Treatment Options for Penile Cancer, by Stage

The treatment options for penile cancer are based mainly on the stage (extent) of the cancer, although other factors can also be important. This section sums up the most common treatment options based on the stage of the cancer.

Stage 0

Stage 0 includes 2 types of tumors: carcinoma in situ (CIS) and verrucous carcinoma. Both of these tumors are only in the top layers of skin, but they have some different treatment options.

Patients with CIS that is only in the foreskin can often be treated with circumcision. If the tumor is in the glans and does not affect other tissues, it may be possible to treat it with some type of local therapy (such as laser ablation, topical 5-FU or imiquimod, or cryotherapy). Other options might include some type of surgery, such as Mohs surgery or wide excision. Radiation therapy might also be a possible option. Partial penectomy (removal of part of the penis) is usually not needed.

Verrucous carcinoma can often be treated with laser therapy, Mohs surgery, wide excision, or cryotherapy. Only rarely will a partial penectomy be needed. Radiation is not used for this type of tumor, because it can make it more likely to spread.

Stage I

These tumors have grown below the skin of the penis but not into deeper layers.

Options for treatment may include circumcision (for tumors confined to the foreskin) or a more extensive surgery (Mohs surgery, wide excision, or removal of part of the penis [partial penectomy]), or radiation therapy. Laser ablation may also be an option.

Stage II

Stage II penile cancer includes tumors that have grown deep into the tissues of the penis (such as the corpus spongiosum or cavernosum) or the urethra, but have not spread to nearby lymph nodes.

These cancers are usually treated with a partial or total penectomy, with or without radiation therapy. A less common approach is to use radiation therapy as the first treatment with surgery remaining as an option if the cancer is not destroyed completely by the radiation. Radiation may also be used as the main treatment in men who can’t have surgery because of other health problems.

Some doctors recommend checking groin lymph nodes for cancer, even if they are not enlarged. This may be done with a sentinel lymph node biopsy or with a more extensive lymph node dissection. If the lymph nodes show cancer spread, then the cancer is not really a stage II. It is a stage III or IV (and is treated as such).

Stage III

Stage III penile cancers have reached nearby lymph nodes in the groin. The main tumor may have grown into the deeper tissues of the penis (the corpus spongiosum or corpus cavernosum) or urethra, but has not grown into nearby structures like the bladder or prostate.

Stage III cancers are treated with a partial or total penectomy. In a few cases, chemotherapy (chemo) or chemo plus radiation may be used first to shrink the tumor so that it can be removed more easily with surgery.

These cancers require an inguinal lymphadenectomy to remove lymph nodes in the groin. Radiation therapy to the groin may be used as well, either after surgery or instead of surgery in selected cases. If lymph nodes are very large, chemotherapy (with or without radiation) might be used as well.

These cancers can be hard to cure, so men may want to consider taking part in clinical trials of new treatments.

Stage IV

Stage IV penile cancer includes different groups of more advanced cancers.

In some stage IV cancers, the main tumor has grown into nearby tissues, like the prostate, bladder, scrotum, or abdominal wall. Treatment typically includes surgery, which is often a total penectomy. If the tumor is in the scrotum or parts of the abdominal wall, the testicles and/or the scrotum may also need to be removed. A new opening can be made in the abdomen or the perineum (space between the scrotum and anus) to allow urination. If the tumor has grown into the prostate or bladder, these may need to be removed as well. Chemo (sometimes with radiation) may be given before surgery (called neoadjuvant treatment) to try to shrink the tumor and make it easier to remove. The inguinal (groin) lymph nodes on both sides will be removed as well. This area may also be treated with radiation after surgery (unless it was given before surgery).

Stage IV also includes cancers that have spread more extensively in the lymph nodes, such as cancer in groin lymph nodes that has grown through the nodes and into surrounding tissue or cancer spread to lymph nodes inside the pelvis. These cancers are treated with surgery to remove the main tumor in the penis, such as penectomy. The lymph nodes in both groin areas are also removed. The lymph nodes inside the pelvis will also be removed if they are thought to contain cancer spread (if they are enlarged, for example). After the lymph nodes are removed, those areas are often treated with radiation to try to kill any cancer cells that may be have left behind. Chemotherapy might be part of this treatment as well.

Penile cancer that has spread to distant organs and tissues is also considered stage IV. These cancers can’t be removed or destroyed completely with surgery and radiation. Treatment is aimed at keeping the cancer in check and preventing or relieving symptoms to the best extent possible. Choices to treat the penile tumor usually include wide local excision, penectomy, or radiation therapy. Surgery or radiation therapy (sometimes along with chemotherapy) may also be considered to treat nearby lymph nodes. Radiation may also be used to treat areas of cancer spread in the bones or in the brain or spinal cord.

Chemo is often used to treat cancer that has spread to other areas, like the lungs or liver. Studies are under way to determine the value of chemotherapy combined with surgery or radiation therapy.

Stage IV cancers are very hard to cure, so men may want to think about taking part in clinical trials of new treatments.

Recurrent cancer

The treatment of cancer that comes back after treatment (recurrent cancer) depends on where the cancer recurs and what treatments were used before. If penectomy was not done before, a recurrent penile cancer may be treated with surgical removal of part or all of the penis. Radiation therapy may also be an option. Surgery, radiation therapy, and/or chemotherapy may also be options for some cancers that recur in the lymph nodes. Chemo may also be helpful in treating penile cancers that come back in other parts of the body.

These tumors can be hard to treat, so men may want to think about taking part in a clinical trial of a newer treatment.

The American Cancer Society medical and editorial content team

