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TNM Staging

The stage of a cancer tells you how big it is and how far it has spread. It helps your doctor decide which treatment you need.

As well as stage, treatment also depends on your type of cancer, where the cancer is on your penis, and other health conditions you may have.

Your tests and scans will give some information about the stage of your cancer, but sometimes your doctor may not be able to tell you the exact stage until you have surgery.

The TNM staging system is the most common way that doctors stage penile cancer. TNM stands for Tumour, Node, Metastasis.

Doctors may also use a number staging system.

Tumour (T)

Tumour (T) describes the size of the tumour.

There are several stages in tumour size in penile cancer.

TX means the tumour can't be assessed

T0 means there is no evidence of a tumour

Tis or carcinoma in situ (CIS) describes the earliest stage of penile cancer and cancer cells are only in the top layers of the skin. The areas look like small lumps (nodules) or sores (ulcers) and can vary in size. The condition can stay at this stage for several years.

Ta means the cancer is wart-like or verrucous in the top layers of the skin

T1 means the tumour has grown into the tissue below the top layers of skin. It’s divided into T1a and T1b:

  • T1a means it has not grown into the blood or lymph vessels, or nerves, and is not Grade 3
  • T1b means it has grown into the blood and lymph vessels, or nerves, OR is Grade 3

T2 means the tumour has grown into the spongy erectile tissue of the penis (corpus spongiosum) and may or may not have spread to the urethra.

T3 means the tumour has grown into the corpora cavernosum, and may or may not have spread to the urethra.

T4 means the tumour has grown into nearby body parts such as the prostate gland, scrotum or pubic bone.

Your doctor might call carcinoma in situ (CIS) of the penis by other names, depending on where on the penis it is. CIS of the head of the penis (glans) is called erythroplasia of Queyrat whilst CIS on the shaft of the penis (or the skin of other parts of the body) is known as Bowen’s disease.

Node (N)

Node (N) describes whether the cancer has spread to the lymph nodes.

There are several stages in node in penile cancer.

NX means nearby lymph nodes can't be assessed.

N0 means there are no lymph nodes containing cancer cells.

N1 means there are cancer cells in one lymph node in the groin (inguinal).

N2 means there are cancer cells in:

  • several lymph nodes on the same side of the groin (unilateral)
  • OR in lymph nodes on both sides of the groin (bilateral)

N3 means there are cancer cells in lymph node(s) in one or both sides of the pelvis OR the cancer cells in a nearby lymph node have grown into surrounding tissues.

Metastasis (M)

Metastasis (M) describes whether the cancer has spread to a different part of the body.

There are two stages of metastasis:

M0 means the cancer has not spread to other tissues or organs

M1 means the cancer cells has spread to other parts of the body, or to lymph nodes outside the pelvis

Treatment

The stage of your cancer helps your doctor to decide which treatment you need. Treatment also depends on:

  • your type of cancer (the type of cells the cancer started in)
  • where the cancer is 
  • other health conditions that you have

The stage of the cancer and these other factors can also give an idea of your outlook (prognosis).

Treatment may include:

  • surgery
  • other treatments like laser therapy, cryotherapy or chemotherapy creams
  • radiotherapy
  • chemotherapy
  • chemotherapy with radiotherapy(chemoradiotherapy)

You may also have treatment as part of a clinical trial.

Last reviewed: 
11 Dec 2018
  • American Joint Committee on Cancer (AJCC) manual (8th edition)

    S Edge and others

    Springer, 2018

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