After penile cancer has been diagnosed, tests are done to find out if cancer cells have spread within the penis or to other parts of the body.

The process used to find out if cancer has spread within the penis or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).

• Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.

• Chest x-ray : An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

There are three ways that cancer spreads in the body.

The three ways that cancer spreads in the body are:

• 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 (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

The following stages are used for penile cancer:

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells or growths that look like warts are found on the surface of the skin of the penis. These abnormal cells or growths may become cancer and spread into nearby normal tissue. 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. The tumor cells look a lot like normal cells under a microscope.

Stage II

In stage II, cancer has spread:

• to connective tissue just under the skin of the penis. Also, cancer has spread to lymph vessels or blood vessels or the tumor cells may look very different from normal cells under a microscope; or
• through connective tissue to erectile tissue (spongy tissue that fills with blood to make an erection); 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. Cancer has also spread:

• to connective tissue just under the skin of the penis. Also, cancer may have spread to lymph vessels or blood vessels or the tumor cells may look very different from normal cells under a microscope; or
• through connective tissue to erectile tissue (spongy tissue that fills with blood to make an erection); 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. Cancer has also spread:

• to connective tissue just under the skin of the penis. Also, cancer may have spread to lymph vessels or blood vessels or the tumor cells may look very different from normal cells under a microscope; or
• through connective tissue to erectile tissue (spongy tissue that fills with blood to make an erection); 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 to lymph nodes in the groin or pelvis; or
• to one or more lymph nodes in the pelvis, or cancer has spread from the lymph nodes to the tissues around the lymph nodes; or
• to distant parts of the body.