General Information About Penile Cancer
Penile cancer is a disease in which malignant (cancer) cells form in the tissues of the penis.
The penis is a rod-shaped male reproductive organ that passes sperm and urine from the body. It contains two types of erectiletissue (spongy tissue with blood vessels that fill with blood to make an erection):
- Corpora cavernosa: The two columns of erectile tissue that form most of the penis.
- Corpus spongiosum: The single column of erectile tissue that forms a small portion of the penis. The corpus spongiosum surrounds the urethra (the tube through which urine and sperm pass from the body).
The erectile tissue is wrapped in connective tissue and covered with skin. The glans (head of the penis) is covered with loose skin called the foreskin.
Human papillomavirus infection may increase the risk of developing penile cancer.
Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will
get cancer; not having risk factors doesn't mean that you will
not get cancer. People who think they may be at risk should
discuss this with their doctor. Risk factors for penile cancer
include the following:
Circumcision may help prevent infection with the human papillomavirus (HPV). A circumcision is an operation in which the doctor removes part or all of the foreskin from the penis. Many boys are circumcised shortly after birth. Men who were not circumcised at birth may have a higher risk of developing penile cancer.
Other risk factors for penile cancer include the following:
- Being age 60 or older.
- Having phimosis (a condition in which the foreskin of the penis cannot be pulled back over the glans).
- Having poor personal hygiene.
- Having many sexual partners.
- Using tobacco products.
Possible signs of penile cancer include sores, discharge, and bleeding.
These and other symptoms may be caused by penile cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:
- Redness, irritation, or a sore on the penis.
- A lump on the penis.
Tests that examine the penis are used to detect (find) and diagnose penile cancer.
The following tests and procedures may be used:
- Physical exam and history: An exam of the body to check general signs of health, including checking the penis for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
- The stage of the cancer.
- The location and size of the tumor.
- Whether the cancer has just been diagnosed or has recurred (come back).
Top
Stages of Penile Cancer
After penile cancer has been diagnosed, tests are done to find out if cancer cells have spread within the penis or to other parts of the body.
The process used to find out if cancer has spread within the penis or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
- MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
The following stages are used for penile cancer:
Stage 0 (Carcinoma in Situ)
In stage 0, abnormalcells are found on the surface of the skin of the penis. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
Stage I
In stage I, cancer has formed and spread to connective tissue just under the skin of the penis.
Stage II
In stage II, cancer has spread to:
- connective tissue just under the skin of the penis and to one lymph node in the groin. or
- erectiletissue (spongy tissue that fills with blood to make an erection) and may have spread to one lymph node in the groin.
Stage III
In stage III, cancer has spread to:
- connective tissue or erectiletissue of the penis and to more than one lymph node on one or both sides of the groin; or
- the urethra or prostate, and may have spread to one or more lymph nodes on one or both sides of the groin.
Stage IV
In stage IV, cancer has spread:
- to tissues near the penis and may have spread to lymph nodes in the groin or pelvis; or
- anywhere in or near the penis and to one or more lymph nodes deep in the pelvis or groin; or
- to distant parts of the body.
Top
Recurrent Penile Cancer
Recurrentpenile cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the penis or in other parts of the body.
Top
Treatment Option Overview
There are different types of treatment for patients with penile cancer.
Different types of treatments are available for patients with penile cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Three types of standard treatment are used:
Surgery
Surgery is the most common treatment for all stages of penile cancer. A doctor may remove the cancer using one of the following operations:
- Mohs microsurgery: A procedure in which the tumor is cut from the skin in thin layers. During the surgery, the edges of the tumor and each layer of tumor removed are viewed through a microscope to check for cancer cells. Layers continue to be removed until no more cancer cells are seen. This type of surgery removes as little normal tissue as possible and is often used to remove cancer on the skin.
It is also called Mohs surgery.
 |
| Mohs surgery. A surgical procedure to remove a visible lesion on the skin in several steps. First, a thin layer of cancerous tissue is removed. Then, a second thin layer of tissue is removed and viewed under a microscope to check for cancer cells. More layers are removed one at a time until the tissue viewed under a microscope shows no remaining cancer. This type of surgery is used to remove as little normal tissue as possible. |
- Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor.
