Penile Cancer

ON THIS PAGE: You will find out more about the factors that increase the chance of developing penile cancer. Use the menu to see other pages.

What are the risk factors for penile cancer?

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. Knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors may raise a person's risk of developing penile cancer:

• HPV infection. The most important risk factor for penile cancer is infection with this virus. Sexual activity with a person who has HPV is the most common way someone gets HPV. There are different types of HPV, called strains. Research links some HPV strains more strongly with certain types of cancers. You can reduce your risk of HPV infection by limiting your number of sex partners, because having many partners increases the risk of HPV. Using a condom cannot fully protect you from HPV during sex. HPV vaccines can prevent people from developing certain cancers. Learn more about HPV and cancer.

• Smoking. Smoking tobacco may contribute to the development of penile cancer, especially in people who also have HPV.

• Age. Penile cancer is most common in people older than 50. In the United States, the average age of diagnosis for penile cancer is about 68 years. However, Black and Hispanic people are more likely to be diagnosed earlier, at an average age of 60. In the United States, about 80% of people with penile cancer are at least 55 when diagnosed. Worldwide, about 20% of people diagnosed with penile cancer are younger than 40.

• Phimosis. Phimosis occurs when the foreskin becomes tight and is difficult to retract. People with phimosis have an increased risk of developing penile cancer. This is most likely because those with phimosis are less likely to be able to thoroughly clean the penis. Poor penile hygiene increases the chances of chronic inflammation, which can lead to cancer. There are surgical and nonsurgical treatments available for phimosis. It can also be prevented with circumcision.

• Smegma. Smegma is a thick substance that can build up under the foreskin. It is caused by dead skin cells, bacteria, and oily secretions from the skin. Smegma was previously believed to increase the chances of developing penile cancer, but there is very little evidence supporting that belief. If smegma does cause cancer, called carcinogenic, that would explain the connection between phimosis (see above) and penile cancer. Regardless, good penis hygiene is recommended. Those who are uncircumcised should pull back, or retract, the foreskin and thoroughly wash the penis on a regular basis. This is to make sure that smegma does not irritate the penis.

• HIV/AIDS. Infection with human immunodeficiency virus (HIV) is a risk factor for penile cancer. HIV is the virus that causes acquired immune deficiency syndrome (AIDS). When a person has HIV, the immune system is less able to fight off early-stage cancer.

• Psoriasis treatment. The drug psoralen combined with ultraviolet (UV) light may increase the risk of developing penile cancer.

Are there way to prevent penile cancer?

Different factors cause different types of cancer. Researchers continue to look into what factors cause penile cancer, including ways to prevent it. Although there is no proven way to completely prevent penile cancer, you may be able to lower your risk. Talk with your health care team for more information about your personal risk of cancer.

• Circumcision. Circumcision before adulthood appears to provide some protection from penile cancer. People who have been circumcised in their youth have a much lower rate of penile cancer, and epidermoid/squamous cell carcinoma of the penis almost never occurs in them. However, it is important to note that circumcision reduces but does not eliminate the risk of penile cancer.

• Personal hygiene. Carefully and completely cleaning under the foreskin on a regular basis can lower the risk of developing penile cancer.

• Lifestyle factors. Not smoking and avoiding sexual practices that could lead to an HPV or HIV/AIDS infection can help lower your risk of penile cancer.

Learn more about cancer prevention and healthy living.

The next section in this guide is Symptoms and Signs . It explains what changes or medical problems penile cancer can cause. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If the cancer has spread, it is called metastasis. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

How penile cancer is diagnosed

There are different tests used for diagnosing penile cancer. Not all tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

• The type of cancer suspected

• Your signs and symptoms

• Your age and general health

• The results of earlier medical tests

In addition to a physical examination, the following tests may be used to diagnose penile cancer:

• Biopsy. If there is an unusual change on or in the penis or nearby lymph nodes, a biopsy may be needed to learn more about the change. A biopsy is the only way to make a definite diagnosis, even if other tests can suggest that cancer is present. During biopsy, a small amount of tissue is removed for examination under a microscope. A pathologist analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.
  
