Surgery is the most common treatment for all stages of penile cancer. If the cancer is detected early, then the surgery is a simple excision of the tumor and the rest of the penis is left intact. If the cancer is detected late, part of the penis might have to be cut off. Patients with T2 or larger cancers need to have some or most of their inguinal lymph nodes removed. A sentinel node procedure (see below) only removes the nodes if they contain cancer. Otherwise, the lymph nodes can be removed without this procedure. Your team will discuss with you the treatment option that gives you the best chance of curing your cancer while preserving as much of the penis as possible.

Fortunately, most early stage penile cancers can be completely cured by fairly minor surgery. There are several different kinds of surgery for these cancers.

Simple excision: The tumor is cut out with a surgical knife, along with some surrounding normal skin, and the remaining skin is carefully stitched back together. This is the same as an excisional biopsy.

Electrodesiccation and curettage: This treatment removes the cancer by scraping the tumor with a curette (a long, thin instrument with a scraping edge, similar in appearance to a vegetable peeler) and then treating the area where the tumor was located with an electric current delivered through a needle to destroy any remaining cancer cells. This process may be repeated up to 3 times. Electrodesiccation and curettage are useful for treating small basal cell and squamous cell (skin) cancers on the penis.

Cryosurgery: This treatment uses liquid nitrogen to freeze and kill cells. After the dead tissue thaws, blistering and crusting may occur. The wound may take several weeks to heal and may leave a scar. The treated area may have less color after treatment. Cryosurgery can be used for precancerous conditions and for small basal cell and squamous cell carcinomas (types of skin cancer).

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 carefully marks its location with colored dyes. The surgeon checks the sample under a microscope immediately. If it is still malignant, more pieces of the tumor will be removed in a similar fashion and examined until the skin samples are found to be free of cancerous cells.

This process is slow, but it means that normal tissue next to 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.

Laser surgery: This relatively new approach uses a beam of laser light to vaporize cancer cells. It is useful for squamous cell carcinoma in situ (involving only the outer layer of the skin or epidermis) and for very thin or shallow basal cell carcinomas (types of skin cancer).

Wide local excision: This operation removes the cancerous tissue plus some of the normal tissue on either side (known as a wide margin). Some healthy tissue must be removed to be certain that all of the cancer has been removed.

Circumcision: This operation may be performed to remove the foreskin and some neighboring skin. This method is used if cancer is limited to the foreskin. It is also done before any radiation therapy.

Surgical removal of part or all of the penis: This operation, also called penectomy, removes part or all of the penis. It is the most common and most effective surgical procedure to treat a penile cancer that has penetrated deeply inside the penis. Lymph nodes in the groin are usually not removed at the same time because the enlargement may represent inflammation or infection and not spread of cancer.

Partial penectomy removes only the end of the penis. The surgeon leaves enough of the shaft to allow the man to direct his stream of urine away from his body.

If the shaft cannot be saved, 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 the urethra (tube from the bladder) between the man's scrotum (sac for the testicles) and his anus. You can still control urination, because the sphincter (the "on-off" valve) in the urethra is above the level of the penis.

Sexual Impact of Penectomy

Penectomy, the surgical removal of all or part of the penis, can have a devastating effect on a man's self-image and sexual intercourse. If cancer of the penis is diagnosed early, local radiation, chemotherapy creams, or a simple surgical procedure can sometimes be used to treat it. These treatments often have little effect on sexual pleasure and intercourse.

Satisfying intercourse is possible for many, but not all, men after partial penectomy. The remaining shaft of the penis still becomes erect with excitement. It usually gains enough length to achieve penetration. Although the most sensitive area of the penis (the glans, or "head") is gone, a man can still reach orgasm and ejaculate normally. His partner should also still be able to enjoy intercourse and often reach orgasm.

Some men give up sex after total penectomy. Since cancer of the penis is most common in elderly men, many already are unable to have intercourse because of other health problems. If a man is willing to put some effort into his sex life, however, pleasure is possible after total penectomy. He can learn to reach orgasm when sensitive areas such as the scrotum, skin behind the scrotum, and the area surrounding the surgical scars are caressed. Having a sexual fantasy or looking at erotic pictures or stories can also increase excitement.

A man can help his partner reach orgasm by caressing the genitals, by oral sex, or by stimulation with a vibrator. The activity some couples enjoy after total penectomy can give hope to those coping with lesser changes in their sex lives.

Groin Lymph Node Removal

If a sentinel lymph node dissection was done and cancer was found, or if during your follow-up care after treatment of penile cancer an enlarged lymph node appears in your groin, an inguinal lymphadenectomy (surgical removal of lymph nodes) will be needed. In this procedure, the surgeon makes a 4-inch incision in your groin and carefully removes all the lymph node-bearing tissues. This must be done with care because important muscles, nerves, and blood vessels run through this area.

In the past, surgery was often done on both of the groin areas. With this operation, many patients (up to half) developed severe lymphedema (swelling from fluid collection) in both legs after surgery. This can be disabling. Now, with sentinel node dissection, doctors can avoid this operation unless they are fairly certain the cancer has spread. Still, even removing lymph nodes in one groin area can have side effects, mainly swelling of the leg on the same side as the surgery.

Revised: 05/31/2006