- Cryosurgery: A treatment that uses an instrument to freeze and destroy abnormal tissue. This type of treatment is also called cryotherapy.
- Circumcision: Surgery to remove part or all of the foreskin of the penis.
- Wide local excision: Surgery to remove only the cancer and some normal tissue around it.
- Amputation of the penis: Surgery to remove part or all of the penis. If part of the penis is removed, it is a partial penectomy. If all of the penis is removed, it is a total penectomy.
Lymph nodes in the groin may be taken out during surgery.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly onto the skin (topical chemotherapy) or into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Topical chemotherapy may be used to treat stage 0 penile cancer.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web
site.
Biologic therapy
Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy. Topical biologic therapy may be used to treat stage 0 penile cancer.
Radiosensitizers
Radiosensitizers are drugs that make tumor cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers helps kill more tumor cells.
Sentinel lymph node biopsy followed by surgery
Sentinel lymph node biopsy is the removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. It is the first lymph node the cancer is likely to spread to from the tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes. After the sentinel lymph node biopsy, the surgeon removes the cancer.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's clinical trials database.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
Top
Treatment Options by Stage
A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.
Stage 0 (Carcinoma in Situ)
Treatment of stage 0 may be one of the following:
- Mohs microsurgery.
- Topical chemotherapy.
- Topicalbiologic therapy.
- Laser surgery.
- Cryosurgery.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage 0 penile cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Stage I Penile Cancer
If the cancer is only in the foreskin, wide local excision and circumcision may be the only treatment needed.
Treatment of stage I penile cancer may include the following:
- Surgery (partial or total penectomy with or without removal of lymph nodes in the groin.
- External or internal radiation therapy.
- Mohs microsurgery.
- A clinical trial of laser therapy.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I penile cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Stage II Penile Cancer
Treatment of stage II penile cancer may include the following:
- Surgery (partial or total penectomy, with or without removal of lymph nodes in the groin).
- External or internal radiation therapy followed by surgery.
- A clinical trial of sentinel lymph node biopsy followed by surgery.
- A clinical trial of laser surgery.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage II penile cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Stage III Penile Cancer
Treatment of stage III penile cancer may include the following:
- Surgery (penectomy and removal of lymph nodes in the groin) with or without radiation therapy.
- Radiation therapy.
- A clinical trial of sentinel lymph node biopsy followed by surgery.
- A clinical trial of radiosensitizers.
- A clinical trial of chemotherapy before or after surgery.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III penile cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Stage IV Penile Cancer
Treatment of stage IV penile cancer is usually palliative (to relieve symptoms and improve the quality of life). Treatment may include the following:
- Surgery (wide local excision and removal of lymph nodes in the groin).
- Radiation therapy.
- A clinical trial of chemotherapy before or after surgery.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IV penile cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Top
Treatment Options for Recurrent Penile Cancer
Treatment of recurrent penile cancer may include the following:
- Surgery (penectomy).
- Radiation therapy.
- A clinical trial of biologic therapy.
- A clinical trial of chemotherapy.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent penile cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Top
To Learn More About Penile Cancer
For more information from the National Cancer Institute about penile cancer, see the following:
For general cancer information and other resources from the National Cancer Institute, see the following:
Top
This information is provided by the National Cancer Institute.
This information was last updated on January 25, 2010.
Purpose of This PDQ Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of penile cancer. This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board.
Information about the following is included in this summary:
- Risk factors.
- Cellular classification.
- Staging.
- Treatment options by cancer stage.
This summary is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Some of the reference citations in the summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations. Based on the strength of the available evidence, treatment options are described as either “standard” or “under clinical evaluation.” These classifications should not be used as a basis for reimbursement determinations.
This summary is available in a patient version, written in less technical language, and in Spanish.
