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Penile cancer

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Diagnosing penile cancer

Diagnosis is the process of finding the cause of a health problem. The process of diagnosis may seem long and frustrating, but it is important for the doctor to rule out other reasons for a health problem before making a cancer diagnosis. Diagnostic tests for penile cancer are usually done when:

  • the symptoms of penile cancer are present, such as a growth or sore on the penis
  • the doctor suspects penile cancer after talking with a man about his health and completing a physical examination

Many of the same tests used to initially diagnose cancer are used to determine the stage (how far the cancer has progressed). Your doctor may also order other tests to check your general health and to help plan your treatment. Tests may include the following.

Medical history and physical examination

The medical history is a record of present symptoms, risk factors and all the medical events and problems a person has had in the past.

In taking a medical history, the doctor will ask questions about:

  • a personal history of
    • human papillomavirus (HPV) infection and other sexually transmitted infections
    • phimosis (foreskin that does not fully pull back [retract])
    • poor genital hygiene
    • not being circumcised
    • weakened immune system
    • smoking
    • treatment for psoriasis
  • signs and symptoms that may suggest penile cancer

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

  • look at and feel any growths or sores on the penis and genital area
    • The doctor will look at the size, location and characteristics of any abnormal areas.
    • For men who are not circumcised, the doctor will pull back and check under the foreskin.
  • feel the lymph nodes in the groin
    • About half of all men with penile cancer have lymph nodes in the groin (inguinal lymph nodes) that can be felt (palpable).
    • Swelling of the lymph nodes in the groin may be due to infection, inflammation or cancer (metastases).

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Complete blood count

A complete blood count (CBC) measures the number and quality of white blood cells, red blood cells and platelets. A CBC is done to:

  • check for a reduction in healthy red blood cells (anemia)
    • Anemia may be present if there are symptoms of bleeding.

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Biopsy

During a biopsy, tissues or cells are removed from the body so they can be tested in a laboratory. The pathology report from the laboratory will confirm whether or not cancer cells are present in the sample. The biopsies that could be used for penile cancer are:

  • excisional biopsy
    • The surgeon removes the entire abnormal area.
    • If the abnormal area is small or confined to the foreskin, it can often be completely removed by an excisional biopsy.
      • Circumcision (removal of the foreskin) may be done if the abnormal area is on the foreskin.
  • incisional biopsy
    • An incisional biopsy removes only a small piece of tissue from the abnormal area.
    • An incisional biopsy may be done if the tumour on the penis is large, seems to be growing deeply into the tissue or is ulcerated (appears as an open sore on the skin).
  • fine needle aspiration (FNA)
    • FNA may be used to take a biopsy of a growth on the penis.
    • FNA may also be used on nearby enlarged lymph nodes to see if they contain cancer.

Lymph node biopsy

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

The doctor will examine the lymph nodes to check if they look or feel swollen.

  • If the lymph nodes are large and firm to the touch, the doctor may do a lymph node biopsy to find out if they contain cancer.
  • If the lymph nodes cannot be felt, the doctor may monitor the lymph nodes using ultrasound or may do a sentinel lymph node biopsy.

Fine needle aspiration (FNA) biopsy

Fine needle aspiration (FNA) biopsy may be used to remove some fluid from an enlarged lymph node to check for cancer cells. FNA is sometimes used instead of removing lymph nodes to see if they contain cancer. If the biopsy shows that there are cancer cells present, surgery may be done to remove all the lymph nodes in the area.

The doctor may use ultrasound or a computed tomography (CT) scan to guide the needle into the lymph node if it is too deep to be felt.

Sentinel lymph node biopsy

The sentinel node is the first lymph node or cluster of lymph nodes that receives fluid from the area around a tumour. Cancer cells will most likely spread to these lymph nodes first. Sentinel lymph node biopsy (SLNB) is the removal of the sentinel lymph node so it can be examined to see if contains cancer cells. There may be more than one sentinel lymph node, depending on the drainage route of the lymph vessels around the tumour.

  • If the results of the SLNB are negative (cancer cells are not present), it is unlikely that other lymph nodes are affected and no additional surgery is necessary.
  • If the results of the SLNB are positive (cancer cells are present), all of the lymph nodes in the area may be removed.

Surgical or excisional lymph node biopsy

Surgery may be done to remove an enlarged lymph node and check for cancer cells. An inguinal lymphadenectomy (groin lymph node dissection) removes lymph nodes in the groin and checks them for cancer.

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Blood chemistry tests

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are functioning and can also be used to detect abnormalities. They are used to diagnose penile cancer.

  • The serum calcium level may be higher than normal in advanced penile cancer.
    • High levels of serum calcium (hypercalcemia) may indicate damage to the bone. (Bone destruction causes calcium to leave the bone and enter the blood.)
  • Liver enzymes, such as alanine aminotransferase (ALT), aspartate transaminase (AST) and alkaline phosphatase, measure liver function.

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Computed tomography (CT) scan

A CT scan uses special x-ray equipment to make 3-dimensional and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures. It is used to:

  • see if the cancer has spread to surrounding lymph nodes, especially in men who are obese
  • guide a needle to help collect cells and tissues from lymph nodes during a fine needle aspiration biopsy
  • see if the cancer has spread to the liver, lungs or other organs

Sometimes a contrast mediumcontrast mediumA substance used in some diagnostic procedures to help parts of the body show up better on x-rays or other imaging tests. is used with a CT scan to help provide better detail. It is usually injected into a vein in the hand or arm.

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Magnetic resonance imaging (MRI)

MRI uses powerful magnetic forces and radio-frequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3-dimensional pictures. It is used to:

  • find out the extent of the penile cancer
    • Sometimes a drug is injected into the penis to make it erect during the test. The doctor can see the inside of the penis more clearly when it is erect.
  • see if the cancer has spread to the brain or spinal cord
  • see if the cancer has spread to nearby organs and tissues

Sometimes a contrast medium, such as gadolinium, is used with MRI to help provide better detail. It is usually injected into a vein in the hand or arm.

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Ultrasound

Ultrasound uses high-frequency sound waves to make images of structures in the body. It is used to:

  • find out the extent of the penile cancer
    • Sometimes a drug is injected into the penis to make it erect during the test. The doctor can see the inside of the penis more clearly when it is erect.
  • guide a needle to help collect cells and tissues from lymph nodes during a fine needle aspiration (FNA) biopsy

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X-ray

An x-ray uses small doses of radiation to make an image of the body’s structures on film. It is used to:

  • check if cancer has spread to the lungs (chest x-ray)
  • check if cancer has spread to the bones

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Bone scan

A bone scan uses bone-seeking radioactive materials (radiopharmaceuticals) and a computer to create a picture of the bones. It is used to see if penile cancer has spread (metastasized) to the bones.

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Positron emission tomography (PET) scan

A PET scan uses radioactive materials (radiopharmaceuticals) to detect changes in the metabolic activity of body tissues. A computer analyzes the radioactive patterns and makes 3-dimensional colour images of the area being scanned. PET scan may be combined with a CT scan (PET-CT) to see if cancer has spread to nearby lymph nodes.

PET scans are not available in all treatment centres.

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See a list of questions to ask your doctor about diagnostic tests.

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