Penile Cancer: Stages

What does the stage of a cancer mean?

The stage of a cancer is how much cancer there is and how far it has spread in your body. Your healthcare provider uses exams and scans to find out how big the cancer is and where it is. These can show if the cancer has grown into nearby areas and if it has spread to other parts of your body. The stage of a cancer is one of the most important things to know when deciding how to treat the cancer.

The TNM system for penile cancer

The American Joint Committee on Cancer has developed a standard staging system that's most commonly used. It's called the TNM system. Ask your healthcare provider to explain the stage of your cancer to you in a way you can understand.

The first step in staging is to find the value for each part of the TNM system. Here's what the letters stand for in the TNM system:

• The T tells how far the main tumor has grown.

• The N tells if the lymph nodes near the tumor have cancer in them.

• The M tells if the cancer has spread ( metastasized) to other parts of the body.

Numbers and letters after T, N, and M can give more details about each of these factors. There are also two other values that can be assigned:

• X means the provider does not have enough information to tell the extent of the main tumor (TX), or if the lymph nodes have cancer cells in them (NX).

• 0 means no sign of cancer, such as no sign of spread to the lymph nodes (N0).

Grade

The grade of the cancer also affects the stage of penile cancer. Grade is a measure of how quickly the cancer is likely to grow and spread. It’s based on how abnormal the cancer cells look under the microscope compared to normal cells.

Penile cancer cells are graded on a scale from 1 to 3 (G1, G2, and G3). Lower-grade cancers look more like normal cells. They will likely grow and spread more slowly. G3 cancers look very different from normal, healthy cells. They tend to grow and spread more quickly. A higher-grade penile cancer is more likely to spread to lymph nodes or already have spread at the time of diagnosis.

GX means the grade is not known.

What are the stage groupings of penile cancer?

Stage groupings are determined by combining the T, N, and M values from the TNM system. These groupings give an overall description of the cancer. A stage grouping can have a value of 0 or numbers 1 through 4. The higher the number, the more advanced the cancer is. This means it's bigger and has spread farther. Additional letters and numbers can be used to give more details.

These are the stage groupings of penile squamous cell carcinoma, the most common kind of penile cancer, and what they mean:

Stage 0. The cancer is only on the surface of the skin. It has not grown into deeper layers of the skin or anywhere else. It's also known as carcinoma in situ.

Stage 1. The cancer has grown into the tissue just below the surface of the skin, but not into blood vessels, nerves, or lymph vessels. It hasn't spread to lymph nodes or distant parts of the body. The cancer cells look a lot like normal cells under a microscope (low grade, G1, or G2).

Stage 2. The cancer has not spread to nearby lymph nodes or to organs in other parts of the body. It's divided into two subgroups:

• Stage 2A is either of these:

  • The cancer has grown into the tissue just below the surface of the skin and into nearby blood vessels, nerves, or lymph vessels. Or the cells look more abnormal (high grade, G3).

  • The cancer has grown into the corpus spongiosum. This is a chamber that runs along the bottom to the head of the penis. It wraps around the tube that carries urine and semen out of the penis (the urethra).

• Stage 2B. The cancer has grown deeper into the penis to one of the two corpus cavernosa. These two chambers run along both sides of the upper part of the penis. Blood vessels inside these chambers fill with blood to get an erection.

Stage 3. The cancer has not spread to organs in other parts of the body, but it has spread to lymph nodes. It's divided into two subgroups:

• Stage 3A. The cancer has grown deeper into the penis, maybe to the corpus cavernosum or the corpus spongiosum. It has also spread to one or two nearby lymph nodes in the groin on the same side of the body.

• Stage 3B. The cancer has grown deeper into the penis, maybe to the corpus cavernosum or the corpus spongiosum. It has also spread to three or more nearby lymph nodes in the groin on the same side of the body, or to groin lymph nodes on both sides of the body.

Stage 4. This stage can be any of the following:

• The cancer has spread into nearby tissues, such as the prostate gland, scrotum, or pubic bone. It may or may not have spread to nearby lymph nodes. It has not spread to organs in other parts of the body.

• The cancer may or may not have spread into deeper layers of the penis or nearby tissues. It has spread to nearby lymph nodes in the pelvis, or it has grown through the outside of a lymph node and into nearby tissue. It has not spread to organs in other parts of the body.

• The cancer may or may not have spread into deeper layers of the penis, nearby tissues, or lymph nodes. It has spread to organs in other parts of the body such as the liver, bone, or lungs.

Talking with your healthcare provider

Healthcare providers consider the grade, stage, and your overall health when advising a treatment plan. They also look at your feelings and preferences.

Staging information helps healthcare providers compare your case with others who have penile cancer. Based on studies done on groups of people in similar stages of the disease, a healthcare provider can make some predictions about how the cancer may behave and how different treatments may work.

Once your cancer is staged, talk with your healthcare provider about what the stage means for you. Make sure to ask questions and talk about your concerns.