Top
General Information
Note: Estimated new cases and deaths from penile (and other male genital) cancer in the United States in 2009:[1]
- New cases: 1,290
- Deaths: 300
Risk factors
Penile cancer is rare in most developed nations, including the United States, where the rate is less than 1 per 100,000 men per year. Some studies suggest an association between human papillomavirus (HPV) infection and penile cancer.[2][3][4][5] Observational studies have shown a lower prevalence of penile HPV in men who have been circumcised (odds ratio = 0.37; 95% confidence interval, 0.16–0.85).[6] Some, but not all, observational studies also suggest that male newborn circumcision is associated with a decreased risk of penile cancer.[7][8] According to published data, if the relationship is causal, the number needed to treat was about 909 circumcisions to prevent a single case of invasive penile cancer.[9]
Treatment overview
When diagnosed early (stage 0, stage I, and stage II), penile cancer is highly curable.
Curability decreases sharply for stage III and stage IV. Because of the rarity of
this cancer in the United States, clinical trials specifically for penile
cancer are infrequent. Patients with stage III and stage IV cancer can be candidates
for phase I and phase II clinical trials testing new drugs, biologicals, or surgical
techniques to improve local control and distant metastases.
The selection of treatment depends on the size, location, invasiveness,
and stage of the tumor.[10][11]
References:
American Cancer Society.: Cancer Facts and Figures 2009. Atlanta, Ga: American Cancer Society, 2009. Also available online. Last accessed January 6, 2010.
Del Mistro A, Chieco Bianchi L: HPV-related neoplasias in HIV-infected individuals. Eur J Cancer 37 (10): 1227-35, 2001.
Griffiths TR, Mellon JK: Human papillomavirus and urological tumours: I. Basic science and role in penile cancer. BJU Int 84 (5): 579-86, 1999.
Poblet E, Alfaro L, Fernander-Segoviano P, et al.: Human papillomavirus-associated penile squamous cell carcinoma in HIV-positive patients. Am J Surg Pathol 23 (9): 1119-23, 1999.
Frisch M, van den Brule AJ, Jiwa NM, et al.: HPV-16-positive anal and penile carcinomas in a young man--anogenital 'field effect' in the immunosuppressed male? Scand J Infect Dis 28 (6): 629-32, 1996.
Castellsagué X, Bosch FX, Muñoz N, et al.: Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. N Engl J Med 346 (15): 1105-12, 2002.
Schoen EJ, Oehrli M, Colby C, et al.: The highly protective effect of newborn circumcision against invasive penile cancer. Pediatrics 105 (3): E36, 2000.
Neonatal circumcision revisited. Fetus and Newborn Committee, Canadian Paediatric Society. CMAJ 154 (6): 769-80, 1996.
Christakis DA, Harvey E, Zerr DM, et al.: A trade-off analysis of routine newborn circumcision. Pediatrics 105 (1 Pt 3): 246-9, 2000.
Razdan S, Gomella LG: Cancer of the urethra and penis. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. 7th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2005, pp 1260-7.
Chao KS, Perez CA: Penis and male urethra. In: Perez CA, Brady LW, eds.: Principles and Practice of Radiation Oncology. 3rd ed. Philadelphia, Pa: Lippincott-Raven Publishers, 1998, pp 1717-1732.
Top
Cellular Classification
Virtually all penile carcinomas are of squamous cell origin and include the following subtypes:
- Verrucous carcinoma.[1]
- Warty carcinoma (verruciform).[2]
- Basaloid carcinoma.[3]
Although they are less common subtypes, warty carcinoma and basaloid carcinoma appear to be more highly associated with human papillomaviruses (HPV), particularly HPV 16, than typical squamous cell carcinoma or verrucous carcinoma of the penis.[3][4][5]
In addition, neuroendocrine carcinomas can also be seen.[6]
References:
Schwartz RA: Verrucous carcinoma of the skin and mucosa. J Am Acad Dermatol 32 (1): 1-21; quiz 22-4, 1995.
Bezerra AL, Lopes A, Landman G, et al.: Clinicopathologic features and human papillomavirus dna prevalence of warty and squamous cell carcinoma of the penis. Am J Surg Pathol 25 (5): 673-8, 2001.
Cubilla AL, Reuter VE, Gregoire L, et al.: Basaloid squamous cell carcinoma: a distinctive human papilloma virus-related penile neoplasm: a report of 20 cases. Am J Surg Pathol 22 (6): 755-61, 1998.
Gregoire L, Cubilla AL, Reuter VE, et al.: Preferential association of human papillomavirus with high-grade histologic variants of penile-invasive squamous cell carcinoma. J Natl Cancer Inst 87 (22): 1705-9, 1995.
