Surgery for penile cancer

Surgery is a medical procedure to examine, remove or repair tissue. Surgery, as a treatment for cancer, means removing the tumour or cancerous tissue from your body. This usually means cutting into the body, but surgery to remove cancer can also be done in different ways, such as by using extreme cold (cryosurgery) or lasers.

Surgery is usually used to treat penile cancer. The type of surgery you have depends mainly on the size of the tumour, the stage of the cancer, and whether the cancer has spread to the lymph nodes. When planning surgery, your healthcare team will also consider other factors, such as your age and overall health.

Surgery may be the only treatment you have or it may be used along with other cancer treatments. You may have surgery to:

• completely remove the tumour
• remove lymph nodes if the cancer has spread to them
• reduce pain or ease symptoms (called palliative surgery)

The following types of surgery are used to treat penile cancer.

A circumcision removes the foreskin of the penis. It’s often used to treat a very small tumour located only on the foreskin.

You may also need a circumcision:

• if the foreskin covers the abnormal area that needs a biopsy

• before having radiation therapy for penile cancer

A glans resurfacing removes the outer layer of the abnormal tissue on the head of the penis (glans). It may be used for penile intraepithelial neoplasia (PeIN) or for a low-grade penile tumour that is only in the top layers of the skin on the glans. Your surgeon will cover the area with a skin graft taken from another part of your body, such as your thigh, after the surgery.

A wide local excision removes the penile tumour with a small margin of normal tissue around it (called the surgical margin). Removing the margin helps lower the risk of the cancer coming back.

A wide local excision is mainly used to treat early-stage penile cancer that is only in the head of the penis. You may need a skin graft from another part of the body to cover the area if there isn’t enough surrounding skin left to close the wound.

Mohs surgery removes the tumour and surrounding tissue, layer by layer, until the tissue is completely clear of cancer cells. It’s done to save as much normal tissue as possible (called tissue sparing) to minimize shortening of the penis and preserve its function.

Mohs surgery may be used instead of a wide local excision to treat some types of early-stage penile cancer.

Mohs surgery is also called Mohs micrographic surgery.

Find out more about Mohs surgery.

Laser surgery uses a powerful, narrow beam of light (called a laser beam) to destroy cancer cells. Laser surgery is sometimes used to treat PeIN.

Find out more about laser surgery.

Cryosurgery destroys cancer cells by freezing them. Doctors apply an extremely cold liquid or gas to the tissues of the penis through a metal tube called a cryoprobe. The area is allowed to thaw and then is frozen again. The freeze-thaw cycle may need to be repeated a few times.

Cryosurgery is sometimes used to treat PeIN.

Find out more about cryosurgery.

A glansectomy removes the head of the penis. It’s used to treat penile cancer that is only on the head of the penis or foreskin. It may be offered when a glans resurfacing or wide local excision can’t be done.

You will usually have the head reconstructed using skin grafts taken from your thigh. In some cases, your surgeon might instead pull skin from the shaft of your penis to cover the tip.

You may need to have a catheter inserted during the surgery to help drain urine from the bladder while you heal. Your doctor will usually remove the catheter about a week later at a follow-up appointment.

You can usually urinate (pee) normally and have penetrative sex after a glansectomy. But you might notice some changes in sensation in your penis.

A partial penectomy removes the head of the penis and part of the shaft. It’s often used to treat penile cancer that has grown into one or both of the upper chambers of the shaft (the corpora cavernosa) or deeper tissues of the penis.

Your surgeon will try to leave enough of the shaft to allow you to pee standing up and to keep sexual function. Your penis may be reconstructed using skin grafts, depending on how much tissue is removed during surgery. After a partial penectomy, you can usually pee normally and have penetrative sex.

A total (radical) penectomy removes the entire penis. It’s used to treat:

• large penile tumours
• tumours that have grown deep into the shaft
• tumours near the root (base) of the penis

During a total penectomy, the surgeon removes the entire penis and stitches together the remaining skin near the root of the penis. They also create an opening between the anus and scrotum (called perineal urethrostomy) so you can urinate. You can still control urination because the muscle that keeps the bladder closed is further inside your body and isn’t affected by the surgery. But you'll need to urinate sitting down after a total penectomy.

You may be offered a reconstruction of the penis after a total penectomy if the cancer hasn’t spread to other parts of the body. This is a rare, major operation that isn’t suitable for everyone and can only be done at a few hospitals. Penile reconstruction is also called phalloplasty.

During a penile reconstruction, the surgeon uses skin grafts and thick pieces of tissue with its own blood supply (skin flaps) taken from other parts of your body to make the new penis. The skin from the forearm is most commonly used to reconstruct the penis. If the surgeon can reconnect the nerves and blood vessels, you may feel sensation or get erections with the reconstructed penis.

A penile reconstruction can take up to 10 hours to complete. Talk to your doctor to see if you can have this surgery.

Penile cancer can spread to the inguinal lymph nodes, which are in the groin. The groin is the area in the fold or depression where the thigh meets the belly (abdomen). Penile cancer can also spread to the lymph nodes in the pelvis. Lymph node surgery helps your doctor stage the cancer, plan treatment and determine a prognosis.

A dynamic sentinel lymph node biopsy (DSLNB) is done when the tumour is small and shows no clear signs of spreading to the lymph nodes on an ultrasound. Sentinel lymph nodes are the first lymph nodes in a chain or group of lymph nodes that cancer is most likely to spread to. A DSLNB removes a sentinel lymph node to see if it contains cancer cells.

Unlike a standard sentinel lymph node biopsy, a DSLNB uses an advanced imaging technique called single photon emission computed tomography (SPECT) combined with computed tomography (CT). This imaging technique helps doctors locate sentinel nodes more accurately and distinguish them from non-sentinel nodes more clearly.

An inguinal lymph node dissection (ILND) removes lymph nodes in the groin. This is done when cancer has spread to these lymph nodes. You may also need an ILND following a DSLNB if cancer is found in the sentinel nodes. An inguinal lymph node dissection is also called an inguinal lymphadenectomy.

A pelvic lymph node dissection (PLND) removes lymph nodes from the pelvis. It may be done during, or after, an ILND if cancer is found in 3 or more lymph nodes in the groin.

Find out more about a sentinel lymph node biopsy, inguinal lymph node dissection and pelvic lymph node dissection.

Side effects of surgery will depend mainly on the type of surgery and your overall health. Tell your healthcare team if you have side effects that you think are from surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Surgery for penile cancer may cause these side effects:

• pain and discomfort
• infection
• scarring
• wound separation
• bleeding
• lymphedema
• seroma
• blood clot
• hematoma
• narrowing of the urethra
• changes to how you urinate
• skin problems
• changes in the colour and texture of your penis
• sexual problems

Find out more about surgery and side effects of surgery. To make the decisions that are right for you, ask your healthcare team questions about surgery.