Surgery is the most common treatment for all stages of penile cancer. If the cancer is detected early, then the tumor can be removed without having to cut off part of the penis. If the cancer is detected late, part of the penis might have to be removed with the tumor. 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.

Patients with T2 or larger cancers need to have some lymph nodes removed 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. In this procedure, the doctor removes only one lymph node at first. If that lymph node contains cancer, more nodes are removed. This procedure is discussed in more detail later in this section.

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

Simple excision

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 with a large amount of the normal tissue around it (called wide margins). Removing healthy tissue makes it less likely that any cancer cells are left behind.

Curettage and electrodesiccation

With curettage the cancer is removed with a curette (a long, thin instrument with a scraping edge that looks like a vegetable peeler). This is followed by electrodesiccation, which treats the area where the tumor was located using an electric current delivered through a needle to destroy any remaining cancer cells. This process may be repeated up to 3 times. Curettage and electrodesiccation 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.

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 contains cancer, another layer will be 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.

Laser surgery

This 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).

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.

Penectomy

This is an operation to remove all or part 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 that is above the tumor. 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 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 urine to drain located between the scrotum (sac for the testicles) and the anus. Urination can still be controlled because the sphincter (the "on-off" valve) in the urethra is left behind.

Sentinel lymph node dissection

In a sentinel lymph node dissection, the surgeon finds the lymph node that drains the tumor and removes it. If the cancer has spread outside of the penis, this lymph node is the one most likely to contain cancer cells. If the sentinel node contains cancer, more lymph nodes are removed. If the sentinel node does not have cancer cells, the surgeon doesn't have to remove any more lymph nodes. This allows the surgeon to see if the groin lymph nodes contain cancer without having to remove all of them. It is most often done for lymph nodes that are not enlarged.

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 will let the doctor know whether the lymphatic channels around the cancer drain into the left groin or right groin. This tells the doctor which side is likely to contain 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 a sentinel node, the first lymph node receiving lymph from the tumor and the one most likely to contain a metastasis if the cancer has spread. The surgeon finds this node during the operation either visually (by the blue dye) or with a Geiger counter (radioactive tracer) 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 (fluid accumulation in tissues) and problems with wound healing.

If your doctor is considering this procedure, it might be useful to determine how many sentinel node biopsies he/she has done. Experience is very important. It is also important to note that all doctors do not yet perform sentinel lymph node biopsy. Discuss the procedure with your doctor.

Inguinal lymphadenectomy

Many men with penile cancer have swollen groin lymph nodes at the time of diagnosis. About half of the time, the swelling is from infection or inflammation -- not from cancer. These lymph nodes only need to be removed if they contain cancer cells. If the lymph nodes are swollen, some doctors wait a few weeks after the penile cancer is removed. If the swelling doesn't go away with time, then a second operation is done to remove the lymph nodes. Another approach is to do a sentinel lymph node biopsy. If the sentinel lymph node does not contain cancer, no other lymph nodes need to be removed.

This second operation that removes the groin lymph nodes is known as an inguinal lymphadenectomy. 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.

Removing many lymph nodes in an area can lead to abnormal swelling from problems with fluid drainage. This condition is called lymphedema. In the past, this was a common problem after treatment for penile cancer because the lymph nodes from both groin areas were removed to check for cancer spread. Up to half of the patients who had this surgery went on to develop severe lymphedema in both legs. Now this operation is only done when there is good evidence that the cancer has spread. If the sentinel lymph node is removed first, the doctor may be able to avoid doing an inguinal lymphadenectomy. Still, lymphedema can occur even when the lymph nodes from only one groin area are removed.

Last Medical Review: 07/11/2008
Last Revised: 05/13/2009