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Penile Cancer

Penile cancer, otherwise known as cancer of the penis, is cancer that affects the skin and tissue of the penis. In the United States, penile cancer is very rare. Less than one man in 100,000 will get penile cancer. According to the American Cancer Society, each year in the U.S., about 1640 men will be diagnosed with penile cancer and 320 men will die from it. Prostate cancer, which is the most common cancer in men, will be diagnosed in 233,000 men each year, and 29,480 will die from it.

There are five main types of penile cancer. The types are:

  • Squamous cell carcinoma is the most common type of penile cancer. About 95 percent of all cancers of the penis develop from squamous cells, which are flat skin cells. Cancer that develops from squamous cells is called squamous cell carcinoma. Squamous cell cancers tend to grow slowly, and they can usually be cured if they are found early.

    Carcinoma in situ, or CIS, is the earliest stage of squamous cell penile cancer. With CIS, cancer is only found in the top layers of the skin on the penis.
  • Melanoma is a type of skin cancer that can sometimes affect the skin on the penis. It can grow and spread quickly, which makes it especially dangerous. Melanoma is an uncommon type of cancer of the penis, making up less than 2 percent of all penile cancer.
  • Basal cell cancer of the penis is rare, making up less than 2 percent of all cases of penile cancer. It affects the basal cells, which are found in the deepest layers of the skin.
  • Adenocarcinoma, otherwise known as Paget disease of the penis, is a very rare form of penile cancer that can develop from sweat glands in the penis. Adenocarcinoma can look very much like carcinoma in situ of the penis, so it may be difficult to diagnose.
  • Sarcoma is another rare type of penile cancer that develops from the blood vessels, smooth muscle or connective tissue cells of the penis. It is considered a soft tissue cancer. Sarcomas tend to grow more quickly than other types of cancer.

What causes penile cancer?

The exact cause of penile cancer is not known, however, many risk factors for getting penile cancer are known. A risk factor is something that increases a person’s chance of getting a disease. Some risk factors for penile cancer are:

  • HPV infection (human papilloma virus infection) – HPV is a virus. There are many strains of HPV. Some strains cause genital warts and others can cause cancer, including penile cancer. HPV is considered a sexually transmitted virus, as most people contract it through contact with infected sex organs.
  • Not being circumcised – Uncircumcised men have a higher risk of getting penile cancer. To reduce the risk, make sure you clean underneath the foreskin to reduce the risk of infection, smegma and phimosis.
  • Phimosis – Phimosis is a condition that makes it difficult to retract the foreskin of the penis. When the foreskin cannot be easily retracted, it’s difficult to clean properly underneath it, which can lead to problems. Phimosis may be preventable by retracting the foreskin and cleaning underneath it regularly.
  • Smegma – This is a foul-smelling, thick substance that can develop when oily secretions, dead skin cells and bacteria build up under the foreskin of the penis. Retracting the foreskin and cleaning thoroughly underneath it can help reduce the risk of smegma, which may also reduce the risk of penile cancer.
  • Smoking –Smoking can put people at risk for many types of cancer, not just lung cancer. Smokers or former smokers who are also infected with HPV have an even higher risk of getting penile cancer than someone who has either risk factor individually.
  • AIDS – Men who have AIDS are at higher risk of penile cancer, most likely due to their decreased immune response.
  • UV light treatment for psoriasis – A skin disease called psoriasis is sometimes treated with PUVA therapy, which involves taking the drug psoralens and following up with exposure to ultraviolet A (UVA) light. To reduce the risk of penile cancer, men who undergo this type of therapy should cover their genitals during treatment.
  • Age – More than half of the men who develop penile cancer are over the age of 68.

What are the signs and symptoms of penile cancer?

The first sign of penile cancer is usually changes to the skin of the penis. The skin changes may include:

  • Color change – The skin may become darker or lighter or may change color from flesh-toned to red.
  • Change in skin thickness – The skin of the penis may become thicker or change texture.
  • Tissue buildup – You may notice a buildup of tissue on the penis or a raised area of skin.
  • Sore or ulcer – Some penile cancer may begin with a sore or ulcerated area of skin on the penis.
  • Lump on the penis – You may notice a lump or bump on the penis.

Most of the time, the skin changes will begin on the glans (head) of the penis, but penile cancer can occur anywhere on the penis. If you are uncircumcised, you should regularly retract the foreskin and check the skin underneath for changes. And all men should check their penis regularly for any changes. If you see any changes to your penis, call your doctor.

Other signs and symptoms of penile cancer include:

  • Reddish, velvety rash on the penis
  • Small bumps that can appear crusty
  • Flat growths that are blue-ish brown in color
  • Unusual or new discharge from the penis that may have a foul odor
  • Swelling of the tip of the penis
  • Swollen lymph nodes in the groin area that may feel like lumps under the skin of the groin

If you have any symptoms of penile cancer, call your doctor and make an appointment right away. Getting an early diagnosis is important because when penile cancer is caught early, treatment tends to be much more effective.

