Penile Cancer Stages

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) uses a computer linked to an x-ray machine to make a series of detailed pictures of areas inside the body, such as the pelvis. The pictures are taken from different angles and are used to create 3-D views of tissues and organs. 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.
• PET scan (positron emission tomography scan) uses a small amount of radioactive sugar (also called radioactive glucose) that is injected into a vein. The PET scanner rotates around the body and makes a picture of where the sugar is being used in the body. Cancer cells show up brighter in the picture because they are more active and take up more sugar than normal cells do. When this procedure is done at the same time as a CT scan, it is called a PET/CT scan.
• MRI (magnetic resonance imaging) 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 uses high-energy sound waves (ultrasound), which bounce off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
• Chest x-ray is a type of radiation that can go through the body and make pictures of the organs and bones inside the chest.
• Sentinel lymph node biopsy is the removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node in a group of lymph nodes to receive lymphatic drainage from the primary tumor. It is the first lymph node the cancer is likely to spread to from the primary tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes. Sometimes, a sentinel lymph node is found in more than one group of nodes.
• Lymph node dissection is a procedure to remove one or more lymph nodes in the groin during surgery. A sample of tissue is checked under a microscope for signs of cancer. This procedure is also called a lymphadenectomy.

Stage 0 is divided into stages 0is and 0a.

• In stage 0is, abnormal cells are found on the surface of the skin of the penis. These abnormal cells form growths that may become cancer and spread into nearby normal tissue. Stage 0is is also called carcinoma in situ or penile intraepithelial neoplasia.
• In stage 0a, squamous cell cancer that does not spread is found on the surface of the skin of the penis or on the underneath surface of the foreskin of the penis. Stage 0a is also called noninvasive localized squamous cell carcinoma.

In stage I, cancer has formed and spread to tissue just under the skin of the penis. Cancer has not spread to lymph vessels, blood vessels, or nerves. The cancer cells look more like normal cells under a microscope.

Stage II is divided into stages IIA and IIB.

• In stage IIA, cancer has spread:
  • to tissue just under the skin of the penis. Cancer has spread to lymph vessels, blood vessels, and/or nerves; or
  • to tissue just under the skin of the penis. Under a microscope, the cancer cells look very abnormal or the cells are sarcomatoid; or
  • into the corpus spongiosum (spongy erectile tissue in the shaft and glans that fills with blood to make an erection).
• In stage IIB, cancer has spread:
  • through the layer of connective tissue that surrounds the corpus cavernosum and into the corpus cavernosum (spongy erectile tissue that runs along the shaft of the penis).

Stage III is divided into stages IIIA and stage IIIB. Cancer is found in the penis.

• In stage IIIA, cancer has spread to 1 or 2 lymph nodes on one side of the groin.
• In stage IIIB, cancer has spread to 3 or more lymph nodes on one side of the groin or to lymph nodes on both sides of the groin.

In stage IV, cancer has spread:

• to tissues near the penis, such as the scrotum, prostate, or pubic bone, 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 through the outer covering of the lymph nodes to nearby tissue; or
• to lymph nodes outside the pelvis or to other parts of the body, such as the lung, liver, or bone.

Stage IV penile cancer is also called metastatic penile cancer. Metastatic cancer happens when cancer cells travel through the lymphatic system or blood and form tumors in other parts of the body. The metastatic tumor is the same type of cancer as the primary tumor. For example, if penile cancer spreads to the liver, the cancer cells in the liver are actually penile cancer cells. The disease is called metastatic penile cancer, not liver cancer.

Recurrent penile cancer is cancer that has come back after it has been treated. If penile cancer comes back, it may come back in the penis or in other parts of the body, such as the liver or lungs. Tests will be done to help determine where the cancer has returned. The type of treatment for recurrent penile cancer will depend on where it has come back.

Learn more in Recurrent Cancer: When Cancer Comes Back.