Rubin MA, Kleter B, Zhou M, et al.: Detection and typing of human papillomavirus DNA in penile carcinoma: evidence for multiple independent pathways of penile carcinogenesis. Am J Pathol 159 (4): 1211-8, 2001.
Vadmal MS, Steckel J, Teichberg S, et al.: Primary neuroendocrine carcinoma of the penile urethra. J Urol 157 (3): 956-7, 1997.
Top
Stage Information
The American Joint Committee on Cancer (AJCC) has designated staging by TNM
classification.[1]
TNM Definitions
Primary tumor (T)
- TX: Primary tumor cannot be assessed
- T0: No evidence of primary tumor
- Tis: Carcinoma in situ
- Ta: Noninvasive verrucous carcinoma
- T1: Tumor invades subepithelial connective tissue
- T2: Tumor invades corpus spongiosum or cavernosum
- T3: Tumor invades urethra or prostate
- T4: Tumor invades other adjacent structures
Regional lymph nodes (N)
- NX: Regional lymph nodes cannot be assessed
- N0: No regional lymph node metastasis
- N1: Metastasis in a single superficial, inguinal lymph node
- N2: Metastasis in multiple or bilateral superficial inguinal lymph nodes
- N3: Metastasis in deep inguinal or pelvic lymph node(s), unilateral or
bilateral
Distant metastasis (M)
- MX: Distant metastasis cannot be assessed
- M0: No distant metastasis
- M1: Distant metastasis
AJCC Stage Groupings
Stage 0
Stage I
Stage II
- T1, N1, M0
- T2, N0, M0
- T2, N1, M0
Stage III
- T1, N2, M0
- T2, N2, M0
- T3, N0, M0
- T3, N1, M0
- T3, N2, M0
Stage IV
- T4, any N, M0
- Any T, N3, M0
- Any T, any N, M1
References:
Penis. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002, pp 303-8.
Top
Stage 0 Penile Cancer
Note: Some citations in the text of this section are followed by a level of
evidence. The PDQ editorial boards use a formal ranking system to help the
reader judge the strength of evidence linked to the reported results of a
therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more
information.)
Stage 0 penile cancer is defined by the following TNM classifications:
Carcinoma in situ of the penis is referred to as erythroplasia of Queyrat when it occurs on the glans, and Bowen disease when it occurs on the penile shaft. These precursor lesions progress to invasive squamous cell carcinoma in 5% to 15% of cases. In case series studies, human papillomavirus DNA has been detected in the majority of these lesions.[1][2] With no data from clinical trials in this disease stage, treatment recommendations are largely based on case reports and case series involving limited numbers of patients.
Treatment options:
- Surgical excision can result in scarring, deformity, and impaired function. To minimize these effects, Mohs micrographic surgery, which involves the excision of successive horizontal layers of tissue with microscopic examination of each layer in frozen section, has been used in patients with in situ and invasive penile cancers.[3][4][Level of evidence: 3iiiDiv]
- Topical application of 5-fluorouracil cream has been reported to be effective in cases of erythroplasia of Queyrat [5] and Bowen disease.[6][Level of evidence: 3iiiDiv]
- Imiquimod 5% cream is a topical immune response modifier that has been reported to be effective with good cosmetic and functional results.[7][8][9][Level of evidence: 3iiiDiv]
- Laser therapy with Nd:YAG or CO2 lasers has also been reported to result in excellent cosmetic results.[10][Level of evidence: 3iiiDiv]
- Cryosurgery has been reported to result in good cosmetic results in patients with erythroplasia of Queyrat and verrucous penile carcinoma.[11][12][Level of evidence: 3iiiDiv]
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with
stage 0 penile cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
References:
Cupp MR, Malek RS, Goellner JR, et al.: The detection of human papillomavirus deoxyribonucleic acid in intraepithelial, in situ, verrucous and invasive carcinoma of the penis. J Urol 154 (3): 1024-9, 1995.
Rubin MA, Kleter B, Zhou M, et al.: Detection and typing of human papillomavirus DNA in penile carcinoma: evidence for multiple independent pathways of penile carcinogenesis. Am J Pathol 159 (4): 1211-8, 2001.
