Types of surgery for penile cancer
This page tells you about the different operations you might have for cancer of the penis. You can find out about
- A quick guide to what's on this page
- Deciding which operation you might have
- Laser surgery
- Glans resurfacing
Types of surgery for penile cancer
The operation you have depends on where the cancer is, the type and size of the cancer, and whether it has spread. Your doctor will talk to you about the best type of surgery for your cancer.
- Laser surgery treats carcinoma in situ and the surgeon uses a powerful beam of light that acts like a knife to remove the cancer cells.
- Circumcision is the removal of the foreskin. If the cancer only affects the foreskin, this might be the only treatment that you need.
- Glans resurfacing removes the top layers of tissue from the glans of the penis. The area is then covered with a skin graft. It treats carcinoma in situ (CIS) and small cancers that are low grade in the top layers of the skin.
- Cryotherapy treats carcinoma in situ and uses liquid nitrogen to freeze and kill the cancer cells.
- Wide local excision is when the cancer is removed along with a border of healthy tissue around it.
- Removing the head of the penis (glansectomy). After this operation your surgeon uses a skin graft to reconstruct the head of your penis. It looks like a circumcised penis. You will be able to pass urine normally and most men are able to have sex afterwards.
- Removal of the penis (penectomy) is for large cancers and part, or all, of your penis is removed (partial or total penectomy). A total penectomy is only done if your cancer is deep into or at the base of the penis. It might be possible to reconstruct the penis afterwards.
- Removal of the lymph nodes – your surgeon might also remove lymph nodes from your groin and possibly your pelvis.
You can view and print the quick guides for all the pages in the treating penile cancer section.
The operation you have will depend on
- where the cancer is
- the type and size of the cancer
- whether the cancer has spread
Your doctor will talk to you about the best type of surgery for your cancer before your operation.
Remember that you have to give your consent before your doctor can operate. Ask your surgeon any questions you have about the operation before you sign the consent form.
This is the most common treatment. It is for carcinoma in situ.
The surgeon uses a powerful beam of light that acts like a knife. It cuts away the cancer cells but doesn't go too deep into the tissue. You have a general anaesthetic.
You can have a circumcision under a local or a general anaesthetic. After your operation your penis is slightly swollen and bruised for about a week. You will have stitches that usually dissolve after a week to 10 days. Keep the wound clean. Wash or clean it as your nurse advises. You might have some pain for a few days. A mild painkiller such as paracetamol can help.
Some men worry about their sex lives after a circumcision. There is no proof that men are less sensitive or have more difficulty getting an erection after a circumcision.
Glans resurfacing surgery removes the top layers of tissue from the tip (glans) of the penis. Your surgeon then covers the area with a skin graft.
This treatment is for
- carcinoma in situ (CIS)
- small cancers that are low grade in the top layers of the skin on the penis
Cryotherapy uses liquid nitrogen to freeze and kill the cancer cells. It treats carcinoma in situ.
Your doctor puts a probe on the area to freeze the cells. After cryotherapy your skin usually forms a blister. This might form a scab or crust. The scab usually fall off after a couple of weeks. Once the skin has healed it might be a different colour, usually leaving a paler scar.
You can have cryotherapy under a local anaesthetic. But it can sometimes take more than an hour. So you might have either a sedative or a general anaesthetic.
The surgeon removes the cancer along with a border of healthy tissue around it. Your surgeon might call this a clear margin of tissue. The border of healthy tissue lowers the risk of the cancer coming back. European guidelines suggest that the border is a few millimetres wide.
The tissue sample is sent to the lab where a pathologist looks at the cells under a microscope. This helps your doctor to find out more about the cancer. The pathologist also checks that the border of tissue around the tumour is free of cancer cells.
You have a general anaesthetic for a wide local excision and are in hospital overnight. You will have some pain after the surgery and your penis may be swollen for a week to 10 days.
The surgeon removes the glans (head) of the penis. They then do a skin graft to make a new head. You usually have the skin taken from your thigh. After this operation your penis will look like a circumcised penis. You will be able to pass urine normally. You will also be able to have sex after this operation.
