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Treatment decisions

Find out about how your doctor decides which treatment you need, the types of treatment you might have and treatment by stage.

Deciding which treatment you need

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

The treatment you have depends on:

  • where your cancer is
  • how far it has grown or spread (the stage)
  • the type of cancer
  • how abnormal the cells look under a microscope (the grade)
  • your general health and level of fitness

Your doctor will discuss your treatment, its benefits and the possible side effects with you.

Treatment overview

The main treatments are:

  • surgery
  • radiotherapy
  • chemotherapy
  • chemoradiotherapy

You have one or more of these treatments depending on the stage of your cancer.

Treatment by stage

Stage 0 cancer, or carcinoma in situ

There are various treatments to treat penile CIS. These aim to keep the penis looking and working normally. 

Treatments you may have include:

  • chemotherapy creams such as fluorouracil (5FU) or a cream called imiquimod that uses the immune system to fight cancer
  • laser therapy
  • cryotherapy
  • glans resurfacing surgery where the top layers of tissue from the glans or tip of the penis and removed and then covered with a skin graft

Stage 1

Surgery is the main treatment for stage 1 penile cancer. You might have surgery alone or a combination of other treatments.

You might have removal of the foreskin (circumcision) Ii the cancer is only in the foreskin.

You might have the following treatments if your cancer is elsewhere on the penis :

  • removal of the cancer and a surrounding area of tissue (wide excision)
  • removal of part of the penis (partial penectomy)
  • radiotherapy to the penis
  • laser treatment

Stage 2

Surgery is the main treatment for stage 2 penile cancer. You usually have removal of part of the penis or removal of the whole penis.

You might also have radiotherapy. Some men have radiotherapy first and then surgery if some cancer cells remain afterwards. 

Your doctor might check the lymph nodes in your groin with a test called sentinel lymph node biopsy to see if cancer cells have spread there. Or your surgeon might remove the lymph glands. 

Stage 3

You usually have removal of part of the penis or removal of the whole penis.

Some men have chemotherapy or chemotherapy with radiotherapy before surgery.

You also have treatment for the lymph glands in the groin. You might have the glands removed with surgery (lymphadenectomy). Or you may have radiotherapy to the groin nodes. If you have surgery you might have radiotherapy afterwards. 

If the lymph nodes are very large you might have chemotherapy (with or without radiotherapy). 

Stage 4

Cancer in nearby tissues

You usually have surgery.

Some men have chemotherapy (sometimes with radiotherapy) before surgery to shrink the tumour. Your surgeon will remove the lymph nodes in your groin (inguinal nodes) on both sides.

Afterwards you might also have radiotherapy to that area, unless you had it before surgery.

Cancer beyond nearby lymph nodes or in pelvic lymph nodes

You usually have surgery to remove the whole penis and the lymph nodes in the groin on both sides. They might remove the lymph nodes inside the pelvis as well.

You might have radiotherapy to the lymph node areas. Some men also have chemotherapy.

Cancer in distant organs or tissues

Treatment aims to control the cancer and maintain a good quality of life.

You might have surgery to remove as much of the cancer in the penis as possible. Or you might have radiotherapy to shrink the cancer. 

You might have surgery or radiotherapy (sometimes with chemotherapy) to treat lymph nodes close to the penis.

Radiotherapy may also help to treat areas of cancer in other parts of the body, such as the bones, brain or spinal cord. Chemotherapy can help to treat cancer that has spread to the lungs or liver. 

If the cancer comes back (recurrent cancer)

Treatment depends on where the cancer comes back and which treatment you had before.

  • For cancers that come back in the penis, you might need further surgery to remove the cancer cells, which may be followed by radiotherapy.
  • For cancers that come back in the lymph nodes, you might have surgery to remove the nodes, radiotherapy or chemotherapy.
  • For cancers that come back in other parts of the body, you might have chemotherapy or radiotherapy.

Clinical trials to improve treatment

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to improve treatment by:

  • making existing treatments better
  • developing new treatments
Last reviewed: 
06 Apr 2016
  • Penile carcinoma: ESMO clinical practice guidelines

    H. Van Poppel, N. A. Watkin, S. Osanto, L. Moonen, A. Horwich, V. Kataja

    Annals of Oncology 2013; 24 (Suppl 6): vi115-vi124

  • American Joint Committee on Cancer (AJCC) manual (7th edition)

    S Edge and others

    Springer, 2010

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