Surgical Procedures: Surgery and Staging for Penile Cancer

Cancerous cells in or on the tissue of the penis is called penile cancer. The penis is responsible for both reproduction and urination. The most common type of penile cancer is squamous cell carcinoma. Other types include melanoma, verrucous carcinoma, adenocarcinoma (Paget’s disease of the penis), basal cell carcinoma, and sarcoma.

What is staging and how is it performed?

Staging is a way to find out how far the cancer has spread in your body. Your provider will have you get a few tests to figure out the stage of your cancer. For penile cancer, these tests may be:

Physical Exam: This is a general exam to look at your body and to talk about past health issues.

Biopsy: A biopsy takes cells from the cancer, or a piece of the cancer, to see what type of cancer it is and how it looks under a microscope. A doctor called a pathologist looks at the sample in a laboratory.

Imaging: Radiology tests can look inside your body to look at the cancer and determine if it has spread. These tests can include:

• CAT scan (CT scan).
• Positron emission tomography scan (PET scan).
• Magnetic resonance imaging (MRI).

Penile cancer spreads to other parts of the body through the tissue, lymph, and blood systems. Cancer stage determines how extensive the cancer is, how far it has spread, and what treatment course will be recommended. For penile cancer, providers use the American Joint Committee on Cancer TNM staging system. This system tells your healthcare team the extent of the tumor (T), spread to the lymph nodes (N), and distant metastasis (spread) (M). The TNM values are then combined to determine a stage of I through IV.

Surgical Procedures Used for the Treatment of Penile Cancer

Surgery is often used to treat penile cancer. The procedure used will depend on many factors, including the size and location of the cancer. Your surgeon will talk to you about your specific procedure.

Surgical procedures used to treat penile cancers include:

Mohs Microsurgery: This is the removal of layers of skin until there is no cancer left. After each layer is removed it is looked at with a microscope right away to make sure there are no cancer cells. This leaves as much normal tissue as possible.

Laser Surgery: A laser beam is used to remove lesions from the surface of the penis.

Cryosurgery: Abnormal tissue is frozen and destroyed.

Circumcision: This procedure removes part of or all of the foreskin.

Wide Local Excision: Removal of all of the cancerous area and a small portion of surrounding normal tissue.

Amputation:Removal of the penis. Can be partial or total:

• Partial Penectomy: Removal of the end of the penis, leaving the shaft intact.
• Total Penectomy: Removal of the entire penis, with the creation of a urinary opening between the scrotum and anus, called a perineal urethrostomy.

Emasculation: Removal of the penis and testicles. Often used to treat advanced cancers.

Lymph Node Removal: Removal of lymph nodes.

Sentinel Lymph Node Removal: A special dye or radioactive substance is injected near the cancerous tumor and allowed to absorb. The first lymph node to be seen with dye is removed and checked for cancerous cells. If there is cancer in this “sentinel lymph node," then additional lymph nodes will be removed.

Inguinal Lymph Node Removal: Removal of inguinal lymph nodes through an incision (cut) in the groin.

What are the risks associated with penile surgery?

As with any surgery, there are risks and possible side effects. These can be:

• Reaction to anesthesia (anesthesia is the medication you are given to help you sleep through the surgery, not remember it and manage pain. Reactions can include wheezing, rash, swelling, and low blood pressure).
• Infection.
• Issues with wound healing.
• Lymphedema (swelling).
• Fluid collections.
• Narrowed urethra that can make it hard to urinate.
• Potential to have to sit to urinate.
• Potential inability to have sexual intercourse.
• Need for testosterone supplementation if undergoing emasculation.
• Need for reconstructive surgery.
• Chronic pain.
• Change in self-image.

What is recovery like?

Recovery from a penile surgery may require a stay in the hospital for one to two nights depending on the extent of the procedure you have had. You may have a temporary urinary catheter to drain urine from your bladder and will be given instructions on catheter care before leaving the hospital.

Your medical team will give you information about the medications you will be taking, such as those for the prevention of pain, blood clots, infection, and constipation, along with medications that treat other conditions.

Your healthcare provider will discuss your particular activity restrictions depending on the surgery you have had.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.