Penile cancer is a rare type of malignancy that begins in the skin or tissues of the penis. The diagnostic process involves several steps, starting with a physical assessment and leading to tissue analysis and detailed imaging. A structured evaluation is performed to determine the exact nature and extent of any suspicious changes, ensuring the diagnosis is accurate and the treatment plan is tailored to the individual’s condition.
Initial Clinical Evaluation
The diagnostic journey typically begins with a visit to a primary care physician or a specialist, such as a urologist. The doctor takes a comprehensive patient history, inquiring about the duration of symptoms, recent changes, and risk factors like human papillomavirus (HPV) infection.
A thorough physical examination follows. The physician visually inspects the penis and genital area for abnormal growths, sores, or skin changes. They also palpate the primary lesion to determine its size, texture, and how deeply it might have grown into the penile tissue.
Examination of the groin lymph nodes is also a crucial part of this initial assessment. Since penile cancer often spreads first to the groin, the doctor checks these areas for any enlargement or firmness. These findings guide the need for more definitive testing.
Definitive Biopsy Procedures
A biopsy is the only way to definitively confirm whether a suspicious area is cancerous. This procedure involves removing a small tissue sample for microscopic examination by a pathologist. The type of biopsy performed depends on the size and location of the lesion.
For small or superficial lesions, a punch biopsy uses a small, circular tool to remove a core of tissue. An excisional biopsy may remove the entire lesion if it is small enough, often performed under local anesthesia. This method serves as both a diagnostic test and a form of initial treatment.
If a lesion is large or appears to be growing deeply, an incisional biopsy takes only a representative piece of the abnormal tissue. The pathologist examines the cells to confirm malignancy and determine the cancer’s cell type and grade. The grade describes cell aggressiveness, which is a significant factor in determining the necessary treatment.
Determining the Extent of Disease
Once cancer is confirmed, further tests are needed to determine if the disease has spread beyond the primary tumor, a process known as staging. Imaging techniques evaluate the local extent of the disease and check for distant spread.
A Magnetic Resonance Imaging (MRI) scan of the penis assesses how deeply the tumor has invaded penile structures, such as the corpus spongiosum or corpus cavernosum. Computed Tomography (CT) scans of the abdomen and pelvis check for enlarged lymph nodes and potential spread to distant organs.
Positron Emission Tomography (PET) scans, sometimes combined with CT, identify areas of increased metabolic activity that may indicate cancer cells throughout the body.
To address the risk of microscopic spread, a Sentinel Lymph Node Biopsy (SLNB) is a common staging procedure for early-stage disease. This technique involves injecting a dye or radioactive tracer near the tumor, which travels to the “sentinel” node—the first lymph node receiving drainage. The surgeon removes only this specific node for pathological analysis. If the sentinel node is cancer-free, it is highly likely the cancer has not spread to other lymph nodes, often avoiding extensive lymph node removal.
Interpreting the Final Diagnosis
The final diagnosis synthesizes all information gathered from the physical exam, biopsy, and staging tests. The pathology report provides detailed information, including the tumor’s histologic type, depth of invasion, and tumor grade. These details are used to assign a stage to the cancer, which is the most important factor in treatment planning.
The internationally recognized tumor, node, metastasis (TNM) classification system defines the stage. The “T” describes the size and local spread of the primary tumor, the “N” indicates spread to nearby lymph nodes, and the “M” indicates metastasis to distant sites.
A multidisciplinary team, including urologists and oncologists, reviews all results to assign a final, comprehensive stage. This stage dictates the appropriate course of action, which may range from local, organ-sparing treatments to more extensive surgery or systemic therapies. Understanding the stage and grade provides the necessary context for the patient’s prognosis and treatment plan.