How Is Penile Cancer Staged?

The stage of a cancer is a standard way for doctors to sum up how far the 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 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 its stage in a way that you can understand. Knowing all you can about staging can help you take a more active role in making informed decisions about your treatment.

There are actually 2 types of staging for penile cancer:

  • The clinical stage is your doctor’s best estimate of the extent of your disease, based on the results of the physical exam, a biopsy of the main tumor, and any imaging tests you have had.
  • The surgical or pathologic stage is based on the same factors as the clinical stage, plus what is found during surgery to remove the main tumor or lymph node biopsies.

If you have surgery, the stage of your cancer might actually change afterward (for example, if cancer is found to have spread farther than was suspected). Pathologic staging is likely to be more accurate than clinical staging, because it gives your doctor a firsthand impression of the extent of your disease.

The American Joint Committee on Cancer (AJCC) TNM system

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 the main (primary) tumor (how far it has grown within the penis or into nearby organs).
  • N stands for spread to nearby lymph nodes (bean-sized collections of immune system cells to which cancers often spread).
  • M is for metastasis (spread) to distant organs.

Letters or numbers appear after T, N, and M to provide more details about each of these factors.

Another factor that can affect the stage of some cancers is the grade of the cancer. This is a measure of how abnormal the cancer cells appear under a microscope. The grade is often expressed as a number, from 1 to 4. The higher the number, the more abnormal the cells look. Higher-grade cancers tend to grow and spread more quickly than lower-grade cancers.

T categories

TX: Primary tumor cannot be assessed

T0: No evidence of primary tumor

Tis: Carcinoma in situ (cancer that is only in the top layers of skin). This is sometimes called erythroplasia of Queyrat when it occurs on the glans of the penis. It can be called Bowen disease when it occurs on the shaft of the penis.

Ta: Verrucous (wart-like) carcinoma that is only in the top layers of skin (non-invasive)

T1: The tumor has grown into the tissue below the top layers of skin (called the subepithelial connective tissue)

  • T1a: The tumor has grown into the subepithelial connective tissue, but it has not grown into blood or lymph vessels. The cancer is grade 1 or 2.
  • T1b: The tumor has grown into the subepithelial connective tissue and has either grown into blood and lymph vessels OR it is high-grade (grade 3 or 4).

T2: The tumor has grown into at least one of the internal chambers of the penis (the corpus spongiosum or corpora cavernosum)

T3: The tumor has grown into the urethra (the tube that carries urine and semen outside of the body)

T4: The tumor has grown into the prostate or other nearby structures

N categories

NX: Nearby lymph nodes cannot be assessed

N0: The cancer has not spread to nearby lymph nodes

N1: The cancer has spread to a single lymph node in the groin (called an inguinal lymph node)

N2: The cancer has spread to more than 1 inguinal lymph node

N3: The cancer has spread to lymph nodes in the pelvis and/or the cancer in the lymph nodes has grown through the outer covering of the lymph node and into the surrounding tissue

M categories

M0: The cancer has not spread to distant organs or tissues

M1: The cancer has spread to distant organs or tissues (such as lymph nodes outside of the pelvis, lungs, or liver)

Stage grouping

Once the T, N, and M categories have been assigned, this information is combined to assign an overall stage from 0 to IV. This is known as stage grouping.

Stage 0: Tis or Ta, N0, M0:

The cancer is only in the top layers of the skin (Tis or Ta) and has not spread to lymph nodes (N0) or distant sites (M0).

Stage I: T1a, N0, M0:

The cancer has grown into tissue just below the top layer of skin but has not grown into blood or lymph vessels, and it is grade 1 or 2 (T1a). It has not spread to lymph nodes (N0) or distant sites (M0).

Stage II: Any of the following:

T1b, N0, M0: The cancer has grown into tissue just below the top layer of skin and is either high-grade (grade 3 or 4) or has grown into blood or lymph vessels (T1b). It has not spread to lymph nodes (N0) or distant sites (M0).

OR

T2, N0, M0: The cancer has grown into at least one of the internal chambers of the penis (the corpus spongiosum or corpora cavernosum) (T2). The cancer has not spread to lymph nodes (N0) or distant sites (M0).

OR

T3, N0, M0: The cancer has grown into the urethra (T3). It has not spread to lymph nodes (N0) or distant sites (M0).

Stage IIIa: T1 to T3, N1, M0:

The cancer has grown into tissue below the top layer of skin and may have grown into the corpus spongiosum, the corpus cavernosum, or the urethra (T1 to T3). The cancer has also spread to a single groin lymph node (N1). It has not spread to distant sites (M0).

Stage IIIb: T1 to T3, N2, M0:

The cancer has grown into tissue below the top layer of skin and may have grown into the corpus spongiosum, the corpus cavernosum, or the urethra (T1 to T3). It has also spread to 2 or more groin lymph nodes (N2). It has not spread to distant sites (M0).

Stage IV: Any of the following:

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

OR

Any T, N3, M0: The cancer has spread to lymph nodes in the pelvis OR the cancer in the groin lymph nodes has grown out of a lymph node and into the surrounding tissue (N3). The cancer has not spread to distant sites (M0).

OR

Any T, any N, M1: The cancer has spread to distant sites (M1).

Recurrent cancer

A cancer is called recurrent if it went away with treatment, but then later comes back. It may return in the penis or in any other part of the body. This isn’t a formal stage of the TNM system.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Last Medical Review: March 30, 2015 Last Revised: February 9, 2016

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