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What is penile cancer?

Cancer is a disease of the cells. Normally, cells multiply and die in an orderly way, so that each new cell replaces one that has been lost. Sometimes, however, cells become abnormal and keep growing, forming a mass or lump called a tumour or a sore called an ulcer. Some of these are malignant (cancerous) and can grow and spread to other parts of the body. 

Penile cancer is a rare type of cancer and occurs on the foreskin, the glans (head) of the penis, or on the skin of the penile shaft. It occurs mostly in uncircumcised men (men who still have foreskin around the head of the penis). 

There are several types of penile cancer:

  • squamous cell cancer (SCC) – the most common type of cancer of the penis which accounts for around 95% of cases
  • carcinoma in situ (CIS), penile intraepithelial neoplasia (PeIN) - the earliest stage of squamous cell penile cancer where cancer cells are only found in the very top layer of the skin cells
  • basal cell carcinoma (BCC) – anther type of skin cancer that can develop in deeper cells of the squamous cells
  • adenocarcinoma – a type that develops in the sweat glands in the skin of the penis
  • melanoma of the penis
  • penile sarcoma – a very rare type of cancer that develops in the deeper tissues of the penis.  

Penile cancer is rare with around 103 Australians diagnosed every year. It is more likely to be diagnosed in men over 50 years of age but it can occur in younger men.  



Penile cancer symptoms

People with penile cancer may experience a range of different symptoms. Symptoms may include:  

  • a growth or sore on the head of the penis (the glans), the foreskin or on the shaft of the penis that doesn’t heal in a couple of weeks

  • bleeding from the penis or under the foreskin

  • a smelly discharge under the foreskin 

  • a hard lump under the foreskin 

  • changes in the colour of the skin on the penis or foreskin  

  • thickening of the skin on the penis or foreskin that makes it difficult to pull back the foreskin 

  • pain in the shaft or tip of the penis 

  • swelling at the tip of the penis  

  • a rash on the penis or a persistent red patch of skin that does not go away 

  • lumps in the groin due to swollen lymph nodes.



Causes of penile cancer

The cause of penile cancer is not known in most cases. However, there are several risk factors:  

  • human papillomavirus (HPV)

  • not being circumcised

  • smoking tobacco

  • increasing age

  • certain skin conditions such as psoriasis 

  •  HIV/AIDS

  • premalignant lesions/conditions 

  • exposure to ultraviolet (UV) radiation.



Diagnosis of penile cancer

If your doctor thinks that you may have penile cancer, they will talk to you about your medical history, perform a physical examination and suggest that you have certain tests.  

If the results of these tests suggest that you may have penile cancer, your doctor will refer you to a specialist called a urologist for further tests. These tests may include: 

Blood tests

Blood tests will include a full blood count to measure your white and red blood cells, your platelets and chemicals produced by cancer cells (tumour markers).   

Biopsy

A biopsy involves the removal of a small sample of tissue from the affected area for examination under a microscope. For penile cancer you may have: 

  • a punch biopsy, under local anaesthetic, of the affected area to remove tissue 
  • a fine needle aspiration biopsy under local anaesthetic, where a thin needle is inserted into the tumour or lymph node 
  • a sentinel lymph node biopsy under local anaesthetic, to see if cancer cells have spread to lymph nodes 
  • removal of the lymph nodes from one or both sides of the groin area to see if the cancer has spread. This is performed under general anaesthetic.  

Ultrasound

Soundwaves are used to create pictures of the inside of your body. You will be asked to lie down and a gel will be spread over the affected part of your body and then a small device (transducer) is moved over the area. The ultrasound takes about 15 minutes and is painless.  

CT scan

Special machines are used to scan and create pictures of the inside of your body. You may have an injection of dye into your veins before the scan which makes the pictures clearer.  During the scan you will lie on a table which moves in and out of the scanner.  A CT scan takes about 10-30 minutes.  

MRI

An MRI scan produces detailed cross-sectional pictures of your body and can show the extent of any tumours.  You will lie on a table which slides into a large metal tube that is open at both ends. An MRI scan takes about 30-90 minutes.  

