Penile cancer is a rare malignancy that originates in the tissues of the penis, usually starting in the skin or mucosal surfaces. Most cases are classified as squamous cell carcinoma, developing from the flat cells lining the organ’s surface. Early detection is crucial for successful outcomes and preserving quality of life, as delayed treatment can have severe consequences. The diagnostic process involves a structured sequence of steps to detect cancerous cells and determine the extent of their spread before treatment begins.
Initial Medical Examination
The diagnostic journey begins with a thorough consultation and physical examination by a healthcare provider, such as a urologist or dermatologist. The doctor will first take a detailed medical history, asking about symptoms, their duration, and any potential risk factors, including Human Papillomavirus (HPV) status, smoking habits, and personal hygiene practices. This initial discussion helps the clinician understand the context of the presenting symptoms.
Following the history, a non-invasive physical inspection of the genital area is performed to look for any visible abnormalities. The doctor carefully inspects the penis, including the glans and foreskin, for signs such as persistent lumps, ulcers, discoloration, or thickened patches of skin. Many early changes can be subtle or mistaken for less serious conditions, which is why a focused examination is essential.
The examination includes palpation, where the doctor gently feels the area for hard or irregular masses on the penis. The regional lymph nodes in the groin area are also checked for swelling or firmness. Swollen nodes may signal that the cancer has begun to spread to the lymphatic system.
The Definitive Diagnostic Step
If the initial examination reveals a suspicious area, the only way to definitively confirm the presence of cancer is by performing a biopsy. This procedure involves removing a small sample of the abnormal tissue, which is then sent to a pathologist for microscopic analysis. The procedure is typically performed in an outpatient setting using a local anesthetic to numb the area, minimizing discomfort for the patient.
Several biopsy techniques may be utilized, depending on the size and location of the lesion. A punch biopsy uses a small, circular cutting instrument to take a core sample of the tissue. An incisional biopsy involves using a scalpel to remove a small portion of the abnormal growth. Excisional biopsies remove the entire lesion and are typically reserved for very small tumors.
Once the tissue is collected, the pathologist analyzes the cells to determine if cancer is present and its specific type. The pathologist also assigns a grade to the cancer, which describes how abnormal the cells look compared to normal cells. This grade indicates the tumor’s aggressiveness, as higher-grade cancers tend to grow and spread more quickly. The biopsy results form the foundation of the diagnosis, providing information necessary for treatment planning.
Determining the Extent of the Cancer
Once the cancer diagnosis is confirmed, additional tests are needed to determine the exact extent of the disease, a process known as staging. Imaging techniques help visualize how deeply the tumor has grown and whether it has spread outside the penis. Magnetic Resonance Imaging (MRI) is frequently used to assess the primary tumor, providing detailed images of soft tissues and showing the depth of invasion.
Computed Tomography (CT) scans of the chest, abdomen, and pelvis are routinely employed to check for spread to distant organs or lymph nodes. A Positron Emission Tomography (PET) scan, often combined with a CT scan, may also be used. The PET scan involves injecting a radioactive sugar tracer that highlights areas of increased metabolic activity, which is characteristic of cancer cells. These scans are helpful in evaluating the extent of spread, especially to the lymph nodes.
The sentinel lymph node biopsy (SLNB) is a procedure used for staging, especially when there is no palpable groin swelling. This technique involves injecting a tracer substance near the tumor that travels to the “sentinel” node—the first lymph node where cancer cells would likely spread. This node is surgically removed and checked for cancer cells. This helps the care team determine if a full lymph node removal surgery is necessary, potentially avoiding unnecessary procedures.