During your appointment the doctor will examine the whole of the penis and your groins to feel for any swellings. To make a firm diagnosis, the doctor will arrange to take a sample of tissue (a biopsy) from any sore or abnormal areas on the penis. This will be done under an anaesthetic (local or general) and the procedure should be relatively painless. The biopsies will then be examined under a microscope.
You will need further tests to check whether or not the cancer has spread. Cancer can spread in the body, either in the bloodstream or through the lymphatic system. The lymphatic system is part of the body’s defence against infection and disease. It is made up of a network of lymph glands which are also known as lymph nodes. These glands are linked by fine ducts which contain lymph fluid. If the cancer has spread to the lymph nodes in your groin they may start to enlarge.
The results of these tests will help the doctor to decide on the best type of treatment for you.
A CT (Computerised Tomography) scan is a specialised type of X-ray. A series of pictures is taken and fed into a computer to build up a detailed picture of the inside of the body. The scan can show whether or not the cancer has spread to other parts of the body. It is painless and takes 10 to 30 minutes.
An MRI (magnetic resonance imaging) scan is a specialised type of imaging. A series of pictures is taken and fed into a computer to build up a detailed picture of the inside of the penis. You may be given an injection of Caverject®, a drug given into the penis to induce an erection. The scan can help the doctors to visualise the depth of the invasion of the tumour within the penis. The procedure can take up to 60 minutes. People who suffer with claustrophobia may not be able to tolerate this scan, and for those with certain types of metal work this scan may not be suitable.
Not everyone with a penile cancer diagnosis will need to have an MRI scan – this will be decided by your clinical team.
An ultrasound is a painless scan to assess the lymph nodes in your groin and assess for signs of cancer spreading.
If you have any enlarged lymph nodes in the groin, the radiologist will put a needle into the node to get a sample of cells. This is to see whether or not the enlargement is due to cancer. Enlarged lymph nodes can also be due to infection.
Grading
Grading refers to the appearance of the cancer cells under the microscope and gives an idea of how aggressive the cancer is.
Low-grade (G1) means that the cancer cells look very much like normal cells; they are usually slow-growing and are unlikely to spread. In high grade tumours (G3), the cells look very abnormal, are likely to grow more quickly, and are more likely to spread.
Staging
The stage of a cancer is a term used to describe the degree of invasion into neighbouring tissue and whether there is any spread beyond the penis.
As with all cancers the outcome will depend on how advanced it is when diagnosed. Penile cancer is very curable provided men are treated early and the cancer has not spread to other areas of the body. For those in whom cancer has spread to the groins, the cancer is still curable, but men may need additional treatment. For those who present late with very advanced disease, then cure may be less likely.
