Cancers of the penis are usually types of skin cancers. Skin cancer can occur anywhere on the penis, but it most commonly occurs at the glans penis (the cone-shaped end of the penis), especially its base. Cancers affecting the skin of the penis, uncommon in the United States, are even rarer in men who have been circumcised.
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The cause of penile cancer may be long-standing irritation, usually under the foreskin. Other risk factors include having a sexually transmitted infection (particularly human papillomavirus infection or HIV/AIDS), having balanitis, being uncircumcised, having poor hygiene, and using tobacco. Squamous cell carcinoma occurs most commonly. Early forms of that cancer that are uncommon include squamous cell carcinoma in situ (formerly Bowen disease), extramammary Paget disease, and erythroplasia of Queyrat.
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Cancer usually first appears as a painless, reddened area, often with sores, but it can also be a hardened area or look like a wart. Cancers, unlike many other growths, do not heal for weeks. Erythroplasia of Queyrat causes a discrete, reddish, velvety or crusted area on the penis, usually on the glans penis or the inner foreskin. Lymph nodes in the groin may become enlarged because the cancer has spread to them or because they are infected and inflamed.
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Biopsy
Sometimes computed tomography (CT) or magnetic resonance imaging (MRI)
To diagnose cancer of the penis, doctors remove a tissue sample for examination under a microscope (biopsy). Sometimes computed tomography or magnetic resonance imaging is done to determine whether the cancer has spread into nearby structures or other tissues outside the penis. Enlarged and inflamed lymph nodes may be biopsied.
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Sometimes topical fluorouracil or imiquimod cream
Surgery
Radiation
To treat early or small cancers, doctors prescribe a cream containing fluorouracil or imiquimod or remove the cancer and some normal surrounding tissue with a laser during surgery. For some cancers, radiation therapy can be considered, either as seeds that are inserted or as external radiation. For other cancers, doctors surgically remove the cancer, sparing as much of the penis as possible. Usually, men who undergo this type of surgery are able to use the remaining penile tissue for urination and sexual function. If cancer involves larger areas, the penis needs more extensive surgery.
Sometimes penile cancer spreads to the lymph nodes in the groin, and these nodes may need to be removed. Doctors treat men with multiple, bilateral or bulky inguinal lymph nodes that are concerning for cancer with neoadjuvant chemotherapy (given to shrink the tumor prior to surgical removal). If the tumor cannot be completely resected (surgically removed), then radiation may also be a consideration.
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In most men, cancers are small and have not spread. These men survive for many years after treatment. Most men with cancer that has spread beyond the groin lymph nodes die within 5 years.
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Strategies to prevent penile cancer include circumcision in early life, improved long-term hygiene in uncircumcised men, and vaccination against the most common cancer-causing strains of human papillomavirus in adolescents.
