What is penile cancer?

Penile cancer, while rare, is a type of cancer that begins in or on the penis, which is part of the male reproductive system.

Cancer begins when cells grow out of control, causing a tumor to form. It’s normal to feel nervous, upset or confused about a cancer diagnosis or that of a loved one, but understanding this disease may be a powerful tool in processing those feelings and making better treatment decisions.

Main types of penile cancer

There are several types of penile cancer, some more rare than others. Doctors will identify the type to determine the severity of the cancer and the appropriate treatment options.

Squamous cell carcinoma: Almost all penile cancers (about 95 percent) begin in flat skin cells (squamous cells), according to the American Cancer Society (ACS). Squamous cell carcinoma (or squamous cell cancer) may develop anywhere on the penis but tends to start on the foreskin or glans (head). This generally slow-growing cancer may be treatable if found at an early stage.

• Verrucous carcinoma: Also called a Buschke-Lowenstein tumor, a verrucous carcinoma on the penis is an uncommon form of squamous cell cancer. It may resemble a large genital wart and is usually slow-growing—but it has the capacity to grow to a large size over time.
• Carcinoma in situ (CIS): This squamous cell cancer of the penis typically hasn’t reached deeper skin tissue and remains in the top layers of skin.

Basal cell carcinoma: This rare type of penile cancer is slow-growing and doesn’t often spread to other parts of the body.

Melanoma: A small number of penile cancers are melanomas. A type of skin cancer, melanoma begins in skin cells called melanocytes. This cancer may grow and spread quickly and be more high-risk than basal and squamous skin cancers.

Adenocarcinoma (Paget disease of the penis): A very rare type of penile cancer, it begins with the sweat glands in the skin of the penis. It closely resembles carcinoma in situ of the penis.

Sarcoma: This type of cancer, also rare, starts in the blood vessels, smooth muscle or connective tissue cells within the penis.

With so many types of penile cancers, it may be confusing to understand their differences. It’s always best to consult a doctor and ask plenty of questions.

Most common risk factors for penile cancer

About 2,210 cases of penile cancer are expected to be diagnosed in 2021, according to the ACS. This rare cancer accounts for fewer than 1 percent of cancers in U.S. men.

Still, it’s important to know the risk factors of the disease and to address any concerns about penile or reproductive health with a doctor.

• Human papillomavirus (HPV): An HPV infection may increase the risk of penile cancer. HPV comprises more than 150 related viruses, according to the ACS, and is found in about 50 percent of penile cancer cases.
• No circumcision: Men circumcised when they were young have a lower risk of penile cancer. While it’s not completely understood why, it’s thought to be related to conditions known as phimosis and smegma. Uncircumcised men may develop phimosis, which happens when the foreskin becomes tight, preventing it from easily retracting. This may result from inflammation or from smegma, a thick secretion that builds up under the foreskin if not cleaned well. Uncircumcised men should watch out for both phimosis and smegma and always keep their penis and foreskin clean.
• Smoking: Smoking and using tobacco products increases the risk of penile cancer. Those who smoke and have an HPV infection face an even higher risk.
• Age: As men age, their risk of penile cancer increases. Men older than 55 represent about four out of five penile cancer diagnoses in the United States, according to the ACS.
• AIDS: Men with AIDS are thought to be at higher risk of penile cancer, likely due to their weakened immune system.
• Ultraviolet (UV) light for treating psoriasis: Men with psoriasis sometimes receive a treatment using a UV light source (called PUVA). A higher rate of penile cancer has been seen among men who’ve undergone PUVA. As a result, psoriasis patients have their genitals covered when receiving treatment.

Symptoms of penile cancer

Penile cancer doesn’t always present with symptoms. Still, symptoms are possible, so men who suspect any changes are urged to seek medical help. Some of the most common symptoms include:

• Changes in color of the penis
• Unexplained growths or sores
• Discharge from the penis, including blood from the tip or under the foreskin
• Unexplained pains
• Lesions or rashes
• Small, crusty bumps
• Swelling of the penis or of lymph nodes in the groin area

Diagnosing penile cancer

In diagnosing penile cancer, doctors may ask questions about the patient’s age, overall health, symptoms and medical history. They may also perform a physical examination and, later, a diagnostic test. These may include a biopsy, X-ray, magnetic resonance imaging (MRI) or computed tomography (CT) scan. If the doctor thinks there’s a chance the cancer has spread to nearby lymph nodes, an inguinal (groin) lymph node dissection may also be ordered.

Once the results are in, doctor and patient should discuss what they mean and which treatment options would be appropriate.

Treatments for penile cancer

There are several types of treatment available for penile cancer, based on the type of cancer and its staging.

• Surgery is the most common treatment for all stages of penile cancer. Surgeries include the following types:
  • Mohs microsurgery. A surgeon cuts the tumor from the skin in thin layers. Using a microscope, each layer of skin is examined, looking for cancer cells. Layers of tissue continue to be removed until the surgeon reaches the point where no more cancer cells are found.
  • Laser surgery. Using a laser beam, a surgeon makes cuts into skin tissue to remove a tumor or surface skin lesion.
  • Cryosurgery. The surgeon uses a special instrument to freeze and destroy cancer cells.
  • Circumcision. This is a surgery that removes the foreskin from the penis, either partially or completely.
  • Wide local excision. This type of surgery cuts the cancer from the skin. Amputation of the penis. This is the surgical removal of all or part of the penis.

• Radiation therapy uses high-energy radiation, such as X-rays, to target and destroy cancer cells. Radiation may be done either internally or externally.
  • With internal radiation, controlled radioactive materials—such as seeds or catheters—are placed in or near the cancer in order to kill the cancer cells.
  • With external radiation, a machine sends rays of radiation specifically to the parts of the body that need treatment.

• Chemotherapy: With chemotherapy, doctors prescribe drugs, either injected or taken orally, to kill cancer cells. This is known as systemic chemotherapy and allows drugs to enter the bloodstream and reach the cancer cells.
  • For some types of penile cancer, chemotherapy drugs may be applied directly to the skin (known as topical chemotherapy).

• Biologic therapy uses the body’s immune system to fight off cancer and is also referred to as immunotherapy.