Can penile cancer be prevented?

Because there is no definitive cause for penile cancer and some men who get penile cancer don’t have any known risk factors, it’s not possible to prevent all cases of penile cancer. However, some experts believe that many cases of penile cancer are preventable, and the best way to prevent it is by avoiding risk factors. Aside from age, all risk factors for penile cancer can be avoided.

Here are some ways you can reduce your risk for getting penile cancer:

  • Avoid HPV infection. HPV infection is a major risk factor for penile cancer. One problem with HPV is that the strains that cause cancer don’t usually show symptoms, so people can have it and spread it without even knowing they are infected. Condoms offer some protection from HPV, but you can still contract the virus even when wearing a condom. You can also contract HPV during oral and anal sex. Limiting your number of sexual partners is one way to reduce your risk. There is a vaccine against some strains of HPV that is approved for use in males. Gardasil is meant to prevent two strains of HPV that can cause genital and anal cancer, however, it has not been proven yet that it can prevent penile cancer. Talk with your doctor (or your child’s doctor) about whether Gardasil is right for you.
  • Don’t smoke. If you do smoke, quit.
  • Maintain good genital hygiene. If you are uncircumcised, make sure to retract and clean thoroughly underneath your foreskin every day.

How is penile cancer diagnosed?

If you have symptoms of penile cancer, your doctor will examine you and order some diagnostic tests to find out whether you have cancer and, if you do, what type of cancer it is. The tests may include:

  • Biopsy – To make a definitive diagnosis of penile cancer, you will likely need to undergo a biopsy. Biopsy involves removing some tissue from your penis or lymph nodes and examining it in a laboratory. There are three types of biopsy that may be performed.
    • Incisional biopsy involves removing only part of the abnormal tissue. It is usually done for larger lesions, sores or ulcerations, and lesions that appear to grow deeper into the tissue.
    • Excisional biopsy removes the entire lesion or abnormal growth. This is usually done when the abnormal area is small.
    • Lymph node biopsy is usually done when penile cancer has invaded the tissues within the penis. It will help your doctor find out whether the cancer has spread beyond the tissue of the penis. Usually, lymph node biopsy is done through fine needle aspiration (FNA), a procedure in which a doctor inserts a thin needle into the lymph node(s) and withdraws cells and fluid to find out whether cancer is present in the lymph node(s). Sometimes, the entire lymph node(s) will be surgically removed to check for cancer.
  • Imaging tests can help doctors diagnose and stage penile cancer. They use x-rays, magnetic fields or sound waves to create pictures of the inside of a body. Some of the imaging tests used to diagnose penile cancer and determine the stage of the cancer include:
    • CT scan (computed tomography scan)
    • MRI (magnetic resonance imaging)
    • Ultrasound

Treatments for penile cancer

Penile cancer treatment will depend on a number of factors, including the type and stage of cancer, your overall health and your preference regarding the treatment options.

At Beaumont, you will have a multidisciplinary team of doctors and professionals working with you to find the best treatment for you. Your team of specialists may include a urologist, an oncologist, a radiation oncologist, a nurse practitioner, and a psychologist or social worker, among others.

The main treatment options for penile cancer are:

  • Surgery – Surgery is the most common treatment for penile cancer. There are a number of surgeries used to treat it. Which surgery is chosen will depend on the type and stage of cancer. Surgical options include:
    • Circumcision (removal of the foreskin used when cancer is confined to the foreskin)
    • Mohs Surgery (micrographic surgery that removes the cancer cells and spares as much healthy tissue as possible)
    • Laser surgery (a surgical procedure to kill cancer cells using laser technology)
    • Cryotherapy (freezing the cancerous tissue to destroy it)
    • Partial penectomy (removal of part of the penis)
    • Total penectomy (removal of all of the penis)
  • Radiation therapy – Radiation therapy may be used on its own or in conjunction with other treatments. It is sometimes given before surgery to shrink cancer cells or after surgery to remove any remaining cancer that couldn’t be surgically removed. Some doctors will also use radiation therapy as a first line treatment and will save surgery for later if the radiation doesn’t kill all of the cancer.
  • Chemotherapy – Chemotherapy may be used on its own or along with other treatments. Sometimes it is used prior to surgery, and sometimes it is used after surgery. Chemotherapy can also be used to kill cancer that has spread to other parts of the body.
  • Topical therapy (for some very early penile cancers) – Topical therapy may be sufficient if the cancer is limited to the head of the penis. Topical therapy may include imiquimod or 5-FU cream.

Clinical trials

There are often clinical trials going on that involve treatment for penile cancer. Clinical trials may give men with penile cancer an opportunity to have experimental treatments that aren’t widely available. If you have penile cancer, talk with your doctor about clinical trials and whether there are any that might be right for you.

Make an appointment

If you have symptoms of penile cancer or already have a diagnosis of penile cancer and would like to talk with us about treatment options, call 877-BEAT-CANCER (877-232-8226) to make an appointment.