The first 60 days: Penile cancer
Penile cancer is a squamous skin-type cancer, about half of it caused by HPV. Caught early it is usually cured with organ-sparing surgery that has replaced amputation, and HPV vaccination and circumcision prevent it; the hard cases are those with lymph-node spread, where cisplatin-based chemotherapy plus surgery and now immunotherapy are being tested in the InPACT trial. Below, week by week, is what OnCo's record of Penile cancer 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 node-negative, intermediate or high-risk primary, Node-positive.
- SurgeonNamed in the standard of care for: Primary tumour, Clinically node-negative, intermediate or high-risk primary, Node-positive.
- Medical oncologistNamed in the standard of care for: Primary tumour, Node-positive, Metastatic or recurrent.
- Clinical oncologist (radiotherapy)Named in the standard of care for: Primary tumour, Node-positive, Metastatic or recurrent.
- Palliative and supportive care teamNamed in the standard of care for: Metastatic or recurrent.
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.
Organ-sparing treatment where feasible (glansectomy, glans resurfacing, wide local excision, laser or brachytherapy); partial or total penectomy reserved for extensive tumours.
- 2.Clinically node-negative, intermediate or high-risk primaryEAU-ASCO 2023; NCCN Guidelines: Penile Cancer
Dynamic sentinel node biopsy (or modified inguinal lymphadenectomy where unavailable); observation only for low-risk primaries.
Radical inguinal lymphadenectomy; pelvic lymphadenectomy and adjuvant chemotherapy or chemoradiation for extensive disease; neoadjuvant TIP for bulky or fixed nodes (InPACT is testing the sequence).
Cisplatin-based chemotherapy (TIP); checkpoint inhibitors in trials or where approved for tumour-agnostic indications; palliative radiotherapy.
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 IHC / HPV DNA status, Grade and lymphovascular invasion of the primary, Inguinal and pelvic nodal stage, PD-L1 expression, TP53 and CDKN2A status), 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 HPV-associated squamous cell carcinoma, HPV-independent squamous cell carcinoma, Penile intraepithelial neoplasia.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
Primary tumour
- For my situation (primary tumour), which of the standard options do you recommend and why?Guideline options include: Organ-sparing treatment where feasible (glansectomy, glans resurfacing, wide local excision, laser or brachytherapy); partial or total penectomy reserved for extensive tumours.
Clinically node-negative, intermediate or high-risk primary
- For my situation (clinically node-negative, intermediate or high-risk primary), which of the standard options do you recommend and why?Guideline options include: Dynamic sentinel node biopsy (or modified inguinal lymphadenectomy where unavailable); observation only for low-risk primaries.
Node-positive
- For my situation (node-positive), which of the standard options do you recommend and why?Guideline options include: Radical inguinal lymphadenectomy; pelvic lymphadenectomy and adjuvant chemotherapy or chemoradiation for extensive disease; neoadjuvant TIP for bulky or fixed nodes (InPACT is testing the sequence).
- Am I a candidate for Paclitaxel / nab-paclitaxel, Cisplatin, Ifosfamide, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Metastatic or recurrent
- For my situation (metastatic or recurrent), which of the standard options do you recommend and why?Guideline options include: Cisplatin-based chemotherapy (TIP); checkpoint inhibitors in trials or where approved for tumour-agnostic indications; palliative radiotherapy.
- Am I a candidate for Cisplatin, Paclitaxel / nab-paclitaxel, Pembrolizumab or related drugs, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Any stage
- Are there clinical trials I could join, for example of Pembrolizumab, Cemiplimab, HPV & HBV vaccination?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 “Node-positive disease: the best sequence of chemotherapy, radiotherapy and surgery is unknown; InPACT is designed to answer it”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “No approved systemic therapy beyond cisplatin combinations; checkpoint inhibitor trials (often HPV-stratified) are recruiting”. 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.
- A Phase III Study to Evaluate the Efficacy, Immunogenicity and Safety of the 9-valent HPV Vaccine in Chinese MalesPhase 3 · active · NCT06465914A Randomized, Double-blinded, Multicenter and Placebo-controlled Phase III Study to Evaluate the Efficacy, Immunogenicity and Safety of the 9-valent HPV Recombinant Vaccine (Hansenula Polymorpha) in Chinese Males Aged 18-45 Years
- Phase Ib/II of TG4001 and Avelumab in HPV16 Positive R/M CancersPhase 1/2 · active · NCT03260023A Phase Ib/II Trial Evaluating the Combination of TG4001 and Avelumab in Patients With HPV-16 Positive Recurrent or Metastatic Malignancies.
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Penile cancer: the full pagePenile cancer is a squamous skin-type cancer, about half of it caused by HPV. Caught early it is usually cured with organ-sparing surgery that has replaced amputation, and HPV vaccination and circumcision prevent it; the hard cases are those with lymph-node spread, where cisplatin-based chemotherapy plus surgery and now immunotherapy are being tested in the InPACT trial.
- 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.
- Lymphadenectomy (lymph node dissection): Surgically removing the lymph nodes that drain a tumour, both to stage the cancer and to clear any spread.
- 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.
Every term links to the glossary.