Care at NUH

Services for Penile Cancer

Diagnostic Evaluation and Staging
Physical examination 
During the initial assessment, the urologist will conduct a physical examination, including a palpation of the penis, to assess the extent of local invasion. Penile cancer is usually a noticeable lesion on the penis, but it can sometimes be hidden under a phimosis. 

The examination will also include a palpation of both groins to assess the likelihood of lymph node involvement. In the progression of penile cancer, lymph noses in the groin are often the initial site of involvement before extending to the pelvic lymph nodes. 

The main diagnostic tool for  differentiating between benign and malignant penile lesions in a biopsy. This involves the removal of a small tissue sample for microscopic examination, a procedure that can be performed under local anaesthesia. 
Ultrasound or magnetic resonance imaging (MRI) can aid in determining the extent of invasion of the penile cancer. If enlarged lymph nodes are not palpated in the groins, an ultrasound of the groin region may be conducted to assess for abnormal nodes. If suspicious lymph nodes are detected, a computed tomography (CT) scan can may be arranged to evaluate disease extent, including potential spread to distant sites in the chest, abdomen or pelvis.  
Treatment Options
Treatment strategy depends on tumour size, invasion extent it has invaded, whether it has spread (metastasis), and the risk of recurrence. 

In general, patients with a low risk of recurrence are suitable for organ preservation treatment, whereas those with a high risk of recurrence will require penile resection. 

For advanced penile cancer, involving large tumours or lymph node involvements, a combination of chemotherapy, other modes of therapeutic modalities and  surgery is likely.  

Penile resection 
Invasive disease requires partial or total amputation of the penis, often including removal of groin lymph nodes in the same setting. 
Chemotherapy before and/or after surgery is often recommended if lymph nodes in the groin or pelvis are involved. 

Partial amputation 
A partial amputation may be suitable for invasive tumours located at the glans, where resection of the tumour will allow sufficient penile length for passing urine while standing. 

Total amputation 
It involves removing the glans and most or all of the underlying corporal bodies, usually for very large tumours extending down the shaft.  
The urethra may need to be rerouted to the perineum for voiding in a sitting position. 
All patients treated for penile cancer require close follow-up for at least five year due to the risk of local recurrence in the penis or groin, as well as distant metastasis. 

Those treated with topical creams or laser treatment may undergo follow-up, potentially including repeat biopsies.  
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