Penile cancer is a rare form of cancer affecting tissues of the penis. Typically, it starts in the skin cells and spreads deeper into the penis and eventually to other body parts if not detected and treated early.
Of all cancers diagnosed in men, penile cancer affects fewer than one case per 100,000 men in the United States. This equates to about 2,100 new cases of penile cancer and 500 deaths from this type of cancer.
Awareness of penile cancer symptoms is critical, as timely detection can ensure sooner treatment and improve patient outcomes. Moreover, regular self-examinations and seeking medical attention for any unusual changes are important steps in detecting penile cancer at an early stage.
Here, we’ll explain common penile cancer symptoms, the different types of penile cancer, and how it is diagnosed and treated. We’ll also focus on helping you understand the risk factors and proactive steps you can take to reduce your risk.
Some of the earliest signs of penile cancer are changes in the skin of the penis. This can include thickening of the skin, redness, irritation, and rash. Other symptoms of penile cancer include warty growths on any part of the penis, including inside the meatus or opening of the urethra (where urine and semen exit the penis). Symptoms can also include unusual discharge, pain, bleeding, or any changes in skin color or texture on or around the penis.
It helps to have a comprehensive understanding of the different types of penile cancer because they each have different signs and symptoms. This knowledge can help ensure timely medical consultation for early detection and prompt penile cancer treatment.
This is the most common type of penile cancer, accounting for about 95% of cases. This type of cancer begins in the flat cells that make up the skin. It typically starts out on the glans. The glans penis, also known as the tip or the head of the penis, is the coronal portion. Lesions here are very painful as this area contains many nerve endings.
Squamous cell carcinoma of the penis can also affect the foreskin, which is also known as the prepuce — a loose fold of skin that covers the head of the penis. All men are born with a foreskin, but some are circumcised, which removes the foreskin.
Melanoma is a less common but more aggressive type of penile cancer. It starts in the pigmented cells called melanocytes. Melanoma is a type of skin cancer that can occur on the skin of the penis and may present as an unusual mole or pigmented lesion. While this is a less frequent type of penile cancer, it’s still important to be vigilant about any atypical skin changes on the penis.
Basal cell carcinoma and sarcoma of the penis are skin cancers that account for a small percentage of cases of penile cancer. Basal cell carcinoma originates in the skin's basal cells and is generally less aggressive than squamous cell carcinoma. Basal cell sarcoma, on the other hand, develops in the connective tissues of the shaft of the penis.
Warty carcinoma of the penis is a rare type of cancer, accounting for just 5-10% of all penile cancers and are a distinct subtype of squamous cell carcinoma. It usually appears as a large growth on the glans penis (head of the penis), usually over 5 cm in size. It may spread into the corpus spongiosum, the spongy tissue that surrounds the male urethra and expands to form the head of the penis. Warty carcinoma has characteristics like thickened skin and large cauliflower-like genital warts.
Sarcomatoid carcinoma is an aggressive, rare variant of penile cancer characterized by both carcinomatous and sarcomatous components. Early signs of sarcomatoid carcinoma may include the presence of a rapidly enlarging or changing mass on the penis, as well as associated symptoms such as pain, bleeding, or ulceration. Prompt medical evaluation is essential for accurate diagnosis and timely initiation of treatment.
Understanding the different stages of cancer can help you understand how penile cancer symptoms change over time. Here’s a quick review.
Precancer: The precancer stage, also referred to as carcinoma in situ (CIS), is where cancer is only in the cells in the skin of the penis. In this stage of penile cancer, the surface of the penis has abnormal cells or growths that may look like warts. However, some types of HPV (human papillomavirus) can manifest as flat warts that are less noticeable.
Stage I: Cancerous cells have formed and may extend through the layers of the skin of the penis.
Stage II: In this stage, cancer of the penis may have spread to the connective tissues. This means that tumors are present under the surface of the penis.
Stage III: Penile cancer at this stage has spread outside the penis to lymph nodes in the groin. You may feel a lump or lumps under the skin in the groin area if the original cancer tumors have spread to another area, like the lymph nodes. The early symptoms of penile cancer metastasis (spread to another area) are painful and swollen lymph nodes. Normally, lymph nodes are soft, bean-sized, and non-tender.
