Treatment

Different types of treatment are available for patients with penile cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. (A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer)

Your treatment options depend on the stage of cancer, your overall health and your preferences about treatment. In metastatic disease, the location and extent of the penile cancer is also an important consideration.

You do not have to rush to make a decision, so consider the options carefully. Ask questions if you do not understand any aspect of treatment or the terms your doctors are using. Research shows that cancer survivors of all educational levels and backgrounds can have a hard time communicating with their health care team. One of the best ways to improve communication with your health care team is to prepare your visits so that you can best make use of the time.

A treatment plan is a way to deal with both the short and long term goals of managing your penile cancer. There are several treatment options for penile cancer, depending on the cancer stage and the patient’s age and general health. Patients have time for second opinions and to talk through all of their options with their doctors and develop a treatment plan that best fits their needs.

Penile Cancer Treatments

Surgery
Surgery is the most common treatment for all stages of penile cancer. If the cancer is detected early, the tumor can often be treated without having to remove part of the penis. If the cancer is detected at a more advanced stage, part or all of the penis might have to be removed with the tumor.

Patients with cancers that have invaded deep within the penis (stage T2 or higher) usually need to have some nearby lymph nodes removed as well to check for cancer spread. Instead of removing all of the groin lymph nodes to look for cancer, some doctors prefer to do a sentinel lymph node biopsy.

Several different kinds of surgery are used to treat penile cancers:

Circumcision - This operation removes the foreskin and nearby skin. This can cure cancers that are only in the foreskin. It is also done to remove the foreskin before radiation therapy to the penis.

Excision - In this operation, the tumor is removed along with normal skin. If the tumor is small, the remaining skin can be stitched back together. This is the same as an excisional biopsy. In a wide local excision, the cancer is removed along with a large amount of normal tissue around it (called wide margins). Removing healthy tissue makes it less likely that any cancer cells are left behind.

Mohs Surgery - Using the Mohs technique, the surgeon removes a layer of the skin that the tumor may have invaded and then checks the sample.. If it contains cancer, another layer is removed and examined. This process is repeated until the skin samples are found to be free of cancer cells. Although the process is slow, more normal tissue near the tumor can be saved. This is a highly specialized technique that should be used only by doctors who have been trained in this specific type of surgery. It is used for pre-cancerous conditions and for some cancers that have not invaded deeply into the penis.

Laser Surgery - This approach uses a beam of laser light to vaporize cancer cells. It is useful for squamous cell carcinoma in situ (involving only the outer layer of the skin) and for very thin or shallow basal cell cancers.

Partial or Total Penectomy - This operation removes part or all of the penis. It is the most common and most effective way to treat a penile cancer that has grown deeply inside the penis. The surgeon will try to leave as much of the shaft as possible. The operation is called a partial penectomy if only the end of the penis is removed (and some shaft remains). If not enough of the shaft can be saved for the man to urinate standing upright without dribbling, a total penectomy will be done. This operation removes the entire penis, including the roots that extend into the pelvis. The surgeon creates a new opening for urine to drain from the perineum, which is the area between the scrotum (sac for the testicles) and the anus. This is known as a perineal urethrostomy. Urination can still be controlled because the sphincter (the "on-off" valve) in the urethra is left behind, but the man will have to sit down to urinate.

Surgery to Remove Lymph Nodes

Patients with cancers that have invaded deep within the penis (stage T2 or higher) usually need to have nearby lymph nodes removed. The surgeon drains the tumor from the first lymph node (sentinel node) and removes it. If the sentinel node contains cancer, a more extensive operation, known as a lymph node dissection or inguinal lymphadenectomy, is performed. If the sentinel node does not have cancer cells, the surgeon doesn't have to remove any more lymph nodes.

Not all doctors agree on how useful this type of operation is for penile cancer, and some prefer to remove more lymph nodes up front with an inguinal lymphadenectomy. Discuss the procedure with your doctor.

Radiation Therapy
Radiation therapy uses high-energy rays or particles to destroy cancer cells. It can be used to treat some early stage penile cancers instead of surgery. In cases where cancer has reached several lymph nodes, radiation may be used along with surgery to remove lymph nodes to try to reduce the risk the cancer will come back. Radiation may also be used for advanced cancers to try to slow the growth of the cancer or to relieve symptoms caused by the cancer.

For uncircumcised men who are going to get radiation to the penis, circumcision is done first to remove the foreskin. This is because radiation can cause swelling and constriction of the foreskin, which could lead to other problems.

Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated. 

Social networking and online support groups are important tools. Reaching out to others who have or have had similar experiences can provide you with valuable insights. Check out Cancer Support Community's The Living Room for more information on clinically facilitated support online. 

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