  If cancerous cells are seen in a tissue sample, then the biopsy is called positive for cancer. If no cancer is found, then the biopsy is called benign or negative for cancer. Sometimes, the pathologist cannot tell if the cells collected are cancerous, which means the biopsy is called indeterminate or non-diagnostic.
  
  The following types of biopsies may be used for penile cancer:

  • A punch biopsy or elliptical excision may be used for an abnormal change that can be seen on the penis. In a punch biopsy, the doctor uses a sharp round surgical tool to remove a circular piece of tissue. In an elliptical excision, the doctor uses a scalpel or other tool to cut out a piece of tissue.

  • A fine needle aspiration is a specific type of biopsy. First, the skin is usually made numb with a topical medication applied on the skin that blocks the sensation of pain. Then, a medication is injected into the area near the tumor to prevent pain in tissues beneath the skin. The doctor will then insert a thin needle into the tumor and remove some cells and fluid. The procedure may be repeated 2 or 3 times to collect samples from different areas of the tumor.
    

  • A sentinel lymph node biopsy is a way to find out if cancer cells have spread to lymph nodes near the penis. In this technique, the doctor removes 1 or a few sentinel lymph nodes to check for cancer cells. The doctor may recommend using imaging scans and dyes to aid with the biopsy. If this is done, it is called a dynamic sentinel node biopsy (DSNB). Lymph nodes are the small, bean-shaped organs that help fight infection. They are connected to each other by tiny vessels called lymphatic vessels. Sentinel lymph nodes are the first lymph node(s) into which the lymph fluid from the tumor drains. If there are multiple lymph vessels draining the area where the tumor is located, then there may be more than 1 sentinel lymph node. For penile cancer, the sentinel lymph nodes are located just under the skin in the groin. If cancer cells are found in these lymph nodes, it means that the cancer is more likely to have spread to other nearby lymph nodes or to other parts of the body. Even if cancer cells are not found during a sentinel lymph node biopsy, there is still a chance that the cancer has spread.

• Inguinal (groin) lymph node dissection. This is the most accurate way to find out whether the cancer has spread to any lymph nodes near the penis. It may be recommended if certain risk factors for spread are present or if there are enlarged lymph nodes on physical exam or imaging studies. In this procedure, the lymph nodes near the penis are removed and checked for cancer. This procedure provides more information than the removal of a single lymph node or a group of lymph nodes. However, after this procedure, there may be problems with wound healing, as well as long-lasting and possibly severe leg swelling, called lymphedema . Research to find ways to prevent these side effects is ongoing (see Latest Research ).

• X-ray. An x-ray creates a picture of the structures inside of the body using a small amount of radiation.

• Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows abnormalities or tumors. A CT scan can be used to measure a tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow. A CT scan helps find out if the cancer has spread to lymph nodes in the groin, pelvis, and the abdomen. It also allows the doctor to see if the cancer has spread to the lungs, liver, and other tissues.

• Magnetic resonance imaging (MRI). An MRI produces detailed images of the inside of the body using magnetic fields, not x-rays. MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

• Positron emission tomography (PET) or PET-CT scan. A PET scan creates pictures of organs and tissues inside the body. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan . However, you may hear your doctor refer to this procedure just as a PET scan. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body.

• Ultrasound. An ultrasound creates a picture of the internal organs using sound ways. It may be used as an alternative if other imaging methods are not available.

After diagnostic tests are done, your doctor will review the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages and Grades . It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with penile cancer. Use the menu to see other pages.

This section explains the types of treatments, also known as therapies, that are the standard of care for penile cancer. “Standard of care” means the best treatments known. Information in this section is based on medical standards of care for penile cancer in the United States. Treatment options can vary from one place to another.