Stage IV: Here, cancer has spread beyond the penis to tissues near the penis, such as the prostate.
Penile cancer is sometimes diagnosed through a combination of physical examination, imaging tests, such as an ultrasound or MRI scan, and biopsies to confirm the presence and type of cancer cells. Once diagnosed, urology cancer treatment for penile cancer care may involve a combination of surgery, radiation therapy, and chemotherapy.
Surgery is the primary treatment for this type of cancer. The type of surgery depends on the stage of the cancer and its location. Advanced surgical techniques, such as Mohs surgery, are a type of micrographic surgery aimed to maintain function and preserve penis shape and structure. In many cases, only a partial surgical excision is needed. In more extreme cases, a total removal of the penis (a penectomy) might be necessary.
Radiation therapy is often a treatment option and a notable organ-saving approach in early-stage cases at specialized centers. This treatment involves focusing high energy to kill and shrink cancer cells.
Chemotherapy is a treatment plan that uses medications to kill cancer cells throughout the body. Also called “chemo,” this type of therapy may be given after surgery or radiation therapy to shrink any remaining tumors or metastasis. Chemotherapy may also be the primary cancer treatment for advanced-stage penile cancer.
Understanding the risk factors and their associations can help individuals reduce the likelihood of developing penile cancer, promote early detection, and improve outcomes for those affected by the disease. Here are some risk factors to know about.
HPV: Human papillomavirus infection, especially from high-risk strains, is a significant risk factor for developing penile cancer. HPV is transmittable through sexual contact.
Age: Older age is a risk factor for penile cancer, as the majority of cases occur in men who are over the age of 60. Indeed, advancing age is also linked to a higher risk of developing various cancer types.
Phimosis: Uncircumcised men have a greater risk of developing penile cancer. This might be due to phimosis — a condition where the foreskin is too tight to pull back. Phimosis is associated with up to 90% of penile cancer cases. Phimosis can lead to chronic inflammation and the accumulation of smegma, which can irritate and increase the risk of penile cancer.
Tobacco use: Smoking is a risk factor for several types of cancer, including penile cancer. Harmful substances in tobacco smoke can damage cells in the body, which increases the risk of cancer developing.
PUVA (psoralen combined with ultraviolet A) Treatment: This therapy helps treat skin conditions like psoriasis, vitiligo, and eczema. Prolonging or repeating PUVA treatment may increase the risk of developing penile cancer in some individuals.
Penile lichen sclerosus: This chronic skin condition can affect the genital area in men. In some cases, it may increase the risk of developing penile cancer.
Unprotected sexual activity: Unprotected sex can increase the risk of contracting HPV or other sexually transmitted infections, which in turn can elevate the risk of penile cancer.
Though penile cancer is rare, it’s also distressing. To provide more clarity, here are some of the most commonly asked questions (and answers) about penile cancer.
Penile cancer develops slowly over time. The speed of progression can vary from person to person. It’s important to consult with a healthcare professional for accurate information and guidance on penile cancer development.
The early symptoms of penile cancer, such as changes in skin texture and persistent itching, can be mistaken for a yeast infection. Seek medical attention if you experience these symptoms, as a proper diagnosis is crucial for timely treatment.
Inflammation of the glans (head) of the penis, known as balanitis, can sometimes be confused with early-stage penile cancer. Seeking prompt evaluation by a healthcare professional is important to differentiate these conditions and appropriately address any concerns.
Penile cancer in its early stages may appear as a lump, ulcer, or discolored patch on the penis. Seek medical attention right away if you notice any unusual changes in the skin of the penis to ensure timely diagnosis and treatment.
Yes, there are several ways to prevent HPV infections:
Penile cancer symptoms can be mistaken for other conditions, such as yeast infections, so awareness and attentiveness are essential. If you notice any unusual symptoms, such as lumps, lesions that don’t heal or have persistent discharge, or any other abnormalities on the penis, don’t delay seeking medical attention.
To be proactive about your health, get regular checkups and take measures to prevent HPV infections. Ezra is committed to helping you learn more about your cancer risk. Take our 5-minute cancer quiz now to calculate your risk factors — knowing your risk is the first step toward reducing it.
