Stages

If penile cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has spread, and if so, to what parts of the body.

The Spreading of Cancer

There are three ways that cancer spreads in the body:

Through tissue.
Cancer invades the surrounding normal tissue.

Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.

Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary tumor and travel through the lymph or blood to other places in the body, another, or secondary tumor, may form. This process is called metastasis. The secondary, or metastatic, tumor is the same type of cancer as the primary tumor. For example, if penile cancer spreads to the other parts of the body, the cancer cells are actually penile cancer cells. The disease is metastatic penile cancer, not bone cancer.

Stages of Penile Cancer

These are the main features of each stage of the disease:

Stage 0 (Carcinoma in Situ) - In stage 0, abnormal cells that look like warts are found on the surface of the skin of the penis. Stage 0 is also called carcinoma in situ.

Stage I - In stage I, cancer has formed and spread to connective tissue just under the skin of the penis. Cancer has not spread to lymph vessels or blood vessels.

Stage II - In stage II, cancer has spread to connective tissue just under the skin of the penis, through connective tissue to erectile tissue or beyond erectile tissue to the urethra.

Stage III - Stage III is divided into stage IIIa and stage IIIb:

In stage IIIa, cancer has spread to one lymph node in the groin. It has also spread to connective tissue just under the skin of the penis, through connective tissue to erectile tissue or beyond erectile tissue to the urethra.

In stage IIIb, cancer has spread to more than one lymph node on one side of the groin or to lymph nodes on both sides of the groin. It has also spread to connective tissue just under the skin of the penis, through connective tissue to erectile tissue or beyond erectile tissue to the urethra.

Stage IV - In stage IV, cancer has spread to tissues near the penis such as the prostate and may have spread tolymph nodes in the groin or pelvis. It may have also spread to one or more lymph nodes in the pelvis, from the lymph nodes to the tissues around the lymph nodes or to distant parts of the body.

Knowing the stage assists the doctor in determining a prognosis. It also better helps you understand the care and treatment that will be required. Generally, treatment for the different stages are as follows:

Stage 0 (Carcinoma in Situ) - Treatment of stage 0 may be one of the following:
Mohs Microsurgery
Topical Chemotherapy
Topical Biologic Therapy
Laser Surgery
Cryosurgery

Stage I
If the cancer is only in the foreskin, wide local excision and circumcision may be the only treatment needed. Treatment of stage I may include the following:
Surgery (partial or total penectomy with or without remocal of lymph nodes in the groin)
External or internal radiation therapy
Mohs Microsurgery
A clinical trial of laser therapy

Stage II - Treatment of stage II may include the following:
Surgery (partial or total penectomy with or without remocal of lymph nodes in the groin)
External or internal radiation therapy followed by surgery
A clinical trail of sentinel lymph node biopsy followed by surgery
A clinical trial of laser surgery

Stage III - Treatment of stage III may include the following:
Surgery (penectomy and removal of lymph nodes in the groin) with or without radiation therapy
Radiation Therapy
A clinical trial of one of the following: Sentinal Lymph Node Biopsy, Radiosensitizers, Chemotherapy

Stage IV - Treatment of stage IV penile cancer is usually Palliative (to relieve symptoms and improve the quality of life). Treatment may include the following:
Surgery (wide local excision and removal of lymph nodes in the groin.)
Radiation Therapy
A clinica trial of chemotherapy before or after surgery

In all cases, treatment should be individualized for you. Although cancers are classified into particular stages, each person is unique.

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