When making treatment plan decisions, you are encouraged to discuss with your doctor whether clinical trials offer additional options to consider. A clinical trial is a research study that tests a new approach to treatment. Doctors learn through clinical trials whether a new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

How penile cancer is treated

In cancer care, different types of doctors who specialize in cancer, called oncologists, often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. For penile cancer, this team often includes a surgeon, a doctor called a urologist who specializes in urinary tract problems, a medical oncologist, and a radiation oncologist. Other specialists, such as a pathologist or reconstructive surgeon, may be involved. Cancer care teams include other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, psychologists, sex therapists, dietitians, physical therapists, occupational therapists, and others. Learn more about the clinicians who provide cancer care.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment.

Patients may have concerns whether their treatment could affect their sexual health and fertility . Talk with your doctor about these topics before treatment begins. These types of conversations are called “shared decision-making.” Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is important for penile cancer because there are different treatment options. Learn more about making treatment decisions .

Common types of treatments used for penile cancer include surgery, radiation therapy, and chemotherapy. Each is described below in more detail. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. The information on this page is based in part on the American Society of Clinical Oncology (ASCO)–European Association of Urology (EAU) " Guidelines on Penile Cancer. " Please note that this link takes you to a different ASCO website.

READ MORE BELOW:

• Active surveillance

• Surgery

• Radiation therapy

• Chemotherapy

• Physical, emotional, social, and financial effects of cancer

• Metastatic penile cancer

• Remission and the chance of recurrence

• If treatment does not work

Active surveillance

For some patients with a small tumor that does not show signs of being aggressive, active surveillance may be offered as an alternative to staging using surgery. During active surveillance, the tumor is monitored, and active treatment would begin if it started causing any symptoms or problems.

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Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue, called a margin, during an operation. A surgical oncologist is a doctor who specializes in treating cancer using surgery. The surgical oncologists who treat penile cancer are usually urologists who have special training in cancer surgery.

Surgery for penile cancer is usually done while a patient receives local or general anesthesia , depending on the patient’s preference and the doctor’s recommendations. Local anesthesia is injected to numb the area where the surgery is being done. General anesthesia makes a person unconscious and blocks any pain during surgery, leaving little or no awareness or memory of the procedure. The types of surgery that may be used for penile cancer are described below.

Laser therapy. Laser therapy is the use of a very powerful beam of light to destroy cancer cells. Laser therapy may be an option for some patients with early-stage penile cancer confirmed by a biopsy. A disadvantage of laser therapy is that it can be difficult for the doctor to determine how far the cancer has spread.

Cryosurgery. Cryosurgery, also called cryotherapy or cryoablation, uses liquid nitrogen to freeze and kill cells. The skin will later blister and peel. This procedure will sometimes leave a scar. More than 1 freezing may be needed.

Circumcision. Circumcision (see Risk Factors and Prevention ) is generally used if the cancer is only on the foreskin.

Excision. An excision is a removal of the tumor and some surrounding healthy tissue using a scalpel or other surgical tool. Sometimes the surgeon may remove a larger area of healthy tissue around the tumor to make sure that all the cancer is removed. Sometimes, a skin graft is needed to cover the area where the skin was removed. A skin graft uses skin from another part of the body to close the wound and reduce scarring.

Mohs surgery. This technique is used to remove the cancer that can be seen on the surface of the penis. In addition to the tumor, a small amount of healthy tissue around the edge is removed to make sure that no cancer is left behind. During the procedure, each small piece of tissue is examined under a microscope until all of the cancer is removed. This is most often used for a small tumor that is only on the surface of the penis. This procedure can be more expensive than an excision.

Glansectomy and glans resurfacing. The head or tip of the penis is called the glans. If the cancer is only in the glans or foreskin, the doctor may offer glansectomy or glans resurfacing. During glansectomy, the glans is removed. During glans resurfacing, layers of tissue are removed from the glans and the area is covered with a skin graft.

