Therapy is based on the stage of cancer, overall health, and a patient’s preferences. It's critical to know the stage of cancer, which ranges from early-stage disease to stage IV penile cancer, which means the cancer cells have already spread to distant sites in the body. The stage of disease impacts penile cancer survival rates.
Some patients' cases are discussed at Wilmot's multidisciplinary tumor board — a conference that is attended by all different specialties required for your care.
Four types of standard treatment are used for penile cancer: surgery, radiation, chemotherapy, and biologic therapy.
This is the most common treatment for penile cancer. Depending on the stage of cancer, several different types of surgery are possible. They include:
Circumcision: This procedure is used if the cancer is only on the foreskin.
Simple or local excision: The surgeon removed the tumor and some surrounding tissue. If a large amount of tissue must be removed a skin graft taken from another part of the body can be placed over the surgical area.
Mohs surgery: A surgeon uses the specialized Mohs technique, cutting out the tumor in thin layers and looking under a microscope after each layer is removed to check for cancer cells until none are seen. This process usually can save as much normal tissue as possible and creates better appearance and function after surgery. Wilmot urologists perform this type of surgery.
Cryosurgery: This procedure involves freezing off the abnormal tissue.
Laser surgery: This procedure involves using a laser beam as a knife to remove a surface lesion or other abnormal tissue.
Partial or total penectomy: A surgeon either amputates the penis or removes part of it. If total removal is required to treat the cancer, surgeons also create a new opening for urine in the perineum. For very advanced cancer, sometimes the scrotum and testicles also must be removed, which requires that the patient take testosterone supplements for the rest of their lives.
Surgery for penile cancer can be life-changing, affecting a man’s self-image and sexual function. Wilmot and the Department of Urology offer follow-up care for patients who’ve had surgery for this type of cancer.
Radiation therapy uses energy from radiation beams, radio isotopes, or charged particles to target tumors and to eradicate cancer cells. Sometimes a radiation source can be placed directly into or next to the penile tumor (called brachytherapy), which protects surrounding tissue from radiation. Radiation can be used to treat early-stage penile cancer or in addition to surgery when cancer has reached the lymph nodes.
Sometimes doctors prescribe drugs known as radio sensitizers that make the penile tumor more sensitive to radiation therapy.
Radiation therapy for penile cancer can include difficult side effects such as damage to the tissue or fistulas, which can impact an ability to have an erection or to control urine. In many cases, though, function gradually returns to normal.
Chemotherapy uses drugs or combinations of drugs — given intravenously or as pills — to destroy cancer cells. Topical chemotherapy (an anti-cancer ointment) can be used for very early-stage penile cancers.
Also known as immunotherapy, this approach uses a patient’s own immune system to fight the disease. One example of a biologic used for penile cancer is Imiquiod, a drug that comes in cream form that harnesses immune cells to destroy the cancerous lesion.
Many cancer treatments cause side effects such as hair loss or fatigue, but not everyone experiences side effects the same way.
The American Cancer Society also offers a free online class to help patients manage the side effects of their illness.
Wilmot's Cancer Control & Survivorship Program is one of the oldest and most highly regarded research programs in the country to investigate the management of side effects.