PET scan

The PET scan is combined with a CT scan where your are injected with a glucose solution containing some radioactive. Cancer cells show up brighter on the scan. 



Treatment for penile cancer

The main treatments for penile cancer include surgery, radiation therapy and chemotherapy. These can be given alone or in combination.  

Surgery

Surgery is the main treatment for penile cancer. A surgeon will remove the tumour as well as some surrounding healthy tissue (margin). The extent and type of surgery depends on the location and the grade and stage of the tumour. Your surgeon will discuss the type of operation you may need. In most cases, any physical changes to your penis after an operation can be corrected with reconstructive surgery. 

Some early-stage, low-grade penile cancers can be treated with techniques other than surgery.  

Laser treatment

If the cancer is very small and only on the any physical changes to your penis after an operation can be corrected with reconstructive surgery.  

Photodynamic therapy (PDT)

Photodynamic therapy uses special drugs, called photosensitising agents, along with light to kill cancer cells. The drugs only work after they have been activated or turned on by the light.  

Cryosurgery

Cryosurgery uses liquid nitrogen to freeze and kill the cancer cells. The procedure may sting and cause slight discomfort. 

Radiation therapy (radiotherapy)

Radiation therapy (also known as radiotherapy) uses high energy x-rays to destroy cancer cells. The radiation comes from a machine outside the body. It may be used for penile cancer:  

  • to treat smaller penile cancers instead of surgery  
  • after surgery, to destroy any remaining cancer cells and stop the cancer coming back  
  • if the cancer cannot be removed with surgery  
  • at the same time as chemotherapy to help shrink the tumour before surgery to make it easier to remove with less damage to the penis  
  • if the cancer has spread to other parts of the body (e.g. palliative radiation for the management of pain). 

There are two ways to have radiation therapy for penile cancer:  

  • external beam radiation therapy  
  • brachytherapy. 

Chemotherapy

Chemotherapy is the use of drugs to kill or slow the growth of cancer cells. You may have one chemotherapy drug, or a combination of drugs. This is because different drugs can destroy or shrink cancer cells in different ways. 

Palliative care

In some cases of advanced cancer, treatment will focus on managing any symptoms, such as pain, and improving your quality of life without trying to cure the disease. This is called palliative treatment. 

As well as slowing the spread of bladder cancer, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other drug therapies. 

Treatment Team

Depending on your treatment, your treatment team may consist of a number of different health professionals, such as:
  • Cancer nurses- assist with treatment and provide information and support throughout your treatment.
  • Medical oncologist- prescribes and coordinates the course of chemotherapy.
  • Surgeon- surgically removes tumours and performs some biopsies.
  • Radiologist- interprets diagnostic scans (including CT, MRI and PET scans).
  • GP (General Practitioner)- looks after your general health and works with your specialists to coordinate treatment.
  • Radiation oncologist- prescribes and coordinates radiation therapy treatment.
  • Other allied health professionals- such as social workers, pharmacists and counsellors.
  • Dietitian- recommends an eating plan to follow while you are in treatment and recovery.
  • Urologist- specialises in the treatment of diseases of the urinary system (male and female) and the male reproductive system.


Screening for penile cancer

There is currently no national screening program for penile cancer in Australia.  



Preventing penile cancer

There is no definite way to prevent penile cancer but there are some risk factors that you can avoid such as quitting smoking and avoiding exposure to UV radiation. Being vaccinated against HPV will also reduce your risk of penile cancer.  



Prognosis of penile cancer

It is not possible for a doctor to predict the exact course of a disease as it will depend on the person's individual circumstances. However, your doctor may give you a prognosis, the likely outcome of your disease, based on the type of cancer you have, your test results, the rate of tumour growth, as well as your age, fitness and medical history. 



Sources

Understanding Penile Cancer. Cancer Council Australia © 2021. Last medical review of the source fact sheet: February 2021.  

Australian Institute of Health and Welfare 2019. Cancer in Australia 2019. Cancer series no.119. Cat. no. CAN 123. Canberra, AIHW. 

This web-based resource was made possible by the Cancer Australia Supporting people with cancer Grant initiative, funded by the Australian Government.