Mohs FE, Snow SN, Messing EM, et al.: Microscopically controlled surgery in the treatment of carcinoma of the penis. J Urol 133 (6): 961-6, 1985.
Moritz DL, Lynch WS: Extensive Bowen's disease of the penile shaft treated with fresh tissue Mohs micrographic surgery in two separate operations. J Dermatol Surg Oncol 17 (4): 374-8, 1991.
Goette DK, Carson TE: Erythroplasia of Queyrat: treatment with topical 5-fluorouracil. Cancer 38 (4): 1498-502, 1976.
Tolia BM, Castro VL, Mouded IM, et al.: Bowen's disease of shaft of penis. Successful treatment with 5-fluorouracil. Urology 7 (6): 617-9, 1976.
Danielsen AG, Sand C, Weismann K: Treatment of Bowen's disease of the penis with imiquimod 5% cream. Clin Exp Dermatol 28 (Suppl 1): 7-9, 2003.
Micali G, Nasca MR, Tedeschi A: Topical treatment of intraepithelial penile carcinoma with imiquimod. Clin Exp Dermatol 28 (Suppl 1): 4-6, 2003.
Schroeder TL, Sengelmann RD: Squamous cell carcinoma in situ of the penis successfully treated with imiquimod 5% cream. J Am Acad Dermatol 46 (4): 545-8, 2002.
van Bezooijen BP, Horenblas S, Meinhardt W, et al.: Laser therapy for carcinoma in situ of the penis. J Urol 166 (5): 1670-1, 2001.
Michelman FA, Filho AC, Moraes AM: Verrucous carcinoma of the penis treated with cryosurgery. J Urol 168 (3): 1096-7, 2002.
Sonnex TS, Ralfs IG, Plaza de Lanza M, et al.: Treatment of erythroplasia of Queyrat with liquid nitrogen cryosurgery. Br J Dermatol 106 (5): 581-4, 1982.
Top
Stage I Penile Cancer
Stage I penile cancer is defined by the following TNM classification:
Stage I penile cancer is curable.[1]
Standard treatment options:
- For lesions limited to the foreskin, wide local excision with circumcision may
be adequate therapy for control.
- For infiltrating tumors of the glans with or without involvement of the
adjacent skin, the choice of therapy is dictated by tumor size, extent of
infiltration, and degree of tumor destruction of normal tissue. Equivalent
therapeutic options include:
- Penile amputation.[2]
- Radiation therapy (i.e., external-beam radiation therapy and brachytherapy).[3][4]
- Microscopically controlled surgery.[5]
Treatment options under clinical evaluation:
- Nd:YAG laser therapy has offered excellent control/cure with preservation of
cosmetic appearance and sexual function.[6][7]
Because of the high incidence of microscopic node metastases, elective
adjunctive inguinal dissection of clinically uninvolved (negative) lymph nodes
in conjunction with amputation is often used for patients with poorly
differentiated tumors. Lymphadenectomy, however, can carry substantial
morbidity, such as infection, skin necrosis, wound breakdown, chronic edema,
and even a low, but finite, mortality rate. The impact of prophylactic
lymphadenectomy on survival is not known. For these reasons, opinions vary on its use.[8][9][10][11]
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with
stage I penile cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
References:
Harty JI, Catalona WJ: Carcinoma of the penis. In: Javadpour N, ed.: Principles and Management of Urologic Cancer. 2nd ed. Baltimore, Md: Williams and Wilkins, 1983, pp 581-597.
Lynch DF, Pettaway CA: Tumors of the penis. In: Walsh PC, Retik AB, Vaughan ED, et al., eds.: Campbell's Urology. 8th ed. Philadelphia: Saunders, 2002, pp 2945-2947.
Chao KS, Perez CA: Penis and male urethra. In: Perez CA, Brady LW, eds.: Principles and Practice of Radiation Oncology. 3rd ed. Philadelphia, Pa: Lippincott-Raven Publishers, 1998, pp 1717-1732.
McLean M, Akl AM, Warde P, et al.: The results of primary radiation therapy in the management of squamous cell carcinoma of the penis. Int J Radiat Oncol Biol Phys 25 (4): 623-8, 1993.