Penectomy. This is the surgical removal of part or all of the penis. It is the most common and effective procedure to treat penile cancer that has grown inside of the penis. Because this is disfiguring surgery, it is important to determine whether it is needed or if removing only the cancer is possible. If a penectomy is needed to treat the cancer effectively, a partial rather than total penectomy is a better option if the cancerous tissue and a 2 cm margin of healthy tissue can be removed while leaving enough length of the penis for the patient to urinate naturally. When this is not possible, a total penectomy is performed, which is the removal of the entire penis. The surgeon will then tunnel the urinary tract underneath the scrotum, meaning the patient will urinate in a sitting position.

Lymph node dissection. Removal of the lymph nodes in the groin and/or pelvis is often performed to find out the stage (see Diagnosis ) or to treat penile cancer. This may be done even if there are no signs that the cancer has spread to the lymph nodes. If the groin lymph nodes are enlarged prior to surgery, then surgery to remove these lymph nodes is generally more extensive. While removing groin lymph nodes on both sides is common, removing deeper lymph nodes in the pelvis is generally only done if cancer is found in the groin lymph nodes. Removing the lymph nodes when the cancer has spread to the lymph nodes, but not anywhere else, can get rid of the cancer and lymph node surgery can increase the likelihood of cure.

However, when the lymph nodes in both the groin and the pelvis are removed on the same side of the body, there is often severe swelling called lymphedema in the leg on that side of the body. This can cause significant discomfort and infections that often occur repeatedly. When making such a treatment decision, you and your doctor should carefully weigh the benefits of removing any cancer that may have spread to lymph nodes with the risk of side effects from the surgery. If leg swelling is likely or does occur, it can be helpful to see a lymphedema specialist .

Side effects of surgery

Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have and how they can be managed. Surgical treatment for penile cancer can permanently change a person’s sexual health and ability to urinate. Talk with your health care team about how your treatment could affect your sexual and urinary health, even if it is uncomfortable to discuss. If you have a sexual partner, it can help to have an honest conversation with them about what worries you and what you expect may happen. Many people experience difficult emotions after treatment for penile cancer, so joining a support group or seeking counseling may be very helpful. Cancer.Net has additional information about sexual health and self-image during and after cancer treatment. It is important to know that more extensive surgery often gives the best chance of a cure and a lower risk of the cancer coming back.

Overall, the possible side effects of surgery depend on the stage of disease and the type of procedure, among other factors.

Learn more about the basics of cancer surgery .

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Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given by implanting radioactive materials in the body, it is called internal radiation therapy or brachytherapy.

A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. For penile cancer, ASCO recommends radiation therapy for smaller tumors that have been confirmed by a biopsy. Radiation therapy can be focused on the tumor in the penis and/or directed at the lymph nodes in the groin and sometimes the pelvis, to destroy any cancer cells that have spread there.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. In addition, radiation therapy can increase the risk of developing other cancers in the future. If radiation therapy is focused on the groin, there is a risk of lymphedema in the leg(s) because of damage to the lymphatic channels that drain fluid from the legs. Most side effects go away soon after treatment is finished, although lymphedema can be an ongoing condition.

Learn more about the basics of radiation therapy .

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Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles of treatment given over a set period of time. For example, a treatment cycle may last 3 weeks and the treatment plan may be made up of 4 cycles of 3 weeks each, which is 12 weeks total.

There are 2 types of chemotherapy that may be used for penile cancer: topical chemotherapy and systemic chemotherapy.

Topical chemotherapy

For small, noninvasive cancers, or “carcinoma in situ,” lower doses of chemotherapy can be used on the surface of the skin. Such drugs include fluorouracil (5-FU) or imiquimod (Aldara).

Systemic chemotherapy

Systemic chemotherapy is given directly into the bloodstream to reach cancer cells throughout the body. Chemotherapy for penile cancer is generally given through an intravenous (IV) tube placed into a vein using a needle or as a pill or capsule that is swallowed (orally). If you are given oral medications to take at home, be sure to ask your health care team about how to safely store and handle them.

