Further tests for penile cancer

You might have a CT scan of your abdomen and chest. This is a type of X-ray that takes pictures from different angles. The pictures are fed into a computer and form a detailed picture of the inside of your body. The doctor can use the scan to check whether the cancer has spread anywhere else in the body, including the lymph nodes. There is more about having a CT scan in the section about cancer tests.

You may have an MRI scan to take detailed pictures of the penis and your groins. MRI scans use radio waves and strong magnets (rather than X-rays) to provide a detailed picture of the inside of your body. MRI can be better at showing up the body's soft tissues than a CT scan. This detail of the area can help your doctor plan surgery. MRI also checks for signs of cancer spread to lymph nodes or elsewhere in your body. There is more about having an MRI scan in the section about cancer tests.

An ultrasound uses sound waves. Doctors usually use it to help them test lymph nodes using fine needle aspiration. The doctor finds the lymph nodes on the scan, using it to help guide the needle into one of the large lymph nodes and draws out fluid and cells for testing. There is more about having an ultrasound in the section about cancer tests.

Sentinel node biopsy is a test to find out if lymph nodes have any cancer cells inside them. It may be used for men who don’t have any obvious signs of lymph node spread, to try and avoid removing lymph nodes in the groin unnecessarily. There is information here about

• Why doctors use sentinel node biopsy (SNB)
• Having sentinel node biopsy

Why doctors use sentinel node biopsy (SNB)

Sentinel nodes are lymph nodes nearest to a cancer – the first place that cancer cells will reach if they spread. There may be one or more than one. If the sentinel node doesn’t contain any cancer cells, it is unlikely that the cancer has spread to any other lymph nodes, or to anywhere else in the body. By testing the sentinel node, surgeons may be able to do a lymph node dissection in fewer men. They will only need to do it if the sentinel node shows that there is definite spread of the cancer. So it can save on unnecessary surgery. But it is a relatively new technique that doctors are still investigating to make sure it is safe and reliable.

Having sentinel node biopsy

In sentinel node biopsy, your surgeon puts local anaesthetic cream on your penis. They then inject a small amount of radioactive material into the area around your cancer. The radioactive tracer drains away to the lymph glands with the fluid that circulates round body tissues. You then have a special scan done using a gamma camera to show up the radioactive material. This shows the lymphatic system and the sentinel nodes. These are marked on your skin.

You then have an operation to remove the sentinel nodes. The surgeon will inject blue dye around the tumour during the operation to show drainage to the sentinel nodes. You will have a 3 or 4cm wound in your groin where the surgeon removes the sentinel nodes. If the doctor finds cancer cells, you will have the rest of the lymph nodes in your groin removed. If no cancer cells are found, you won’t need any more lymph nodes removed.

It is important that surgeons have special training before they can do sentinel node biopsies. This means that this test isn't available everywhere.

X-rays use low doses of radiation to take pictures of different parts of your body. You may have a chest X-ray to check that the cancer has not spread to your lungs. You may also have an X-ray to check for spread to your bones.

A bone scan can show if there is any cancer spread to your bones. The test takes quite a while because you need to have an injection and then wait a couple of hours for it to circulate through your body. There is more about having a bone scan in the section about cancer tests.

A PET-CT scan is a combination of a PET scan and a CT scan. A PET-CT scan takes CT pictures of the structures of your body. At the same time, a mildly radioactive drug shows up areas of your body where the cells are more active than normal. The scanner combines both of these types of information. This allows your doctor to see any changes in the activity of cells and know exactly where the changes are happening. 

You may have a PET-CT scan to check whether there are any cancer cells in the lymph nodes close to the penis or elsewhere in your body. There is detailed information about PET-CT scans in the cancer tests section. PET-CT scans are not available in every hospital so you may need to travel to have one.

Your doctor will ask you to come back to the hospital when your test results have come through. This is bound to take a little time, even if only a week or so. You may feel very anxious during this time.

While you are waiting for results, it may help to talk to a close friend or relative about how you are feeling. If you would like to talk to someone outside your own friends and family, look on our page about organisations that support men with penile cancer. To find out about counselling, look in our section on counselling.