Mohs FE, Snow SN, Messing EM, et al.: Microscopically controlled surgery in the treatment of carcinoma of the penis. J Urol 133 (6): 961-6, 1985.
Smith JA Jr.: Lasers in clinical urologic surgery. In: Dixon JA, ed.: Surgical Application of Lasers. 2nd ed. Chicago, Ill: Year Book Medical Publishers, Inc., 1987, pp 218-237.
Horenblas S, van Tinteren H, Delemarre JF, et al.: Squamous cell carcinoma of the penis. II. Treatment of the primary tumor. J Urol 147 (6): 1533-8, 1992.
Theodorescu D, Russo P, Zhang ZF, et al.: Outcomes of initial surveillance of invasive squamous cell carcinoma of the penis and negative nodes. J Urol 155 (5): 1626-31, 1996.
Lindegaard JC, Nielsen OS, Lundbeck FA, et al.: A retrospective analysis of 82 cases of cancer of the penis. Br J Urol 77 (6): 883-90, 1996.
Ornellas AA, Seixas AL, Marota A, et al.: Surgical treatment of invasive squamous cell carcinoma of the penis: retrospective analysis of 350 cases. J Urol 151 (5): 1244-9, 1994.
Young MJ, Reda DJ, Waters WB: Penile carcinoma: a twenty-five-year experience. Urology 38 (6): 529-32, 1991.
Top
Stage II Penile Cancer
Stage II penile cancer is defined by the following TNM classifications:
- T1, N1, M0
- T2, N0, M0
- T2, N1, M0
Standard treatment options:
- Stage II penile cancer is most frequently managed by penile amputation for
local control. Whether the amputation is partial, total, or radical will
depend on the extent and location of the neoplasm. External beam radiation therapy and brachytherapy with
surgical salvage are alternative approaches.[1][2][3][4][5]
Treatment options under clinical evaluation:
- Nd:YAG laser therapy has been used to preserve the penis in selected patients
with small lesions.[6]
Because of the high incidence of microscopic node metastases, elective
adjunctive dissection of clinically uninvolved (negative) lymph nodes in
conjunction with amputation is often used for patients with poorly
differentiated tumors. Lymphadenectomy, can carry substantial
morbidity, such as infection, skin necrosis, wound breakdown, chronic edema,
and even a low, but finite, mortality rate. The impact of prophylactic
lymphadenectomy on survival is not known.[7][8][9][10]
To reduce the morbidity associated with prophylactic lymphadenectomy, dynamic sentinel node biopsy is being used in patients with stage T2 clinically node-negative penile cancer. One retrospective single-institution study of 22 patients reported a false-negative rate of 11%.[11]
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with
stage II penile cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
References:
Harty JI, Catalona WJ: Carcinoma of the penis. In: Javadpour N, ed.: Principles and Management of Urologic Cancer. 2nd ed. Baltimore, Md: Williams and Wilkins, 1983, pp 581-597.
Schellhammer PF, Spaulding JT: Carcinoma of the penis. In: Paulson DF, ed.: Genitourinary Surgery. Vol. 2. New York: Churchill Livingston, 1984, pp 629-654.
Johnson DE, Lo RK: Tumors of the penis, urethra, and scrotum. In: deKernion JB, Paulson DF, eds.: Genitourinary Cancer Management. Philadelphia, Pa: Lea and Febiger, 1987, pp 219-258.
McLean M, Akl AM, Warde P, et al.: The results of primary radiation therapy in the management of squamous cell carcinoma of the penis. Int J Radiat Oncol Biol Phys 25 (4): 623-8, 1993.
Crook JM, Jezioranski J, Grimard L, et al.: Penile brachytherapy: results for 49 patients. Int J Radiat Oncol Biol Phys 62 (2): 460-7, 2005.
Horenblas S, van Tinteren H, Delemarre JF, et al.: Squamous cell carcinoma of the penis. II. Treatment of the primary tumor. J Urol 147 (6): 1533-8, 1992.
Theodorescu D, Russo P, Zhang ZF, et al.: Outcomes of initial surveillance of invasive squamous cell carcinoma of the penis and negative nodes. J Urol 155 (5): 1626-31, 1996.