Chemotherapy is often recommended after surgery for penile cancer when surgical removal of pelvic lymph nodes revealed cancer in more than 1 of the nodes. Chemotherapy also may be given before surgery when the doctor is concerned that the tumor in the penis may be too large to be completely removed with surgery or that the cancer has spread to the regional lymph nodes and removing the lymph nodes by surgery may be difficult. In that setting, chemotherapy may be used to shrink the cancer so it can be completely removed. Penile cancer that cannot be removed with surgery is sometimes treated with a combination of chemotherapy and radiation therapy. If the cancer has not spread beyond the pelvis, chemotherapy and/or radiation therapy may be given to destroy enough of the cancer to make surgery possible. Chemotherapy is also used for penile cancer that has spread to other parts of the body (see "Metastatic penile cancer," below).

Commonly used systemic drugs for penile cancer include:

• Cisplatin (available as a generic drug)

• Ifosfamide (Ifex)

• Paclitaxel (available as a generic drug)

• Fluorouracil (5-FU)

Less commonly used systemic drugs include:

• Bleomycin (Blenoxane)

• Docetaxel (Taxotere)

• Gemcitabine (Gemzar)

• Methotrexate (multiple brand names)

• Pembrolizumab (Keytruda), which is an immunotherapy that is used only if certain genetic abnormalities are detected

Not all of these drugs are readily available for people with penile cancer. They may only be available as part of a clinical trial. Because penile cancer is uncommon, there have been fewer studies of chemotherapy and other drugs for penile cancer than there are for more common cancers. As a result, there is no strong evidence that chemotherapy for penile cancer helps patients live longer or improves their quality of life. Therefore, the decision to use systemic chemotherapy for penile cancer is not simple. When chemotherapy is used, there is general agreement among cancer specialists that drug combinations that include cisplatin and involve 2 or 3 drugs work better than a single drug, but this has not been proven in clinical trials. The 2 most commonly used combinations are cisplatin, ifosfamide, and paclitaxel and cisplatin plus fluorouracil. Other combinations still being studied include cisplatin and fluorouracil with either paclitaxel or docetaxel. Talk with your health care team about the individual drugs in the treatment plan that is recommended for you.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, mouth sores, hair loss, loss of appetite, and diarrhea. These side effects usually go away after treatment is finished. However, some side effects can be permanent or show up in the future; these are called late effects. For instance, chemotherapy may increase the risk of cardiovascular disease and of other cancers, called secondary cancers, in the future.

Learn more about the basics of chemotherapy .

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications.

It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases .

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Physical, emotional, social, and financial effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative and supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative and supportive care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative and supportive care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments, such as chemotherapy, surgery, or radiation therapy, to improve symptoms.

Before treatment begins, talk with your doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative and supportive care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.

Cancer care is often expensive, and navigating health insurance can be difficult. Ask your doctor or another member of your health care team about talking with a financial navigator or counselor who may be able to help with your financial concerns .

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative and supportive care in a separate section of this website.

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Metastatic penile cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Metastatic penile cancer is generally incurable, but there are treatments that may help shrink the cancer and relieve symptoms to make you more comfortable. Your treatment plan may include a combination of surgery, radiation therapy, and chemotherapy. Chemotherapy for penile cancer that has spread to other parts of the body is used to shrink the cancer and prevent it from growing or spreading for as long as possible. Palliative and supportive care is also important to help relieve symptoms and side effects.

For many people, a diagnosis of metastatic cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, chaplains, or other members of your health care team. It may also be helpful to talk with other patients, such as through a support group or other peer support program.

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Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence .

If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place, called a local recurrence, nearby, called a regional recurrence, or in another place, called a distant recurrence. The risk of recurrence depends on several factors, including the type of penile cancer and how much the cancer has grown and spread.

If a recurrence happens, a new cycle of testing will begin to learn as much as possible about it. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the therapies described above such as surgery, radiation therapy, and chemotherapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat recurrent penile cancer. Whichever treatment plan you choose, palliative and supportive care will be important for relieving symptoms and side effects.

People with recurrent cancer sometimes experience emotions such as despair, disbelief, or fear. You are encouraged to talk with your health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence .

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If treatment does not work

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. It is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns so that they can provide care that is consistent with your wishes. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

Planning for your future care and putting your wishes in writing is important, especially at this stage of disease. Then, your health care team and loved ones will know what you want, even if you are unable to make these decisions. Learn more about putting your health care wishes in writing.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life by addressing both physical discomfort and emotional distress. You and your family are encouraged to talk with your doctor or a member of your palliative care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning .

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss .

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The next section in this guide is About Clinical Trials . It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about the scientific research being done to learn more about this type of cancer and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about penile cancer, ways to prevent it, how to best treat it, and how to provide the best care to those diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you.

• Immunotherapy. Immunotherapy uses the body's natural defenses to fight cancer by improving your immune system’s ability to attack cancer cells. Learn more about the basics of immunotherapy .

• Targeted therapy. Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells and limits the damage to healthy cells.

  Not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. As a result, doctors can better match each patient with the most effective treatment whenever possible. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments .

  For penile cancer, clinical trials are being done using drugs that block the epidermal growth factor receptor (EGFR). EGFR is a protein that helps cancer cells grow and multiply. Researchers have found that drugs that block EGFR may be effective for stopping or slowing the growth of penile cancer.

• Radiation therapy. Researchers are working to find the best way to use radiation therapy for penile cancer. This could include a combination of therapies, including radiation therapy and chemotherapy, in an effort to avoid surgery to remove the penis. Improved techniques use computed tomography (CT) scans to plan treatment, which may help find the dose that best treats the cancer while causing fewer side effects.

• Radiosensitizers. In addition, researchers are looking at the use of radiosensitizers in the treatment of penile cancer. Radiosensitizers are drugs that make tumor cells more sensitive to radiation therapy, which makes radiation therapy more effective.

• Combination therapy. Researchers are studying whether the combination of chemotherapy and radiation therapy better reduces the risk of recurrence and/or increases survival than standard treatments.

• Minimally invasive surgery. Minimally invasive surgery uses small incisions and a camera placed under the skin to perform a lymph node dissection to find out if the cancer has spread. Researchers are also studying endoscopic, or use of a thin, lighted flexible tube, and robotically assisted surgery to diagnose and remove penile cancer that may have spread to regional lymph nodes.

• Palliative and supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current penile cancer treatments to improve comfort and quality of life for patients.

Looking for More About the Latest Research?

If you would like more information about the latest areas of research in penile cancer, explore this related item that takes you outside of this guide:

• To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases .

• Get updates from Cancer.Net delivered right to your inbox. Subscribe to the Inside Cancer.Net email newsletter.

• Visit the website of Conquer Cancer, the ASCO Foundation , to find out how to help support cancer research. Please note that this link takes you to a different ASCO website.

The next section in this guide is Coping with Treatment . It offers some guidance on how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with cancer does not end when active treatment has finished. Your health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead.

For people recovering from penile cancer, follow-up care may include specific examinations of the penis and the lymph nodes in the groin. Depending on your personal risk of the cancer recurring, you may need occasional chest x-rays or computed tomography (CT) scans, as well as some blood tests.

ASCO recommends at least 5 years of follow-up care for people treated for penile cancer. During the first 2 years, patients should have a physical examination every 3 months. For some individuals, a self-examination may be recommended instead. An imaging scan, such as an ultrasound or CT scan, or a biopsy may also be recommended, based on your diagnosis and treatment plan and if anything is found during the physical exam. In years 3 to 5, follow-up care visits should happen every 6 months or once a year, depending on what the doctor recommends based on the extent of the surgery and lymph node involvement. Additional imaging scans or biopsies may be recommended. Regular self-examinations after 5 years are recommended. Let your doctor know if you find anything unusual during your self-exam.

Currently, there is no proven way to lower the chances of recurrence or another type of cancer in people with penile cancer, but it is wise to practice safe, protected sex and maintain proper hygiene (see Risk Factors and Prevention ) after treatment for penile cancer.

