0).

Survival rates for penile cancer

Survival rates are a way for doctors and patients to get a general idea of the outlook for people with a certain type and stage of cancer. Some people want to know the statistics for people in their situation, while others may not find them helpful, or may even not want to know them. Whether or not you want to read about the survival statistics below for penile cancer is up to you.

Survival rates are typically based on previous outcomes of large numbers of people who had the disease, but they cannot predict what will happen in any particular person's case. Many other factors may affect a person's outlook, such as a person's age and general health, and how well the cancer responds to treatment. Your doctor can tell you if the numbers below may apply to you, as he or she is familiar with the aspects of your particular situation.

The 5-year survival rate is the percentage of patients who live at least five years after their cancer is diagnosed. Many of these patients live much longer than five years, but 5-year rates are used to produce a standard way of discussing prognosis (outlook). Relative survival rates compare the survival of people with the cancer to the survival for people without the cancer. Since some people will die of causes other than cancer, this is a way to look only at deaths from the cancer in question. The 5-year relative survival rate is a more accurate way to describe the outlook for patients with a particular type and stage of cancer.

Because penile cancer is not common, it is hard to find accurate survival rates based on the TNM stage of the cancer. The numbers below come from the National Cancer Institute's SEER database, looking at more than 1,000 men diagnosed with penile cancer between 1988 and 2001. These men were diagnosed at least several years ago, so men now being diagnosed may have a better outlook.

• For cancers that are still confined to the penis, the 5-year relative survival rate is around 85%.
• If the cancer has spread to nearby tissues or lymph nodes, the 5-year relative survival rate is around 59%.
• If the cancer has spread to distant parts of the body, 5-year relative survival rate is about 11%.

Last Medical Review: 10/07/2009
Last Revised: 10/07/2009