Lindegaard JC, Nielsen OS, Lundbeck FA, et al.: A retrospective analysis of 82 cases of cancer of the penis. Br J Urol 77 (6): 883-90, 1996.
Ornellas AA, Seixas AL, Marota A, et al.: Surgical treatment of invasive squamous cell carcinoma of the penis: retrospective analysis of 350 cases. J Urol 151 (5): 1244-9, 1994.
Young MJ, Reda DJ, Waters WB: Penile carcinoma: a twenty-five-year experience. Urology 38 (6): 529-32, 1991.
Perdonà S, Autorino R, De Sio M, et al.: Dynamic sentinel node biopsy in clinically node-negative penile cancer versus radical inguinal lymphadenectomy: a comparative study. Urology 66 (6): 1282-6, 2005.
Top
Stage III Penile Cancer
Stage III penile cancer is defined by the following TNM classifications:
- T1, N2, M0
- T2, N2, M0
- T3, N0, M0
- T3, N1, M0
- T3, N2, M0
Inguinal adenopathy in patients with penile cancer is common but may be the
result of infection rather than neoplasm. If palpable enlarged lymph nodes
exist 3 or more weeks after removal of the infected primary lesion and completion of a
course of antibiotic therapy, bilateral inguinal lymph node dissection should
be performed.
In cases of proven regional inguinal lymph node metastasis without evidence of
distant spread, bilateral ilioinguinal dissection is the treatment of
choice.[1][2][3][4] Since many patients with positive lymph nodes are not
cured, clinical trials may be appropriate.
Standard treatment options:
- Clinically evident regional lymph node metastasis without evidence of
distant spread is an indication for bilateral ilioinguinal lymph node
dissection after penile amputation.[5]
- Radiation therapy may be considered as an alternative to lymph node
dissection in patients who are not surgical candidates.
- Postoperative radiation therapy may decrease incidence of inguinal recurrences.
Treatment options under clinical evaluation:
- Clinical trials using radiosensitizers or cytotoxic drugs are appropriate. A
combination of vincristine, bleomycin, and methotrexate has been effective as
both neoadjuvant and adjuvant therapy.[6] Cisplatin (100 mg/m²) as neoadjuvant therapy plus continuous-infusion 5-fluorouracil has also
been shown to be effective.[5] Single-agent cisplatin (50 mg/m2) was tested in a large trial and was found to be ineffective.[7]
Because of the high incidence of microscopic node metastases, adjunctive
inguinal dissection of clinically uninvolved (negative) lymph nodes in
conjunction with amputation is often used for patients with poorly
differentiated tumors. Lymphadenectomy can carry substantial
morbidity, such as infection, skin necrosis, wound breakdown, chronic edema,
and even a low, but finite, mortality rate. The impact of prophylactic
lymphadenectomy on survival is not known. [2][3][8][9]
To reduce the morbidity associated with prophylactic lymphadenectomy, dynamic sentinel node biopsy is being used in patients with stage T2 and stage T3 clinically node-negative penile cancer. One retrospective single-institution study of 22 patients reported a false-negative rate of 11%.[10]
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with
stage III penile cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
References:
Harty JI, Catalona WJ: Carcinoma of the penis. In: Javadpour N, ed.: Principles and Management of Urologic Cancer. 2nd ed. Baltimore, Md: Williams and Wilkins, 1983, pp 581-597.
Theodorescu D, Russo P, Zhang ZF, et al.: Outcomes of initial surveillance of invasive squamous cell carcinoma of the penis and negative nodes. J Urol 155 (5): 1626-31, 1996.
Lindegaard JC, Nielsen OS, Lundbeck FA, et al.: A retrospective analysis of 82 cases of cancer of the penis. Br J Urol 77 (6): 883-90, 1996.
Lynch DF, Pettaway CA: Tumors of the penis. In: Walsh PC, Retik AB, Vaughan ED, et al., eds.: Campbell's Urology. 8th ed. Philadelphia: Saunders, 2002, pp 2945-2947.
Fisher HA, Barada JH, Horton J, et al.: Neoadjuvant therapy with cisplatin and 5-fluorouracil for stage III squamous cell carcinoma of the penis. [Abstract] J Urol 143(4 Suppl): A-653, 352A, 1990.
