Penile Cancer

Assessment

For many men, their first point of contact when seeking help will be their GP. Most GPs won't be an expert in penile cancer but if after an examination they are unable to make an accurate diagnosis, the GP should be able to refer a patient onto a local hospital for further tests. A GP will usually make a referral to a urologist who is a health professional who specialises in diseases affecting the urinary system and genitals. Urology specialists will have a wider range of diagnostic tests and instruments available to them than a GP and will therefore be able to give the patient a more accurate diagnosis.

Asking men about their symptoms
When first seeking help, and throughout the diagnostic phase, men will be asked questions about their general health and the symptoms that they are experiencing. These questions are intended to help the doctor find out more about the patient’s health and possible causes of their symptoms. Some of the questions may be quite sensitive or personal, but it's important that all questions are answered as clearly and honestly as possible in order to help the doctor make the right diagnosis.

The men we spoke to were asked about the following, by their doctors:

  • The symptoms experienced
  • The length of time they had experienced the symptoms
  • How the symptoms had changed
  • Sexual activity
  • Sexually transmitted infections
Diagnosis and misdiagnosis of penile cancer
Health professionals don't always provide the correct diagnosis on the first visit. Penile cancer is rare and this can make diagnosis particularly difficult because primary health care professionals, such as GPs, may not always have the knowledge or experience to make a quick diagnosis. Sometimes a doctor suspected a bladder or prostate problem and did tests appropriate to those conditions, such as blood tests (including PSA, which is a test for prostate cancer), a physical examination to feel for an enlarged prostate, an ultrasound scan or a cystoscopy to examine the inside of the bladder, or a biopsy of the prostate gland. Some men were tested for sexually transmitted infections.  
Physical assessment/examination
Physical examination or visual inspection is an important assessment tool for health professionals and can provide them with a lot of valuable diagnostic information. Mark went to his local A&E department for help. Whilst he was at the hospital, he was examined a number of times.
Being assessed
It is normal to feel anxious about being examined by a health professional. If a man prefers to be examined by a male doctor, he can request this. Many of the men we interviewed told us that although they initially felt uneasy about being examined, they soon became more relaxed and comfortable with being observed by professionals. By the time Frosty had his second consultation, he was comfortable being examined. John suggested that the positive way he was treated by the nurses meant that he didn’t feel embarrassed during examinations.
As penile cancer is a rare condition, when a diagnosis has been given, patients may be asked if they are happy for junior doctors or students to sit in on an examination, to allow them to improve their professional knowledge. Whether a man allows other medical staff to see him is his decision and he is able to refuse examination by students. However, several of our patients commented that it was important that junior doctors and other students were able to learn about something that is a rare condition.
Circumcision
In some men, the cancer of the penis developed under the foreskin. If the foreskin cannot be pulled back (retracted), it is necessary to perform a circumcision in order to examine the head of the penis. Other men had either a partial or total circumcision to relieve symptoms and to reveal the surface of the penis to look for a rash or tumour. Jim had had a complete circumcision many years before being investigated for penile cancer. Simon went to hospital expecting to have a circumcision but the doctor could see the penile cancer without doing this procedure. Mark had a ‘dorsal slit’ (an alternative to circumcision where the foreskin is opened up without removing any tissue), which led to his diagnosis.
 
Unusually, doctors investigating John’s symptoms found a secondary cancer in his groin without knowing the location of the original or ‘primary’ cancer. As part of their investigations, John’s medical team performed a partial circumcision to reveal the glans of his penis.
Biopsies
Taking a biopsy is the best way of identifying the presence of cancerous cells. A biopsy is a simple procedure where a small tissue sample is taken from the affected area of the penis and sent for laboratory analysis. At the laboratory, a pathologist will examine the sample under a microscope and look for cancerous cells.
There are several types of biopsies available, with some more invasive than others. These are:
  • Incisional biopsy – Removal of a small piece of tissue from the affected area.
  • Excisional biopsy – Removal of the whole of the affected area.
  • Fine needle aspiration – Insertion of a fine needle into the penis through which a fluid sample is sucked up. This technique can be used to examine lumps that some men have in their groins.
The type of biopsy undertaken will depend on the site and size of the abnormal area on the man’s penis. A biopsy will be performed using a local or general anaesthetic.
Further tests after diagnosis
Once a diagnosis of penile cancer has been made, further tests may be required to determine whether the cancer has spread to lymph nodes in the groin or other parts of the body (metastasis). X-rays can be used to find evidence of cancer in the chest or bones. A CT scan uses X-rays to provide the doctor with a detailed image of the inside of a patient’s body and is therefore a powerful tool in determining whether metastasis has occurred. MRI scans can also be useful, these use magnetism rather than x-rays and may be better at providing images of soft tissue such as the penis. Men may also be given an ultrasound scan.
A sentinel lymph node biopsy (SLNB) is another test that may be conducted at the time of surgical treatment or afterwards. An SNLB is a relatively simple procedure where the lymph node most likely to contain cancerous cells is identified and removed for inspection. The sentinel lymph node can be identified by injecting a radioactive substance close to the cancer; an instrument is then used to detect which lymph nodes the substance has travelled to.
Assessment can be an on-going process once a diagnosis of penile cancer has been given. After treatment has finished, a man will be regularly assessed to check for recurrence or metastasis. In some men, scans revealed a recurrence either on the penis or in the lymph nodes of the groin requiring further surgery.

Last reviewed January 2015.
Last updated January 2015.

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