HEALTH INSIGHTS

Penile Cancer: Stages

May 03, 2018

Penile Cancer: Stages

What does the stage of a cancer mean?

The stage of a cancer is how much and how far the cancer has spread in your body. Your healthcare provider uses exams and tests to find out the size of the cancer and where it is. He or she can also see if the cancer has grown into nearby areas, and if it has spread to other parts of your body. The stage of a cancer is one of the most important things to know when deciding how to treat the cancer.

The TNM system for penile cancer

The International Union Against Cancer and the American Joint Committee on Cancer have developed a standard system of describing how much a cancer has grown.This system is called the TNM system. Be sure to ask your healthcare provider to explain the stage of your cancer to you in a way you can understand.

The first step in staging is to find the value for each part of the TNM system. Here's what the letters stand for in the TNM system:

  • The T  tells how far the main tumor has grown.

  • The N  tells if the lymph nodes in the area of the original tumor have cancer in them.

  • The tells if the cancer has spread (metastasized) to other organs in the body.

Numbers or letters after T, N, and M give more details about each of these factors. There are also two other values that can be assigned:

  • X means the provider does not have enough information to tell the extent of the main tumor (TX), or if the lymph nodes have cancer cells in them (NX).

  • 0 means no sign of cancer, such as no sign of spread to the lymph nodes (N0).

The grade of the cancer can also effect the stage of penile cancer. Grade is a measure of how quickly the cancer is likely to grow and spread. It’s based on how the cancer cells look under the microscope. The cancer cells are graded on a scale from 1 to 3. Lower grade cancers look more like normal cells. They are likely to grow and spread slowly. Higher grade cancers tend to grow and spread more quickly.

What are the stage groupings of penile cancer?

Stage groupings are determined by combining the T, N, and M values from the TNM system. These groupings give an overall description of your cancer. A stage grouping can have a value of 0 or of a Roman numeral I through IV (1 through 4). The higher the number, the more advanced the cancer is. Letters and numbers can be used after the Roman numeral to give more details.

These are the stage groupings of penile cancer and what they mean:

Stage 0. The cancer is only on the surface of the skin. It has not grown into deeper layers of the skin or anywhere else. It is also known as carcinoma in situ.

Stage I. The cancer has grown into the tissue just below the surface of the skin, without growing into blood vessels, nerves, or lymph vessels. The cancer cells look a lot like normal cells under a microscope (low grade). 

Stage II. The cancer has not spread to nearby lymph nodes or to organs in other parts of the body. It's divided into two sub-groups:

  • Stage IIA is either of these:

    • The cancer has grown into the tissue just below the surface of the skin. It has also grown into nearby blood vessels, nerves, or lymph vessels, and/or the cells look more abnormal (high grade).

    • The cancer has grown deeper into the penis to the corpus spongiosum. This is a chamber that runs along the bottom to the head of the penis and wraps around the urethra (the tube that carries urine and semen out of the penis). 

  • Stage IIB. The cancer has grown deeper into the penis to one of the two corpus cavernosa. These two chambers run along both sides of the upper part of the penis. Blood vessels inside these chambers fill with blood to get an erection. 

Stage III. The cancer has not spread to organs in other parts of the body. It's divided into two sub-groups:

  • Stage IIIA. The cancer has grown deeper into the penis, maybe to the corpus cavernosum and/or the corpus spongiosum. It has also spread to one or two nearby lymph nodes in the groin on the same side of the body as the tumor.

  • Stage IIIB. The cancer has grown deeper into the penis, maybe to the corpus cavernosum and/or the corpus spongiosum. It has also spread to three or more nearby lymph nodes in the groin on the same side of the body as the tumor, or to groin lymph nodes on both sides of the body.

Stage IV. This stage can be any of the following: 

  • The cancer has spread into nearby tissues, like the prostate gland, scrotum, or pubic bone. It may or may not have spread to nearby lymph nodes. It has not spread to organs in other parts of the body.

  • The cancer may or may not have spread into deeper layers of the penis or nearby tissues. It has spread to nearby lymph nodes in the pelvis, or it has grown through the outside of a lymph node and into nearby tissue. It has not spread to organs in other parts of the body.

  • The cancer may or may not have spread into deeper layers of the penis, nearby tissues, or lymph nodes. It has spread to organs in other parts of the body like the liver or lungs.

Talking with your healthcare provider

Healthcare providers consider the grade, stage, and your health when recommending a treatment plan. They also look at your feelings and preferences. Staging information helps healthcare providers compare your own case with other men who have penile cancer. Based on studies done on groups of men in similar stages of the disease, a healthcare provider can make some predictions about how the cancer may behave and how different treatments may work.

Once your cancer is staged, talk with your healthcare provider about what the stage means for you.  Make sure to ask questions and talk about your concerns.

Updated:  

May 03, 2018

Sources:  

Cancer of the penis TNM staging AJCC UICC 2017. UpToDate., Clinical presentation, diagnosis, and staging. UpToDate.

Reviewed By:  

Cunningham, Louise, RN,Stump-Sutliff, Kim, RN, MSN, AOCNS