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Penile cancer
Penile cancer is mostly squamous cell carcinoma; the primary tumour is treated with penile preservation whenever possible, and prognosis is set mainly by the inguinal lymph nodes — so even an impalpable groin gets invasive staging when the tumour invades beyond the superficial layers.
Why it matters in the exam
Risk factors: phimosis, HPV (mainly types 16 and 18), smoking, lichen sclerosus and PUVA treatment; childhood circumcision lowers the risk. The exam shows an older man with a cauliflower-like or ulcerated lesion on the glans or foreskin, and asks about node management or lymphatic drainage: the penis drains to the superficial inguinal nodes, then to the deep nodes and then to the pelvic nodes, and there is no direct "skip" to the pelvis.
Treatment of the primary tumour: superficial lesions (PeIN, Ta, T1) — preserving treatments such as laser, local excision, glansectomy or Mohs; a more invasive tumour — partial penectomy, and when length is insufficient — total penectomy with perineal urethrostomy. In an impalpable groin (cN0): with pTis, pTa or low-grade pT1a — surveillance; from pT1b upward (or high grade or lymphovascular invasion) — dynamic sentinel node biopsy (DSNB) or modified inguinal lymphadenectomy.
Palpable nodes (cN1 or cN2) are confirmed by fine-needle aspiration or biopsy, and radical inguinal lymphadenectomy is performed on the involved side; there is no waiting for weeks of antibiotics "to see whether the nodes shrink", as was once the custom. Pelvic dissection is done when there are 2 or more positive inguinal nodes or extranodal extension. Fixed or bulky nodes (cN3) — neoadjuvant chemotherapy (TIP) followed by surgery in patients who respond. Complications of groin dissection are common: infection, skin necrosis, lymphocele and leg lymphoedema.
Key points
- Mostly squamous cell carcinoma.
- Risk factors: phimosis, HPV, lichen sclerosus.
- The nodes determine prognosis.
- pT1b or above with cN0 — DSNB or modified dissection.
- Pelvic dissection with 2 or more positive nodes.
Summary table
| Situation | Treatment | Note |
|---|---|---|
| Superficial lesion (PeIN, Ta, T1) | Laser, local excision or glansectomy | Penile preservation |
| Invasive tumour | Partial or total penectomy | Perineal urethrostomy in total penectomy |
| cN0 with pTis, pTa or low-grade pT1a | Surveillance | Low nodal risk |
| cN0 with pT1b or above | DSNB or modified dissection | Invasive staging |
| cN1 or cN2 | Radical inguinal lymphadenectomy | Pelvis if 2 or more nodes |
| cN3 | TIP chemotherapy followed by surgery | In patients who respond |
In the full version for subscribers
- A simple algorithm
- Memory aid
- Exam traps
- 5 review cards
- Enough for IMLE
The full version is open to subscribers of: Urology, Medical licensing exam (IMLE), Oncology.
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Sources
- EAU-ASCO Collaborative Guidelines on Penile Cancer, 2025 edition — Diagnosis, management of the primary tumour and lymph nodes
- NCCN Clinical Practice Guidelines in Oncology: Penile Cancer, 2025 — Primary and inguinal node management
- Campbell-Walsh-Wein Urology, 12th edition (2020) — Tumors of the Penis
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.