There are various treatments doctors can use to treat penile cancer. These treatments all aim to keep the penis looking and working normally. Which treatment you have will depend on what you prefer, your surgeon’s recommendations, and which treatments are available at your hospital.
You might have
- Minor Surgery
Your doctor may suggest treatment with cream to the affected area. This might be chemotherapy cream – Fluorouracil (Efudix®), also known as 5FU, is used. Or a cream called Imiquimod cream (Aldara), which uses the immune system to treat cancer.
More on Fluorouracil (Efudix®) can be found here.
More on Imiquimod can be found here.
You might have laser therapy to the affected area. Some surgeons may use cryotherapy. Or you may have an operation to remove the affected skin, followed by a skin graft.
Treating penile cancer
For penile cancer that is not in the very earliest stage, you may have
Which operation you have will depend on
- Where the cancer is
- The type and size of the cancer
- Whether the cancer has spread
Before your operation, your doctor will talk to you about the best type of surgery for your cancer.
Note – you have to give your consent before your doctor can operate. You can ask your surgeon any questions you have about the choice of operation before you sign the consent form
Circumcision is the removal of the foreksin. If the cancer only affects the foreskin, this may be the only treatment that you will need. Circumcision is also done if you need radiotherapy treatment.
You can have a circumcision under a local or a general anaesthetic. After your operation your penis will be slightly swollen and bruised for about a week. You will have some stitches that will dissolve after a week to 10 days. It is important to keep the wound clean and you should wash or clean it as directed by your nurse. You may have some pain for a few days, and need to take a mild painkiller such as paracetamol.
Some men worry about their sex lives after being circumcised. However there is no evidence that men who are circumcised are less sensitive or have any more difficulty getting an erection after the surgery.
Mohs Micrographic Surgery (MMS)
This is a specialist type of surgery and you may have to be referred to another hospital to have it. Mohs micrographic surgery (MMS) is sometimes used for verrucous carcinoma, a rare type of squamous cell penile cancer.
MMS is a slow process because a small amount of cancer tissue is removed at a time. But you will keep as much healthy skin as possible. During surgery the tissue is immediately examined under a microscope. If the tissue contains cancer cells, more tissue is removed and examined. The surgeon continues in this way until they have removed all the cancer. This treatment is not suitable for everyone.
This is the most common. The surgeon uses a powerful beam of light that acts like a knife. It cuts away the tumour but does not go too deep into the tissue. If you are having laser treatment you will have a general anaesthetic.
Cryotherapy uses liquid nitrogen to freeze and kill the cancer cells. Your doctor places a probe on the area to freeze the cells. After you have had cryotherapy your skin usually develops a blister, which may form a scab or crust. The blister and scab usually fall off after a couple of weeks. Once the skin has healed it may be a different colour, usually leaving a paler scar.
You can have cryotherapy under a local anaesthetic. But it can take over an hour, so your doctor might give you either a sedative or a general anaesthetic.
Wide local excision
This is when the cancer is removed along with a border of healthy tissue around it. This is called a clear margin of tissue. Your doctor removes this border of healthy tissue to lower the risk of the cancer coming back. Your surgeon will send the tissue sample to the lab, where a pathologist will look at the cells under a microscope. This will help the doctors find out more about the cancer.
The pathologist will also check that your surgeon has removed the tumour together with a border of tissue that is free of cancer cells. European guidelines recommend that the surgeon removes a margin of a few millimetres around the cancer.
You will need a general anaesthetic for a wide local excision and will be in hospital overnight. You will have some pain after the surgery and your penis may be swollen for a week to 10 days.
Removal of the head of the penis (glansectomy)
You may hear this operation called a glansectomy. This is because the surgeon removes the glans (head). You might have this operation if your tumour is stage 1 or at T1 / T2. Your surgeon will then do a skin graft to reconstruct the head of your penis. You usually have the skin taken from your thigh. After this operation your penis will look like a circumcised penis. You will be able to pass urine normally and most men who were sexually active before the operation remain so after the operation.
If cancer has started to grow into the shaft of your penis, your surgeon will need to remove a bit more. You will still have a skin graft done but your penis will be shorter. It is sometimes possible for surgeons to combine this operation with a penis lengthening operation.
After a glansectomy operation you have a tube to drain the urine from your bladder (catheter) for about 5 days. And you will need to stay in bed for 1 to 2 days. This is to give the graft the best chance to heal. You need to try not to rub or brush against the skin graft on your penis for the first couple of weeks. Your nurse will take out your stitches around 5 days after your operation. You will also have a wound on your thigh, where the surgeon removed the skin. It will take at least a couple of weeks for the area on your thigh to heal.
