How is Cancer of the Penis treated?

The treatment of penis cancer may involve surgery, radiotherapy and chemotherapy.

Conservative Surgery

Small, surface cancers that have not spread are treated by removing only the affected area. The cancer can be removed with conventional surgery, or using laser or by freezing (cryotherapy). If the cancer is affecting only the foreskin, it may be possible to treat it with circumcision alone. This is a simple operation and may be done under local anaesthetic without the need for a stay in hospital.

Wide Local Excision

Most cancers of the penis require at least a wide local excision, which involves removing the tumour and a safe margin of healthy penis. This is to reduce the risk of microscopic amounts of cancer being left behind. The operation is done under general anaesthetic and will involve a short stay in hospital.

Penectomy

If the cancer is too extensive to be removed by a wide local excision, a safe operation may involve removing the full thickness of the shaft of the penis. The operation may either leave a shortened penis (partial penectomy) or it may mean removing the whole penis (total penectomy), in which case some sort of reconstruction is offered.

Reconstructive Surgery

It is often possible to have a penis reconstructed after amputation. This requires a separate operation and there are a number of techniques, often using skin and muscle from your arm to make a new penis. It is also possible for surgeons to reconnect some of the nerves to provide sensation and the necessary blood flow to allow the reconstructed penis to become erect. Surgeons who do this type of surgery have specialist experience and you may need to travel to a specialist hospital to have the surgery done.

Radiotherapy

Radiotherapy involves directing radiation at the cancer to destroy it. This is often likened to the way we use X-rays to take scan. External beam radiotherapy, however, focuses the radiation to damage specific areas (the cancer) rather than taking pictures of it. External radiotherapy is normally given as a series of short daily treatments in the hospital. High-energy x-rays are directed from a machine at the area of the cancer. The number of treatments will depend on the type and size of the cancer but the whole course of treatment for early cancer will usually last up to six weeks.

Radiotherapy can be given using a radioactive implant. This is also known as brachytherapy. Small radioactive wires are carefully positioned in the affected area of the penis while the patient is under a general anaesthetic. The wires stay in place for 4-5 days and are then removed. This method of treatment is usually used for smaller cancers on the end of the penis (the glans). While the implant is in place you need to stay in an isolated room in the hospital so that other people are not exposed unnecessarily to the radiation.

Chemotherapy

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It can be one drug or several drugs used together. It is most commonly used to treat cancer that has spread beyond the penis itself and is given by injection. Chemotherapy cream may sometimes be used to treat very small, early cancers that are confined to the foreskin and end of the penis (glans).