TNM Staging for penile cancer

The stage of a cancer tells you how big it is and whether 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.

Tumour (T)

Tumour (T) describes the size of the tumour.

There are several stages in tumour size in penile cancer.

TX means the tumour cannot 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 raised patches or sores (ulcers) and can vary in size. The condition can stay at this stage for several years. It is now usually called called penile intraepithelial neoplasia (PeIN).

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 and, 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 spongy erectile tissue of the body of the penis (corpora cavernosum). It 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.

Doctors might call penile intraepithelial neoplasia (PeIN) by other names, depending on where on the penis it is. PeIN of the head of the penis (glans) is called erythroplasia of Queyrat whilst PeIN 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.

Clinical staging means the doctor stages you after examining you and looking at test and scan results. Doctors might use clinical staging if you don’t have surgery straight away. You might see your clinical stage written as cTNM.

Pathological staging means the doctor stages you by using the tissue the surgeon removes during an operation. This includes if you have an operation to see if the cancer has spread to any lymph nodes. You might see your pathological stage written as pTNM.

We have included both clinical and pathological staging here. Talk to your doctor about which staging system they have used and why. They can help you understand more about your individual node stage.

Clinical staging

cNX means nearby lymph nodes cannot be assessed.

cN0 means there are no lymph nodes in the groin that look or feel bigger than normal.

cN1 means there is one lymph node in the groin that feels bigger than normal and moves around (is mobile).

cN2 means there are 2 or more lymph nodes that feel bigger than normal and move around (are mobile). These could be on the same, or the opposite, sides of the groin.

cN3 means one of the following:

• there is a lump in a lymph node in the groin which feels bigger than normal and does not move around
• swelling of one of more lymph nodes on one, or both, sides of the pelvis

Pathological staging

pNX means that doctors are unable to find out if cancer has spread to the lymph nodes.

pN0 means there are no lymph nodes containing cancer cells.

pN1 means there is cancer in 1 or 2 lymph nodes in the groin (inguinal).

pN2 means there is cancer in 3 or more lymph nodes in the groin (inguinal) or cancer in lymph nodes on both sides of the groin.

pN3 means one or both of the following:

• there is cancer in lymph nodes in one or both sides of the pelvis
• cancer in a nearby lymph node has 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 have spread to other parts of the body.

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.