The first 60 days: Localised penile cancer (organ-confined, node-negative)
Localised penile cancer is squamous cell cancer confined to the penis with no spread to the groin lymph nodes, and the aim of treatment is to remove the tumour while keeping as much of the penis as possible. Precancer and small tumours are treated with creams, laser or glans-sparing surgery, and the groin nodes are checked by sentinel node biopsy or surveillance rather than removed wholesale. Below, week by week, is what OnCo's record of Localised penile cancer (organ-confined, node-negative) says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- PathologistNamed in the standard of care for: Clinically negative groins.
- SurgeonNamed in the standard of care for: Penile intraepithelial neoplasia, T1 to T2 tumours, Clinically negative groins.
- Medical oncologistNamed in the standard of care for: Penile intraepithelial neoplasia, T1 to T2 tumours, Prevention.
- Clinical oncologist (radiotherapy)Named in the standard of care for: T1 to T2 tumours.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
HPV vaccination (now offered to boys in many countries and being tested in Chinese men) and treatment of phimosis and lichen sclerosus.
Circumcision if the foreskin is involved; topical fluorouracil or imiquimod, laser ablation or glans resurfacing; close follow-up because recurrence is common.
Organ-sparing surgery (wide local excision, glansectomy, partial penectomy) with narrow margins; brachytherapy for small distal tumours; total penectomy only for large or proximal disease.
Surveillance for low-risk tumours (Ta, T1 grade 1 without lymphovascular invasion); dynamic sentinel node biopsy for intermediate- and high-risk tumours, with inguinal lymphadenectomy if positive.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example p16 immunohistochemistry and HPV DNA, Grade and lymphovascular invasion of the primary, Depth and stageof the primary, Surgical margin status, Dynamic sentinel node biopsy result), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include Penile intraepithelial neoplasia, HPV-associated penile squamous cell carcinoma, HPV-independent penile squamous cell carcinoma.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
Penile intraepithelial neoplasia
- For my situation (penile intraepithelial neoplasia), which of the standard options do you recommend and why?Guideline options include: Circumcision if the foreskin is involved; topical fluorouracil or imiquimod, laser ablation or glans resurfacing; close follow-up because recurrence is common.
- Am I a candidate for Fluorouracil (5-FU), and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
T1 to T2 tumours
- For my situation (t1 to t2 tumours), which of the standard options do you recommend and why?Guideline options include: Organ-sparing surgery (wide local excision, glansectomy, partial penectomy) with narrow margins; brachytherapy for small distal tumours; total penectomy only for large or proximal disease.
Clinically negative groins
- For my situation (clinically negative groins), which of the standard options do you recommend and why?Guideline options include: Surveillance for low-risk tumours (Ta, T1 grade 1 without lymphovascular invasion); dynamic sentinel node biopsy for intermediate- and high-risk tumours, with inguinal lymphadenectomy if positive.
Prevention
- For my situation (prevention), which of the standard options do you recommend and why?Guideline options include: HPV vaccination (now offered to boys in many countries and being tested in Chinese men) and treatment of phimosis and lichen sclerosus.
- Am I a candidate for Nonavalent HPV vaccine, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of A Phase III Study to Evaluate the Efficacy, Immunogenicity and Safety of the 9-valent HPV Vaccine in Chinese Males apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Any stage
- Are there clinical trials I could join, for example of HPV & HBV vaccination, A Phase III Study to Evaluate the Efficacy, Immunogenicity and Safety of the 9-valent HPV Vaccine in Chinese Males?Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
- I read that “Local recurrence after organ-sparing surgery is common and needs long follow-up”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “Sentinel node biopsy misses some metastases, and the false-negative rate depends on centre experience”. How does that affect my plan?Open problems are where trials and second opinions matter most.
Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Localised penile cancer (organ-confined, node-negative): the full pageLocalised penile cancer is squamous cell cancer confined to the penis with no spread to the groin lymph nodes, and the aim of treatment is to remove the tumour while keeping as much of the penis as possible. Precancer and small tumours are treated with creams, laser or glans-sparing surgery, and the groin nodes are checked by sentinel node biopsy or surveillance rather than removed wholesale.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- Mohs surgery: Skin cancer surgery in which the tumour is removed in thin layers, each checked under the microscope on the spot, until the edges are clear; it spares the most normal skin.
- HPV status (HPV-positive / HPV-negative): Whether a cancer is caused by human papillomavirus.
- HPV-positive (p16) head and neck cancer: Throat cancers caused by the human papillomavirus, identified by a p16 stain.
- Lymphadenectomy (lymph node dissection): Surgically removing the lymph nodes that drain a tumour, both to stage the cancer and to clear any spread.
Every term links to the glossary.