Treatment options for penile cancer

Your doctor will talk to you about the treatment they suggest. They will explain its benefits and the possible side effects.

The main treatments for cancer of the penis are:

• surgery

• radiotherapy

• chemotherapy

You might have one or more of these treatments.

Deciding which treatment you need

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

To decide which treatment you need, your team looks at your test and scan results to see:

• where your cancer is

• how big it is and whether it has spread into the nearby lymph nodes or somewhere else in the body (the stage)

• the type of penile cancer

• how abnormal the cells look under a microscope (the grade)

They also talk to you and examine you to find out about your general health and level of fitness.

The TNM staging system is the most common way that doctors stage penile cancer. TNM stands for Tumour, Node, Metastasis. This describes whether the cancer is in the top layers of the skin or has grown deeper into the penis. It also describes whether the cancer has spread to the lymph nodes and other parts of the body.

It is important to know if the cancer has spread into the nearby lymph nodes. This is called lymph node involvement. You might have:

• no cancer in the lymph nodes
• cancer in the lymph nodes in your groin
• cancer in the lymph nodes in your groin and pelvis

You might have tests and scans to see if your cancer has spread to another part of your body. If it has spread, this is called advanced, secondary, or metastatic penile cancer.

Ask your doctor if you’re not sure what your TNM stage is, and you want more information about your cancer.

The treatment you have will depend on: 

• what your doctor thinks is best for your type of cancer

• which treatments are available at your hospital

• your personal choice

• your general health and level of fitness

Treatment for penile cancer in the top layers of skin

You might have cancer only in the top layers of the skin of the penis. The areas look like small lumps (nodules) or sores (ulcers) and can vary in size. The condition can stay at this stage for several years. The cancer hasn’t spread anywhere else. Doctors might call this penile intraepithelial neoplasia (PeIN) or pre cancerous cell changes. An older term for this is carcinoma in situ (CIS).

There are various treatments for PeIN. The aim is to keep the penis looking and working normally. 

Treatments you may have include one of the following:

• chemotherapy creams such as fluorouracil (5FU), or a cream called imiquimod that uses the immune system to fight cancer

• laser therapy

• glans resurfacing surgery - where the top layers of tissue from the glans or tip of the penis are removed and then covered with a skin graft

The chemotherapy cream will not make you lose your hair. Your doctor might recommend that you have your foreskin removed (circumcision) before using the creams. This is because it is easier to monitor the penile cancer lesion. It also makes it easier to apply the creams.

Treatment for cancer that has grown deeper into the glans

Surgery is the main treatment for cancer that has grown deeper into the glans. This is T1 or T2 in the TNM staging system. For small, localised cancers , your team will try to prevent the loss of your penis.

You might have removal of the foreskin (circumcision) if the cancer is only in the foreskin.

If your cancer is elsewhere on the penis you might have one of the following treatments:

• removal of the cancer and a surrounding area of tissue (wide local excision) and circumcision

• removal of part of the head of the penis (partial glansectomy)

• total removal of the head of the penis (total glansectomy) with or without glans reconstruction

• removal of part of the penis (partial penectomy) – with or without a glans reconstruction from a skin graft

• internal or external radiotherapy to the penis

Treatment for cancer that has grown deeper into the penis (invasive penile cancer)

Surgery is the main treatment for cancer that has grown deeper into the penis. You might hear this called invasive penile cancer.  This is T2, T3 or T4 in the ‘T’ part of the TNM system.

You might have one of the following:

• total removal of the head of the penis (total glansectomy) with circumcision

• removal of the cancer and a surrounding area of tissue (wide local excision) - this is less common than other treatments for invasive penile cancer

• removal of part of the penis (partial penectomy)

• removal of all of the penis (penectomy)

• chemotherapy then surgery

• internal or external radiotherapy to the penis

For some men, it is more likely that you will need a partial penectomy or penectomy. Your surgeon will try to avoid the need to remove all of the penis, but this may not be possible for everyone.

