Surgical Options

Many types of treatments and surgeries are used to treat penile cancer The goals as stated above, are to limit the amount of tissue taken to preserve sexual function and the ability to urinate while standing up, while controlling the cancer. The amount of surgery needed depends on the location of the tumor. For instance, if the lesion is on the foreskin, then a circumcision might be all that is needed. If it involves the very end of the penis, a local excision and reconstruction will remove the cancer and preserve almost all of the penis. In select cases, wide local removal might be needed, and a skin graft may be required. For smaller tumors, a technique such as Moh’s microsurgery might be indicated, where a thin layer of the skin that the tumor may have invaded is removed and assessed immediately microscopically. For more extensive tumors, a partial or complete penectomy is needed for control of the cancer. The surgeon will try to leave as much of the shaft as possible. If not enough of the penile shaft can be saved so that standing urination can be achieved, then a total penectomy will be done. A new opening for urine to drain from the perineum is created, named a urethrostomy, which is the area between the scrotum. Urination is still under your control as the sphincter muscle in the urethra is not touched, but you will have to sit to urinate.

For tumors that are stage II or higher, a groin dissection may be required to remove potentially affected lymph nodes, and this may be curative for microscopic disease spread. Some physicians perform a sentinel node biopsy, although this is rare, as the risk of inaccurate staging is high. Higher stage and grade cancers are more likely to have spread to the lymph nodes and full lymph node dissections are needed. In this procedure, an incision in the groin is made and the nodes are carefully removed. This is a serious surgery that may require some reconstruction using your own tissue. As more nodes are removed, the risk of complications increases, and can lead to problems with fluid drainage and cause abnormal swelling. Other side effects such as wound healing, infection and blood clots can occur as well. In sum, although serious, many penile cancer patients move through surgery successfully, and live normal lives after treatment.