If cancer has started to grow into the shaft of your penis, your surgeon will need to remove a bit more tissue. You still have a skin graft but your penis will be shorter. It is sometimes possible for surgeons to combine this type of surgery with a penis lengthening operation.
After a glansectomy operation you have a tube to drain the urine from your bladder (catheter) for about 5 days. And you need to stay in bed for 1 to 2 days. This gives the skin graft the best chance of healing well. You need to try not to rub or brush against the skin graft on your penis for the first couple of weeks.
Your nurse takes out your stitches around 5 days after your operation. You will also have a wound on your thigh where the surgeon removed the skin. It takes at least a couple of weeks for the area on your thigh to heal.
If your cancer is large you might need to have either part or all of your penis removed (partial or total penectomy). A total penectomy is only done if the cancer cells go deeply into the penis or if the cancer is at the base of the penis.
Doctors usually do a glansectomy these days rather than a partial penectomy.
Removing part of the penis
If you need a partial penectomy, your surgeon will remove the end of the penis. They try to leave enough of the shaft of your penis behind to allow you to pass urine standing up. The flow of urine will be away from your body.
Removing the whole penis
If you need a total penectomy your surgeon removes the shaft and root of your penis. The root is the part which is inside your body. During the operation the surgeon forms a hole between your anus and your scrotum. You will be able to pass urine through this. You will still have control over passing urine because the muscle that closes the bladder is further inside your body.
A penectomy is a big operation and you will need to stay in hospital for at least a week or more.
Read about having your operation.
It might be possible to make a new penis (reconstruction) after a penectomy, using tissue from elsewhere in the body. This operation is not common.
There are different ways to do the reconstruction.
- The surgeon can take skin and muscle from your arm to rebuild the penis.
- The surgeon can form a flap of skin from your scrotal sac and attach this to the stump of your penis. It stays in place for 4 to 6 weeks. In a second operation the surgeon cuts the end attached to the scrotum sac. They then reconnect the nerves if possible so you can have some feeling in your penis.
A reconstruction operation means there is a chance of having a penis that looks satisfactory. You can also pass urine normally. Having sex with a partner has been possible for some men after this surgery.
Whichever reconstructive surgery you have, it involves a specialised operation by a plastic surgeon. It is important to talk to your surgeon before the operation. Then you can be clear about what the surgery will be able to achieve. You'll also know what your chances are of getting an erection afterwards.
Your surgeon might also remove lymph nodes from your groin. As part of your tests to diagnose penile cancer your doctor will check your lymph nodes. If the nodes are swollen (enlarged) you have a fine needle aspiration. If this shows cancer cells your surgeon will remove your lymph nodes. This is called a lymph node dissection.
The fine needle aspiration might show no cancer cells even if your lymph nodes are larger than normal. In this case you might have the swollen node taken out and tested. If the surgeon finds cancer cells, you have the rest of your nodes removed.
Having lymph node surgery
You usually have surgery to remove the lymph nodes at the same time as surgery to your penis. The surgeon makes a cut (incision) into your groin to take the affected lymph nodes out.
You’ll be in hospital for a few days and have a wound about 10cm long. You also have a drain near to your wound to drain fluid that can build up around your operation site.
Find out more about having your operation.
Your surgeon might need to remove the lymph nodes in your pelvis as well if the groin lymph nodes contain cancer cells. You usually have this as a second operation.
The surgeon might make a cut in the lower part of your tummy (abdomen) to remove the lymph nodes. Or you might have keyhole (laparoscopic) surgery.
For laparoscopic surgery, the surgeon makes several small cuts in the abdomen. They put a bendy narrow tube called a laparoscope through the openings. The laparoscope has a small light and a camera fixed on its end. So the surgeon can see what they are doing on a television screen. The surgeon controls small instruments that fit down the tube.
Generally, men have less pain after laparoscopic surgery. You might also recover more quickly than after open surgery.
Doctors have been looking at new ways of checking lymph nodes to see if they contain cancer cells. The sentinel node is the first or nearest lymph node to the cancer. If the sentinel node doesn’t have any cancer cells, it is unlikely that the cancer has spread.
Find out more about sentinel node biopsy.
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