Penile Cancer

Penile cancer is rare. It occurs on the skin of the penis or within the penis, usually the glans (head of the penis) and occasionally in the shaft of the penis. It most commonly affects men over the age of 40.

There are several types of penile cancer:

  • Squamous cell penile cancer – the commonest type of cancer, more than 90% of cases
  • Carcinoma in situ (CIS) – a type of squamous cell cancer where only the superficial cells in the skin of the penis are affected, and it has not spread deeper.
  • Adenocarcinoma – very uncommon, cancer that starts in the glandular cells of the penis that produce sweat
  • Melanoma of the penis – this is where the cancer develops in the skin cells that give the skin its dark brown, tan or black color

Symptoms of penile cancer

Symptoms of penile cancer include:

  • a growth or sore on the penis that doesn’t heal within 2-4 weeks of treatment
  • bleeding from the penis or from under the foreskin
  • a foul-smelling discharge from the penis
  • thickening of the skin of the penis or foreskin that makes it difficult to draw back the foreskin (phimosis). Sometimes the cancer may hide underneath the narrow foreskin that is difficult to be retracted
  • a change in the color of the skin of the penis or foreskin (a premalignant condition known as BXO / Balanitis Xerotica Obliterans)
  • a rash on the penis which is persistent in spite of treatment
  • Lumps under the skin of your groin

Penile cancers should preferably be diagnosed in the very early stages as it is a very aggressive cancer which can spread fast and result in deforming complications. Any delay in diagnosing penile cancer could reduce the chances of successful treatment.

Causes of penile cancer

The cause of penile cancer is due to cells growing uncontrolled, and in an unorderly fashion. Certain risk factors can increase your chances of getting it, including:

  • Human papilloma virus (HPV)– there are more than 100 types of HPV; there are very specific types which can cause penile cancer. The main types of HPV found in men with penile cancer are HPV 16 and 18. There may be other types too. 

HPV is a common infection that gets passed from one person to another by sexual contact.

In general, around 8 out of 10 people (80%) get infected with the HPV virus at some time during their lifetime. For most people the virus causes no harm and goes away without treatment. But men with human papilloma virus have an increased risk of developing cancer of the penis. 

About 6 out of 10 (60%) penile cancer cases are caused by HPV infection. Some types of HPV cause genital warts. 

  • Age – the condition rarely affects men under the age of 40 and is most common in men aged over 50
  • Smoking – chemicals found in cigarettes can damage cells in the penis, which increases your risk of getting penile cancer
  • Phimosis – when the foreskin is difficult to retract, the chances of developing infections like increases; repeated infections are linked to a higher risk of developing some types of penile cancer as they cause repetitive irritation and resulting with the cells dividing and growing uncontrollably as a result of repetitive stimulation.
  • Uncircumcised – Uncircumcised men may sometimes find it difficult to draw back their foreskin. This is called phimosis. Men with phimosis have a higher risk of penile cancer than other men. 
The age of circumcision can affect the risk of penile cancer:
  • Men who are circumcised as babies appear to be less likely to get penile cancer.
  • Men who are circumcised in their teens seem to have some protection from penile cancer.
  • Circumcision in adulthood seems to make no difference to a man’s risk of penile cancer.

Circumcision is not necessary as a sole method of prevention of penile cancer because it is a very rare cancer. Not being circumcised is only one risk factor for this type of cancer. Other risk factors such as smoking and HPV infection are more important.

If there are any clarifications, you can always speak to your doctor regarding this issue.

Diagnosing penile cancer

To confirm the diagnosis of penile cancer, a biopsy of the lesion has to be taken. A small tissue sample will be removed so it can be examined under a microscope for cancerous cells.

After confirming the diagnosis, staging has to be done.

This may involve blood tests, MRI of the penis as well as CT scan of the abdomen and pelvis.

Stages of penile cancer

Treatment of penile cancer 

Treatment for penile cancer depends on

  1. the size of the affected area
  2. the depth of invasion of the cancer (how deep it has penetrated into the penis)
  3. the stage of the disease (how far it has spread through the lymphatic and blood stream).  

In cases of carcinoma in situ (CIS), where only the superficial skin cells of the penis are affected, treatment usually involves either using topical immunotherapy or chemotherapy creams, cryotherapy,  having laser surgery to remove the affected area of skin, or complete removal of the skin (epithelium) of the glans (“known as glans resurfacing“) followed by skin grafting.

If the foreskin alone is involved, then circumcision should be adequate.

If the depth of the cancer is deeper into the penis, then wide excision, glansectomy (removal of part or whole of the head of the penis), penis removal (penectomy), or removal of part of the penis (partial penectomy) will be required.

Based on the extent of depth of the cancer involving the penis and the grade of the tumor, inguinal lymph node dissection may be necessary to remove the lymph nodes that may be affected by the cancer.

The main treatments for later-stage penile cancer are surgery, radiotherapy or chemotherapy.

Surgery involves removing the cancerous cells and possibly some of the surrounding tissue. After surgery, reconstructive surgery may be offered to improve cosmetic appearance. The urologist may be consulted for this.

With early diagnosis, the urologist will be able to preserve as much penis as possible.



Partial penectomy

Pics from EAU Patient Information

Prevention of penile cancer

For prevention, you can reduce the risks associated with the cancer by:

Stop smoking

Maintain good penis hygiene to prevent the bacterial and viral infections that can increase the risk of penile cancer.

Use condom to reduce the risk of HPV infection

Regularly wash your penis with warm water, including under the foreskin

Evidence does not suggest that being circumcised as an adult will reduce your chances of developing penile cancer, but childhood circumcision may. But the incidence of penile cancer itself is rare. Hence a discussion on this is best done with a urologist.

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