The most common symptoms of penile cancer include:

• A growth or sore that doesn’t heal within 4 weeks – it can look like a wart or blister
• Bleeding from your penis or from under the foreskin
• A foul-smelling discharge under the foreskin (not ejaculation)
• Swelling that makes it difficult to draw back the foreskin (phimosis)
• A change in the colour of the skin or foreskin to a blueish / brown colour
• A rash or small crusty bumps on the penis
• Growths on the penis that are bluish-brown
• Lumps under the skin in the groin area

Your Doctor may refer you by letter, email or through Healthlink. Referrals are reviewed by Consultant Urologists and an appointment will be made for  you in the Outpatient Clinic. Details about your appointment will be posted to you.

If you have questions about your appointment, you can contact the secretary at

01) 852 3442

When you are diagnosed with penile cancer a team of health professionals help to decide the best treatment for you. This is called a multidisciplinary team (MDT).  The team includes:

Consultant Urologist – a doctor that specialises in treating urinary and genital problems.

Mr Ivor Cullen – Urology Consultant

Secretary: 01) 852 3442

Clinical Nurse Specialist – A nurse who gives you information about your cancer and supports you during your treatment.

Alison Doran – Clinical Nurse Specialist

Phone: 01) 7977491

Radiologist – A doctor who looks at scans and x-rays to diagnose cancer.

Pathologist – A doctor who looks at cells or body tissue under a microscope to diagnose cancer.

Medical and Radiation Oncology Consultants – If radiotherapy or chemotherapy is part of your treatment you will  meet a doctor who uses radiotherapy, chemotherapy and other anti-cancer drugs to treat people with cancer.

Other members of the MDT – If you need additional support you may also be referred to a dietician, physiotherapist, occupational therapist, lymphoedema specialist or to the Psycho-Oncology Service in Beaumont.

As with most cancers, the exact causes of penile cancer are not fully known. However, there are a number of factors that increase the risk of developing penile cancer. These include:

Phimosis and poor Hygiene

Phimosis refers to a tight non retractable foreskin that does not “pull back”. This can lead to the build-up of secretions “smegma” leading occasionally to infection and inflammation. Over time, in rare cases this phenomenon can cause the development of penile cancers.

Age: The risk of penile cancer increases with age – it is most common in men over 50.

Not being circumcised: Circumcision removes all (or part) of the foreskin. If you are not circumcised, the foreskin of the penis can sometimes become tight and does not pull back easily (phimosis). Penile cancer is more common in men with phimosis. Sometimes, if you are not circumcised, secretions (smegma) can build up underneath the foreskin. This build-up can irritate and inflame the head of the penis and foreskin, which can increase your risk of cancer.

Human papillomavirus (HPV): This is a common virus that most sexually active people have been exposed to, and that usually causes no harm. However, infection with some types of HPV increases the risk of penile cancer – HPV is found in about half of all penile cancers. The virus is passed from one person to another – sometimes during sexual activity – but it can spread by skin contact with a part of the body already infected. In most cases the infection will clear itself without treatment. However in rare cases it can become chronic and cause penile cancer. Men who are not circumcised may be more likely to have long-term issues with HPV.

Immunosuppression: Men with suppressed or compromised immune systems or men with HIV infection  have a higher risk of penile cancer, which is linked to a weakened immune system.

Smoking: Smoking increases the risk of penile cancer.

Previous exposure to radiation therapy: Patients who have had previous exposure to pelvic irradiation have an increased risk of developing penis cancer

If you have signs and symptoms you usually begin by seeing your GP. If your GP thinks that your symptoms could be caused by cancer, they usually refer you to a doctor called a urologist. A urologist treats problems of the penis, testicles, prostate or urinary system.

At the hospital the Urologist will ask you about your symptoms. They will examine the penis and check the area at the top of the legs (groin) for any swelling.

Biopsy: The main test to diagnose penile cancer is a biopsy. This can be an incisional biopsy where part of the abnormal area is taken for examination. An excisional biopsy can also be taken where the entire lesion is removed for examination in the laboratory.

Fine Needle Aspiration: Your doctor uses a fine needle and syringe to take a sample of cells (biopsy).

Radiological Investigations

Your doctor may also want to do further investigations using one of more of these scans to get more information about how large the cancer is or if it has spread.

• A CT scan takes a series of x-rays which create detailed images of the inside of your body.
• An MRI scan uses magnetism to build up a detailed picture of areas of your body.
• A PET scan produces detailed 3-dimensional images of the inside of your body

Tests to Check the Lymph nodes.

One of the first places penile cancer can spread to is the lymph nodes in the groin. If the cancer has spread the lymph nodes in the groin may be bigger than normal. Your doctor may then arrange for you to have tests to check the lymph nodes.

• Ultrasound: An ultrasound scan uses soundwaves to build up a picture of the inside of the body. A gel is spread onto the groin and a small device is passed over it. This test is painless and only takes a few minutes.
• Fine Needle Aspirate: The doctor may use a needle to take some fluid from the lymph nodes into a syringe. This is called a fine needle aspiration. The fluid is checked under a microscope for cancer cells.
• A sentinel node biopsy (SNLB): This is a way of checking the smallest possible lymph nodes in the groin to see if they contain cancer cells. The sentinel nodes are the first nodes that lymph fluid from the penis drains to. This means they are the nodes most likely to contain any cancer cells.