The team looking after you will discuss the best treatment for your situation. 

It can be shocking and upsetting to hear about your planned operation. Your team will talk about this with you in a sensitive way. You are offered help and support with this.

Lymph node treatment

Doctors look at the risk of your penile cancer spreading to the lymph nodes in your groin or pelvis. We know from research that the cancer usually spreads to the lymph nodes in the groin first, before the pelvis.

Some people with very small and low grade cancers have their lymph nodes monitored. This is also called surveillance. You might have this through a physical examination or scans.

For men with larger or higher grade cancers, there are tests available to see if your penile cancer has spread to the lymph nodes.

If you have cancer in your lymph nodes you might have one of the following:

• removal of lymph nodes in your groin on one, or both, sides

• removal of lymph nodes in your pelvis on one, or both, sides

• chemotherapy before lymph node removal (neoadjuvant chemotherapy)

• chemotherapy after lymph node removal (adjuvant chemotherapy)

• radiotherapy to the lymph nodes – the aim of this is to try and control the cancer in the lymph nodes

Treatment for cancer that has spread

Cancer in the local area

You might have surgery if your cancer has spread into local areas, such as the prostate, bladder, scrotum or abdominal wall. This is often to try and control the cancer. You might need to have the whole penis and other affected areas removed. Your surgeon will talk you through the operation and explain what this involves.

Your surgeon may make a new opening in the abdomen or the perineum (area between the scrotum and anus). You can pass urine through this opening. Your surgeon will explain more about this. Or you might have a catheter (tube) attached to your bladder through your tummy (abdomen). This is called a suprapubic catheter, it drains urine from your bladder into a bag on the outside of your body.

Some people have chemotherapy, sometimes with radiotherapy, before surgery. The aim is to shrink the cancer and make it easier to remove. Your surgeon will remove the lymph nodes in your groin (inguinal nodes) on both sides. After your operation, you might have radiotherapy to the groin. But you won’t have radiotherapy if you had it before your surgery.

Cancer beyond nearby lymph nodes or in pelvic lymph nodes

You usually have surgery if cancer has spread into the nearby lymph nodes and surrounding tissues, or to lymph nodes in the pelvis. The surgeon removes the lymph nodes in your groin on one, or both, sides. Your surgeon might remove the lymph nodes in your pelvis if the groin lymph nodes contain cancer cells. You might have this as a second operation.

You might have radiotherapy to the lymph node areas to try to kill any cancer cells that might be left behind. Some people also have chemotherapy.

Cancer in distant organs or tissues

Your cancer is advanced if it has spread to distant organs and tissues. The aim of your treatment is to keep the cancer under control and prevent or relieve symptoms. You might have surgery to remove as much of the cancer in the penis as possible. Or you might have radiotherapy to shrink the cancer. 

You may have surgery or radiotherapy (sometimes with chemotherapy) to treat lymph nodes close to the penis. Radiotherapy may also help to treat areas of cancer in other parts of the body, such as the bones or brain. Chemotherapy can help to treat cancer that has spread to the lungs or liver. 

If the cancer comes back

Your treatment will depend on several factors if the cancer comes back after treatment. These include where the cancer is, and what treatment you have already had.

Your specialist may suggest more surgery. Or you might have radiotherapy if you are not able to have surgery. You might have chemotherapy if the cancer has spread to other parts of the body.

Clinical trials

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.

Information and support

This cancer affects a deeply personal and private part of your body. A few people prefer not to know about their operation, or other treatment, in advance. But for most men, it may help you to cope better if you understand exactly what is going to happen. It is important to feel supported.

There should be information available for you to take home with you if you want it. Ask your surgeon or specialist nurse for a booklet or printed web pages that you can read through. This will help you to work out what questions you need to ask next time you go to the hospital.

We have information about living with penile cancer, which includes resources and information about organisations that offer support.

For support you can call our nurse freephone helpline on 0808 800 4040. They are available from Monday to Friday, 9am to 5pm. Or you can send them a question online.