Penile cancer

Penile cancer affects the penis. It's very rare and mostly affects men aged over 50 years old.

What is penile cancer?

• Penile cancer is a rare cancer that mostly affects the skin of the penis and the foreskin (the skin covering the head of the penis).
• It's most common in men over 50.
• Anyone with a penis can get penile cancer.
• How serious penile cancer is depends on how big the cancer is, if the cancer has spread, and your general health.

Symptoms of penile cancer

Main symptoms of penile cancer

Most penile cancers affect the skin covering the penis (foreskin), or the head or tip (glans) of the penis.

The most common symptoms are:

• a growth, lump or sore that does not heal within 4 weeks
• a rash
• bleeding from your penis or under your foreskin
• a smelly discharge
• difficulty pulling back your foreskin (phimosis)
• a change in the colour of the skin of your penis or foreskin

Other symptoms of penile cancer may include:

• a lump in your groin
• feeling tired
• tummy pain
• losing weight without trying

See a GP if you have:

• any changes to how your penis looks
• discharge or bleeding from your penis
• any of the other symptoms of penile cancer
• symptoms that are not going away

Try not to be embarrassed. The doctor or nurse will be used to talking about these symptoms.

Important

Some of these symptoms are very common and can be caused by other conditions.

Having the symptoms does not definitely mean you have penile cancer, but it's important to get them checked by a GP.

If your symptoms are caused by cancer, finding it early may mean it's easier to treat.

What happens at your GP appointment

The GP may check your penis and ask you to have a blood test.

They'll usually ask you:

• about your general health
• what your symptoms are
• when your symptoms started
• if you’ve used anything to treat your symptoms, and if it’s made it better or worse

Referral to a specialist

You may get an urgent referral for more tests or to see a specialist in hospital if the GP thinks you have symptoms that could be cancer. This does not definitely mean you have cancer.

Causes of penile cancer

Main causes of penile cancer

Roughly half of all penile cancers are caused by certain types of a virus called human papillomavirus (HPV).

There are different types of HPV and some affect the genital area.

You can get HPV from:

• any skin-to-skin contact of the genital area
• vaginal, anal or oral sex
• sharing sex toys

Most people affected by HPV will not get penile cancer.

Who is more likely to get penile cancer

Penile cancer is most common in men over the age of 50. It can affect anyone with a penis.

You might also be more likely to get penile cancer if you:

• smoke
• have problems pulling back your foreskin (the skin covering your penis) to keep your penis clean (a condition called phimosis)
• have or had treatment for psoriasis with medicines called psoralens and an ultraviolet (UVA) light source (called PUVA treatment)
• have a weakened immune system because of a condition like HIV

How to lower your chance of getting penile cancer

You cannot always prevent penile cancer. But you may be able to lower your chances of getting it.

Do

• protect yourself from getting HPV by getting the HPV vaccination if you can

• use condoms when having any kind of sex, to lower your chances of getting HPV

• stop smoking

• have a circumcision if you have phimosis and this is recommended to treat it

It's important to get any symptoms of penile cancer checked by a GP.

Tests and next steps for penile cancer

Main test for penile cancer

You may need more tests to check for penile cancer if a GP refers you to a specialist.

A biopsy is the main test to diagnose penile cancer.

A specialist does this test by taking a small piece of tissue from the affected area. It’s done under a local anaesthetic, so you do not feel any pain.

You should be able to go home on the same day.

Getting your results

You should get the results of your tests within a few weeks.

You can call the hospital or GP if you're worried. They should be able to update you.

A specialist will explain what the results mean and what will happen next. You may want to bring someone with you for support.

If you’re told you have penile cancer

Being told you have penile cancer can feel overwhelming. You may be feeling anxious about what will happen.

You'll be helped through your diagnosis and treatment by a team of specialists.

This team will include a clinical nurse specialist who will be your main point of contact during and after your treatment. You can ask them any questions you may have.

Treatment for penile cancer

Treatment for penile cancer

Penile cancer may be more treatable if it's found early.

The treatment you need will depend on:

• the size and type of penile cancer you have
• where it is
• if it has spread
• your age and general health

Treatment for early cancer often involves non-surgical treatments, for example, a chemotherapy cream, such as 5 fluorouracil (5FU), and laser therapy.

If the cancer is found later, treatment may include surgery, chemotherapy and radiotherapy.

Surgery

Surgery for penile cancer can include removing:

• the cancer and a small area around it to reduce the risk of it coming back
• the top layer of skin from the head (glans) of the penis
• the head of the penis
• part or sometimes all of the penis, but this is only offered if no other treatment is possible
• some lymph nodes, which are part of the body’s system that helps fight off infections

Surgery may affect how your penis looks, such as the size or shape.

This may affect how you feel about your body. You may have many questions and worries about how you'll pee or have sex.

The specialist team looking after you can answer any questions you have about your surgery.

They'll explain exactly what surgery means for you, how it will affect you and what your options are.

Reconstructive surgery may be possible if your penis needs to be removed. This uses skin and muscle from other parts of the body to create a working penis.

Creams

If caught early, penile cancer can sometimes be treated with creams you apply to the skin of your penis or foreskin.

You may be treated with a cream if your penile cancer has been caught early, and the cancer affects your foreskin or the end of your penis.

You may be treated with:

• fluorouracil (5FU) - a chemotherapy cream which kills cancer cells directly in the skin
• imiquimod – an immunotherapy cream which helps your body’s immune system to kill cancer cells

Laser treatment

Laser treatment uses a strong beam of light, directed at the affected area, to kill cancer cells.

You may have laser treatment for penile cancer if the affected area is small or the cancer is at an early stage.

Cryotherapy

Cryotherapy uses freezing to kill cancer cells. A small device is placed on the affected area to freeze the cancer.

You may have cryotherapy if you have very early stage penile cancer, or the cancer is unlikely to have spread to other parts of your body.

Chemotherapy

Chemotherapy uses medicines to kill cancer cells.

You may have chemotherapy for penile cancer:

• with radiotherapy (chemoradiotherapy)
• before surgery to help make the cancer smaller
• after surgery to kill any cancer cells that might be left behind
• if the cancer has spread to other parts of your body

Radiotherapy

Radiotherapy uses high-energy rays of radiation to kill cancer cells.

You may have radiotherapy for penile cancer:

• with chemotherapy (chemoradiotherapy)
• instead of surgery
• after surgery if there’s a risk that cancer cells are left in the groin
• to treat the lymph nodes in the pelvis if there's a high risk of the cancer coming back
• to help with your symptoms if cancer has spread to other parts of your body

What happens if you're told your cancer cannot be cured

If you've been diagnosed with advanced penile cancer, it may be hard to treat and not possible to cure.

The aim of treatment will be to slow down the growth and spread of the cancer, to help with the symptoms, and help you live longer.

Finding out cancer cannot be cured can be very hard news to take in.

You'll be referred to a team of doctors and nurses called a symptom control team or palliative care team.

They will help you to manage your symptoms and make you feel more comfortable.

The palliative care team can also help you and your loved ones get any other support you need.