More Information on glansectomy http://www.christie.nhs.uk/booklets/500.pdf
This is a surgical procedure to remove part of the penis. During this process a section of skin may be taken from another area of the body such as the thigh to replace some of the tissue removed (skin graft).
This type of surgery will affect the appearance of the penis and it is important for men and their partners to:
- Ask their surgeon or health professional to give them as much information as possible with regard to the possible change in appearance of their penis following surgery. This will help prepare them for the change in body image.
- Men should ask their specialist nurse to discuss the treatment that they are having and what to expect immediately after, and in the long term following treatment. If possible they should try and involve their partner and family as they will be affected by these changes too.
- If men are having difficulty in preparing for their treatment either emotionally or psychologically they can ask their specialist team about counselling; talking to a healthcare professional to express their fears or concerns.
More Information on Partial http://www.christie.nhs.uk/booklets/622.pdf
Removal of the penis (penectomy)
If your cancer is large you may need to have either part or all of your penis removed (partial or total penectomy). A total penectomy is only done if your cancer is deep into your penis, or is at the base of the penis.
Nowadays doctors usually do a glansectomy rather than a partial penectomy. If you need a partial penectomy, your surgeon will remove the end of the penis. They will aim to leave enough of the shaft of your penis behind to allow you to pass urine standing up, with the flow of urine clear of your body.
If you need a total penectomy your surgeon will remove the shaft and root of your penis. The root is the part which goes up inside your body. During the operation, the surgeon will form a hole between your anus and your scrotum, through which you’ll pass urine. You will still have control over passing urine, because the muscle that keeps the bladder closed is further inside your body, above your penis.
Because penectomy is a bigger operation, you will need to stay in hospital for at least a week, perhaps longer.
It may be possible to reconstruct the penis after a penectomy using tissue from elsewhere in the body. This operation isn’t done very often. There are different ways to do the reconstruction. For example, your surgeon can take skin and muscle from your arm. Or you might have surgery in 2 stages to reconstruct your penis. In the first operation the surgeon will form a flap of skin from your scrotal sac and attach this flap to the stump of your penis. This stays in place for 4 to 6 weeks. In the second operation, the end attached to the scrotum sac is cut. If possible, the surgeon will reconnect nerves so that you have some feeling in your penis.
This operation means there is a chance of having a penis that looks satisfactory and you can use to pass urine normally. Some men have been able to have sexual intercourse with vaginal penetration after this surgery.
Whichever way reconstructive surgery is done, it will involve another operation. A specialist plastic surgeon has to do the surgery. It is important to talk to your surgeon before the operation, so that you are clear about what they will be able to achieve and what the chances are of getting an erection afterwards.
More Information on Penectomy http://www.christie.nhs.uk/booklets/600.pdf
Removal of the lymph nodes (lymphadenectomy)
Your surgeon may also remove lymph nodes from your groin. As part of your tests to diagnose penile cancer the doctor will check your lymph nodes to see if they are swollen or enlarged. If they are you will have a fine needle aspiration. If this shows cancer cells your surgeon will remove your lymph nodes. This is called a lymph node dissection. If your lymph nodes are larger than normal but the fine needle aspiration doesn’t show any cancer cells you may have the enlarged node taken out and tested. If cancer cells are found in it you will have the rest of your nodes removed.
You usually have surgery to remove the lymph nodes at the same time as surgery to your penis. Your surgeon will make a cut into your groin to take the affected lymph nodes out. You’ll be in hospital for a few days and will have a wound about 10cm long. You will also have a drain near to your wound to drain fluid that can build up around your operation site.
Depending on the results from the removal of lymph nodes in your groin, you may need to have the lymph nodes in your pelvis taken out as well. You usually have this as a second operation. The surgeon may make a cut (incision) in the lower part of your abdomen to remove the lymph nodes. Or you may have keyhole (laparoscopic) surgery.
With this, the surgeon makes several small cuts in the abdomen. They put a bendy narrow tube called a laparoscope through these entry sites. The laparoscope has a light and camera attached so the surgeon can see what they are doing on a television screen. It also has small instruments that fit down the tube, which the surgeon controls. Generally, there is less pain afterwards and you recover slightly quicker with laparoscopic surgery compared to open surgery. In some hospitals, you may have robot assisted laparoscopic surgery to remove lymph nodes.