Cancer rehabilitation may be recommended, and this could mean any of a wide range of services, such as physical therapy, occupational therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent as possible. Learn more about cancer rehabilitation.

Learn more about the importance of follow-up care .

Watching for recurrence

One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer first diagnosed and the types of treatment given.

The anticipation before having a follow-up test or waiting for test results may add stress to you or a family member. This is sometimes called “scanxiety.” Learn more about how to cope with this type of stress .

Managing long-term and late side effects

Most people expect to have side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years after treatment has ended. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on your diagnosis, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. The American Society of Clinical Oncology (ASCO) offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their primary care doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, treatments received, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship . It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find some questions to ask your doctor or other members of the health care team, to help you better understand your diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Talking often with the health care team is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for a digital list and other interactive tools to manage your care. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask after getting a diagnosis

• What type of penile cancer do I have?

• What is the stage and grade of the cancer? What does this mean?

• Can you explain my pathology report (laboratory test results) to me?

Questions to ask about choosing a treatment and managing side effects

• What treatment options do I have?

• What types of research are being done for penile cancer in clinical trials? Do clinical trials offer additional treatment options for me?

• What treatment plan do you recommend? Why?

• Do I need treatment right away?

• What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

• What are the possible side effects of this treatment, both in the short term and the long term?

• Could I benefit from a second opinion? Why or why not?

• Who will be part of my health care team, and what does each member do?

• Who will be leading my overall treatment?

• How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

• Will this treatment change how I urinate?

• Could this treatment affect my sex life? If so, how and for how long?

• Could this treatment affect my ability to have children? If so, should I talk with a fertility specialist before cancer treatment begins?

• Should I see a psychologist, counselor, or other professional to help me deal with any fears and body image concerns?

• If I’m worried about managing the costs of cancer care, who can help me?

• What support services are available to me? To my family?

• If I have questions or problems, who should I call?

Questions to ask about having surgery

• What type of surgery will I have? Will lymph nodes be removed?

• Will the lymph nodes in my groin be removed? On 1 side or both?

• What are the goals of surgery? How likely are they to be achieved?

• What are the potential harms of surgery? How likely are they to occur?

• What other treatment options are there?

• How long will the operation take?

• How long will I be in the hospital?

• Can you describe what my recovery from surgery will be like?

• Who should I contact about any side effects I experience? And how soon?

• What are the possible long-term effects of having this surgery?

• When should I call your office or go to an emergency room?

Questions to ask about having radiation therapy

• What type of radiation therapy is recommended?

• What are the goals of this treatment?

• How likely is this therapy to be successful in achieving those goals?

• What are the potential harms of this treatment and how likely are they?

• What other treatment options are there?

• How long will I need to have radiation therapy?

• How long will each radiation therapy session take? How often?

• What side effects can I expect during treatment?

• Who should I contact about any side effects I experience? How soon?

• What are the possible long-term or late effects of having this treatment?

• What can be done to prevent or relieve the side effects?

• When should I call your office or go to an emergency room?

Questions to ask about having chemotherapy

• What type of cancer medication is recommended?

• What are the goals of this chemotherapy in my situation?

• How likely is this therapy to be successful in achieving those goals?

• What other treatment options are there?

• What are the potential harms of this treatment and how likely are they?

• How long will it take to give this treatment?

• Will I receive this treatment at a hospital or clinic? Or will I take it at home?

• What side effects can I expect during treatment?

• Who should I contact about any side effects I experience? And how soon?

• What are the possible long-term or late effects of having this treatment?

• What can be done to prevent or relieve the side effects?

• When should I call your office or go to an emergency room?

Questions to ask about planning follow-up care

• What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

• What long-term side effects or late effects are possible based on the cancer treatment I received?

• What follow-up tests will I need, and how often will those tests be needed?

• How do I get a treatment summary and survivorship care plan to keep in my personal records?

• When should I return to my primary care doctor for regular medical care?

• Who will be leading my follow-up care?

• What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources . It offers more resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.