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Penile cancer

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Stages of penile cancer

Staging is a way of describing or classifying a cancer based on the extent of cancer in the body. The most common staging system for penile cancer is the TNM system. The International Union Against Cancer (UICC) uses the TNM system to describe the extent of many solid tumour cancers.

TNM

TNM stands for tumour, nodes, metastasis. TNM staging describes:

  • the size and extent of the primary tumour
  • the number and location of any regional lymph nodes that have cancer cells in them
  • whether the cancer has spread or metastasized to another part of the body

Primary tumour (T)

TX

Primary tumour cannot be assessed

T0

No evidence of primary tumour

Tis

Carcinoma in situCarcinoma in situA very early stage of cancer in which tumour cells have not yet invaded surrounding tissues.

Ta

Non-invasive (the tumour is localized and has not spread) verrucous carcinoma

T1

Tumour invades the connective tissue under the skin (subepithelial). T1 is further divided:

T1a –Tumour invades subepithelial connective tissue, but has not spread to the lymph vessels or blood vessels (lymphovascular invasion). The cancer cells are well differentiated or moderately differentiated.

T1b – Tumour invades subepithelial connective tissue and has spread to the lymphatic channels or blood vessels.

or

The cancer cells are poorly differentiated or undifferentiated.

T2

Tumour invades the erectile tissue (corpus spongiosum or cavernosum).

T3

Tumour invades the urethra.

T4

Tumour invades other nearby structures.

Regional lymph nodes (N)

NX

Regional lymph nodes cannot be assessed

N0

Lymph nodes in the groin (inguinal) are not enlarged (cannot be felt or seen on imaging).

N1

One inguinal lymph node on one side of the body (unilateral) is enlarged (can be felt and moved).

N2

At least 2 inguinal lymph nodes are enlarged (can be felt and moved).

N3

There is a fixed (non-moveable) inguinal nodal mass or enlarged pelvic lymph nodes on one or both sides of the body.

Distant metastasis (M)

M0

No distant metastasis

M1

Distant metastasis

Pathological staging

In addition to the TNM staging of penile cancer, doctors will also determine the pathological stage. The clinical stage is assigned based on the results of diagnostic tests. The pathological stage (pTNM) is based on examination of the tumour and other tissue after surgical removal. The pTNM is linked to the TNM categories.

  • The clinical stage is used in making treatment decisions.
  • The pathological stage, which is given after surgery, is a more accurate way to determine prognosis.

Pathological stage of regional lymph nodes

pNX

Regional lymph nodes cannot be assessed

pN0

No regional lymph node spread (metastasis).

pN1

Metastasis in a single inguinal lymph node.

pN2

Metastasis in at least 2 inguinal lymph nodes.

pN3

Metastasis in one or more pelvic lymph nodes or the cancer has extended outside of the inguinal lymph nodes to the surrounding area.

Stage grouping for penile cancer

The UICC further groups the TNM data into the stages listed in the table below.

UICC staging – penile cancer
UICC stageTNMExplanation

stage 0

Tis

N0

M0

Carcinoma in situ – The cancer is found within the skin of the penis.

The cancer has not spread to lymph nodes or distant sites.

Ta

N0

M0

Non-invasive verrucous carcinoma

The cancer has not spread to lymph nodes or distant sites.

stage I

T1a

N0

M0

Cancer has spread to the connective tissue just below the skin of the penis, but has not invaded the blood vessels or lymph vessels (lymphovascular invasion). The tumour cells are well differentiated or moderately differentiated.

The cancer has not spread to lymph nodes or distant sites.

stage II

T1b

N0

M0

Cancer has spread to the connective tissue just below the skin of the penis and has invaded the blood vessels or lymph vessels, or the tumour cells are poorly differentiated or undifferentiated.

The cancer has not spread to lymph nodes or distant sites.

T2

N0

M0

Cancer has spread more deeply, to the erectile tissue of the penis (corpus spongiosum or cavernosum).

The cancer has not spread to the lymph nodes or distant sites.

T3

N0

M0

Cancer has grown into the urethra, but has not spread to lymph nodes or distant sites.

stage IIIA

T1-T3

N1

M0

Cancer has spread to the connective or erectile tissues of the penis, or to the urethra.

The cancer has also spread to one inguinal lymph node, but it has not spread to distant sites.

stage IIIB

T1-T3

N2

M0

Cancer has spread to the connective or erectile tissues of the penis, or to the urethra.

The cancer has also spread to at least 2 inguinal lymph nodes, but it has not spread to distant sites.

stage IV

T4

any N

M0

Cancer has spread to nearby tissues or organs.

It may or may not have spread to lymph nodes in the groin or pelvis.

The cancer has not spread to distant sites.

any T

N3

M0

Cancer can be anywhere in the penis, urethra or nearby structures. It has spread to pelvic lymph nodes or has grown outside of the inguinal lymph nodes into the surrounding tissue.

The cancer has not spread to distant sites.

any T

any N

M1

Cancer can be anywhere in the penis, urethra or nearby structures.

It may or may not have spread to lymph nodes in the groin or pelvis, but it has spread to distant sites.

Recurrent penile cancer

Recurrent penile cancer means that the cancer has come back after it has been treated. It may recur in the same location as the original cancer or it may recur in another part of the body (metastatic penile cancer).

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