Diagnosis of penile cancer

Diagnosis is the process of finding out the cause of a health problem. Diagnosing cancer often means first ruling out other health conditions that share similar symptoms with cancer. It can be a very worrying time for you and your loved ones. Sometimes this process is quick. Sometimes it can feel long and frustrating. But it’s important for doctors to get all the information they need before making a diagnosis of cancer.

Diagnosing penile cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and do a physical exam. Based on this information, your doctor may refer you to a specialist to confirm a diagnosis of penile cancer.

The following tests are usually used to rule out or diagnose penile cancer. Many of the tests that are used to diagnose cancer are also used to find out the stage (how far the cancer has spread). Your doctor may also order other tests to check your general health and to help plan your treatment.

Your health history is a record of your symptoms and risks and all the medical events and problems you’ve had in the past. Your doctor will ask questions about your history of:

• any symptoms that suggest penile cancer
• human papillomavirus (HPV) infection
• surgical removal of the foreskin (called circumcision)
• trouble pulling back (retracting) the foreskin
• inflammation of the penis
• human immunodeficiency virus (HIV) infections or other conditions that weaken your immune system
• smoking tobacco

Your doctor may also ask about a family history of:

• cancer
• other medical conditions

A physical exam allows your doctor to look for any signs of penile cancer. During a physical exam, your doctor may:

• look at and feel any growths or sores on the penis, nearby skin and the anus
• pull back and check under the foreskin if you’re not circumcised
• feel the lymph nodes in the groin to check if they are swollen or harder than normal

Find out more about physical exams.

A complete blood count (CBC) measures the number and quality of white blood cells, red blood cells and platelets. A CBC may be done to check your general health.

Find out more about a complete blood count (CBC).

Blood chemistry tests measure certain chemicals in the blood. They may be done to check how well certain organs are working and can help find problems.

Serum calcium is measured to check the calcium levels in the blood. High levels of serum calcium (called hypercalcemia) can occur in advanced penile cancer, especially when the cancer has spread to the bone.

Alanine aminotransferase (ALT), aspartate transaminase (AST) and alkaline phosphatase may be measured to check how well the liver is working.

Find out more about blood chemistry tests.

During a biopsy, the doctor removes a sample of abnormal tissue from the penis or nearby skin so it can be tested in a lab. A report from the pathologist will show whether or not cancer cells are found in the sample.

A punch biopsy removes a sample of all the layers of skin (epidermis, dermis and subcutaneous tissue) in an abnormal area.

An incisional biopsy removes only a small piece of tissue from the abnormal area. It may be used if the lesion or abnormal area is large, seems to be growing deeply into the tissue or appears as an open sore (ulcer) on the skin.

An excisional biopsy completely removes the abnormal area. It may be used if the lesion or abnormal area is small or only limited to the foreskin.

You may need to be circumcised if the abnormal area is under the foreskin.

Find out more about a punch biopsy and other types of biopsies.

A lymph node biopsy is a surgical procedure that removes lymph nodes so they can be examined under a microscope to find out if they contain cancer. The most common place for penile cancer to spread is to the lymph nodes in the groin that are closest to the penis.

A fine needle aspiration collects a sample of cells with a very thin needle. It may be done on a lymph node in the groin if it is enlarged and firm enough for the doctor to feel or see on an ultrasound.

A sentinel lymph node biopsy (SLNB) removes the sentinel lymph node. A sentinel lymph node is the first lymph node in a chain or group of lymph nodes that cancer is most likely to spread to.

A dynamic sentinel lymph node biopsy (DSLNB) is a specialized SLNB used for penile cancer. DSLNB uses advanced imaging technology and blue dye to help the doctor find sentinel lymph nodes more accurately than a regular SLNB.

Find out more about a fine needle aspiration (FNA) and sentinel lymph node biopsy.

A computed tomography (CT) scan uses special x-ray equipment to make 3D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures.

A CT scan of the pelvis is used to see if the cancer has spread to surrounding lymph nodes. It can also be used to see if the cancer has spread to the liver, the lungs or other organs.

Sometimes a contrast medium (contrast dye) is used with a CT scan to show organs and structures more clearly. It’s usually injected into a vein in the hand or arm. Tell the technologist or radiologist if you have any allergies or sensitivities to iodine or contrast dyes.

Find out more about CT scans.

A positron emission tomography (PET) scan uses radioactive materials called radiopharmaceuticals to look for changes in the metabolic activity of body tissues. A computer analyzes the radioactive patterns and makes 3D colour images of the area being scanned.

A PET scan is used to see if cancer has spread to nearby lymph nodes. It may be combined with a CT scan (called a PET-CT scan).

Find out more about PET scans.

Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3D pictures.

An MRI is used to find out the size of the tumour and where the cancer is in the body. It’s also used to see if cancer has spread to surrounding lymph nodes, nearby organs and tissues, or to the brain or spinal cord.

Sometimes the doctor will inject a drug into the penis to make it erect during the test. This helps the doctor see the inside of the penis more clearly. A contrast medium, such as gadolinium, may be used with an MRI to help provide better detail.

Find out more about MRIs.

An ultrasound uses high-frequency sound waves to make images of parts of the body. It may be used to find out how far the cancer has spread.

Sometimes the doctor will inject a drug into the penis to make it erect during the test.

Find out more about ultrasounds.

An x-ray uses small amounts of radiation to make an image of parts of the body on film. It’s used to check if cancer has spread to the lungs or the bones.

Find out more about x-rays.

A bone scan uses bone-seeking radioactive materials called radiopharmaceuticals and a computer to create a picture of the bones. It’s used to see if cancer has spread to the bones.

Find out more about bone scans.

Find out more about a diagnosis. To make the decisions that are right for you, ask your healthcare team questions about diagnosis.