Staging: The stage of a cancer is a term used to describe its size and whether or not it has spread beyond its original site in the body. Knowing the particular type and stage of the cancer helps the doctors to decide on the best treatment. Your cancer may be described as:

• Early disease: The cancer only affects the foreskin or the surface of the head of the penis (glans).
• Intermediate disease: The cancer has spread below the surface of the skin into the shaft of the penis and /or tiny amounts of cancer cells can be found in one of the lymph nodes in the groin (microscopic disease).
• Advanced disease: The cancer is found in one or several enlarged lymph nodes in the groin and/or it has spread to other parts of the body.

The type of treatment you have will depend on the location of the cancer and how large or widespread it is.

Topical Treatments – Sometimes for early superficial or non-invasive forms of penis cancer (known as carcinoma in situ or intraepithelial neoplasia) topical creams are used to treat the condition.

• Chemotherapy cream -Sometimes, if the penile cancer is small and in the early stages, it can be treated with a chemotherapy cream called fluorouracil (5FU). This works by destroying cancer cells. You apply the cream to the affected area for about 4-6 weeks.
• Immunotherapy cream – Another cream that is sometimes used is called imiquimod. This is an immunotherapy treatment, which stimulates the body’s immune system to fight cancerous cells. Again, the cream is usually applied for 4-6 weeks.

For more advanced cancers you may need treatment with radiotherapy or chemotherapy.

Radiotherapy – Radiotherapy treats cancer using high-energy X-rays to destroy cancer cells. Radiotherapy is occasionally used instead of surgery. This may be when someone is not well enough to have an operation or doesn’t want to have surgery. Radiotherapy is no longer recommended to treat penis cancers. Instead it is used to treat affected lymph nodes in the groin after surgery to help reduce the risk of the cancer spreading. It also may be given to treat symptoms, such as pain, if the cancer has spread to other parts of the body such as the bones. Radiotherapy can be given externally (from outside the penis) or internally when radioactive material is placed into the penis near the caner. It can be used before or after surgery if the cancer is in the lymph nodes in the groin and/or in the pelvis. For more information about radiotherapy Click Here.

Chemotherapy – Chemotherapy is the use of anti-cancer (cytotoxic) drugs to kill or control cancer cells. It is usually given into a vein (intravenously). It may be given to help control the spread of the cancer. It may also be given before surgery – which can make it easier to remove the growth. Sometimes it is given along with radiotherapy to help it work better. For more information about Chemotherapy. Click Here.

Surgery

Surgery is the main treatment for larger cancers of the penis. If the cancer is small or only a surface cancer that has not spread then it can usually be treated by removing only the affected area and a small area around it.

If the cancer is affecting only the foreskin, it may be possible to treat it by the surgical removal of the foreskin (circumcision) alone.

Wide local excision is required if the cancer has spread over a wider area. This means removing the cancer with a border of healthy tissue around it to reduce the risk of the cancer coming back in the future.

Surgery to preserve the penis and reconstruction: for larger cancers of the head of the penis, the bulbous part (the glans) will be removed. It may be possible to give back a normal appearance by using skin from somewhere else in the body (skin graft) to create a new glans (head) of the penis. This is called a glansectomy. The foreskin and tip of penis are removed and replaced by a skin graft from the thigh. This gives an acceptable cosmetic and functional result.

Removing the penis (penectomy): This may be advised if the cancer is large and is covering a large area of the penis. Amputation may be partial (where only part of the penis is removed) or total (removal of the whole penis). If the tumour extends to near the base of the penis, total amputation may be the only option. In these cases the urethra (water/urine pipe) may be resited beside the anus.

Reconstructive Surgery: If there are no signs that the cancer had spread, penis reconstruction may be possible after amputation. This will require more surgery and will be done at a later stage once you have recovered from the amputation and once the doctors are sure that there is no cancer spread.

Removal of Lymph Glands: Sometimes people will need lymph nodes in their pelvis or abdomen removed to see if the cancer has spread. If the nodes in your groin are obviously enlarged (can be felt) and this is due to cancer spread from the penis, the doctor will recommend that you have all the glands in your groin removed (radical groin dissection).

After your treatment you will have regular follow-up appointments with your surgeon or cancer specialist. They will examine you and you may have blood tests or scans. These appointments sometimes continue for several years. If you have any problems, or notice any new symptoms between appointments, let your cancer team (surgeon, cancer specialist or Clinical Nurse Specialist) know so that we can help.

You may feel anxious between appointments. This is normal and it may help to get support from family, friends or a support organisation.

Here are some organisations that can help you.

1. Arc Cancer Support Centres – 01) 215 0250, 01) 2180250, 01) 215 0250
2. Balbriggan Cancer Support – 087) 3532872, 086) 164 8834
3. Gary Kelly Caner Support Centre in Drogheda – 041) 980 5100
4. Cara Cancer Support Centre in Dundalk – 042) 9374905
5. Cuan Cavan – 086) 455 6632
6. Crocus Monaghan – 087) 3680965