Pizzocaro G, Piva L: Adjuvant and neoadjuvant vincristine, bleomycin, and methotrexate for inguinal metastases from squamous cell carcinoma of the penis. Acta Oncol 27 (6b): 823-4, 1988.
Gagliano RG, Blumenstein BA, Crawford ED, et al.: cis-Diamminedichloroplatinum in the treatment of advanced epidermoid carcinoma of the penis: a Southwest Oncology Group Study. J Urol 141 (1): 66-7, 1989.
Ornellas AA, Seixas AL, Marota A, et al.: Surgical treatment of invasive squamous cell carcinoma of the penis: retrospective analysis of 350 cases. J Urol 151 (5): 1244-9, 1994.
Young MJ, Reda DJ, Waters WB: Penile carcinoma: a twenty-five-year experience. Urology 38 (6): 529-32, 1991.
Perdonà S, Autorino R, De Sio M, et al.: Dynamic sentinel node biopsy in clinically node-negative penile cancer versus radical inguinal lymphadenectomy: a comparative study. Urology 66 (6): 1282-6, 2005.
Top
Stage IV Penile Cancer
Stage IV penile cancer is defined by the following TNM classifications:
- T4, any N, M0
- Any T, N3, M0
- Any T, any N, M1
No standard treatment exists that is curative for patients with stage IV penile cancer.
Therapy is directed at palliation, which may be achieved either with surgery or
radiation therapy.
Standard treatment options:
- Palliative surgery may be considered for control of the local penile lesion
and even for the prevention of the necrosis, infection, and hemorrhage that
can result from neglected regional adenopathy.
- Radiation therapy may be palliative for the primary tumor, regional adenopathy,
and bone metastases.
Treatment options under clinical evaluation:
- Clinical trials combining chemotherapy with palliative methods of local control
are appropriate for such patients (tested chemotherapeutic drugs with some
efficacy include vincristine, cisplatin, methotrexate, and bleomycin). The
combination of vincristine, bleomycin, and methotrexate has been effective both
as adjuvant and neoadjuvant therapy.[1]
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with
stage IV penile cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
References:
Pizzocaro G, Piva L: Adjuvant and neoadjuvant vincristine, bleomycin, and methotrexate for inguinal metastases from squamous cell carcinoma of the penis. Acta Oncol 27 (6b): 823-4, 1988.
Top
Recurrent Penile Cancer
Locally recurrent disease can be approached by surgery or radiation therapy.
If the initial treatment of radiation therapy fails, patients are often salvaged by
penile amputation. Patients with nodal recurrences that are not controllable
by local measures are candidates for phase I and phase II clinical trials testing new
biologicals and chemotherapeutic agents.[1][2][3][4][5]
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with
recurrent penile cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
References:
Pizzocaro G, Piva L: Adjuvant and neoadjuvant vincristine, bleomycin, and methotrexate for inguinal metastases from squamous cell carcinoma of the penis. Acta Oncol 27 (6b): 823-4, 1988.
Ahmed T, Sklaroff R, Yagoda A: Sequential trials of methotrexate, cisplatin and bleomycin for penile cancer. J Urol 132 (3): 465-8, 1984.
Dexeus FH, Logothetis CJ, Sella A, et al.: Combination chemotherapy with methotrexate, bleomycin and cisplatin for advanced squamous cell carcinoma of the male genital tract. J Urol 146 (5): 1284-7, 1991.
Fisher HA, Barada JH, Horton J, et al.: Neoadjuvant therapy with cisplatin and 5-fluorouracil for stage III squamous cell carcinoma of the penis. [Abstract] J Urol 143(4 Suppl): A-653, 352A, 1990.
Hussein AM, Benedetto P, Sridhar KS: Chemotherapy with cisplatin and 5-fluorouracil for penile and urethral squamous cell carcinomas. Cancer 65 (3): 433-8, 1990.
Top
More Information
About PDQ
Additional PDQ Summaries
Important:
This information is intended mainly for use by doctors and other health care professionals. If you have questions about this topic, you can ask your doctor, or call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).
Top
This information is provided by the National Cancer Institute.
This information was last updated on July 1, 2009.