Uro-oncology · KIMS Secunderabad
Penile Cancer — Early Diagnosis and Organ-Preserving Surgery
Penile cancer — predominantly squamous cell carcinoma (SCC) of the penile skin and mucosal surfaces — is a rare malignancy in most Western populations but carries a significantly higher incidence in South and Southeast Asia, sub-Saharan Africa, and parts of South America. In India, penile cancer accounts for approximately 1 to 2% of all male cancers — not uncommon in absolute numbers given India's population. The most important message about penile cancer is consistent with all surface cancers: it is highly curable when detected and treated at an early stage, and increasingly curable with organ-preserving techniques that avoid radical amputation.
The most significant risk factor for penile cancer is phimosis (tight, non-retractile foreskin) — the leading risk factor in India, where circumcision rates are lower than in some populations. The trapped smegma (a sebaceous secretion) under a non-retractile foreskin creates chronic inflammation and carcinogenic exposure to the penile skin. Human papillomavirus (HPV) — particularly HPV 16 and 18 — is the other major risk factor, responsible for approximately 40 to 50% of penile SCC cases.
Clinical features — what to look for
A lesion on the glans (head of the penis) or foreskin — the most common location. The lesion may appear as: a red, velvety plaque (erythroplasia of Queyrat — penile intraepithelial neoplasia, a pre-malignant condition), a white patch (leukoplakia), a raised wart-like growth, an ulcer with irregular edges, or a firm nodule.
Painless ulceration — the majority of penile cancers are painless in the early stages. Pain occurs in advanced or infected lesions.
Phimosis concealing a lesion — a patient with a tight foreskin that cannot be retracted may develop penile cancer hidden beneath the foreskin. Any man with phimosis who develops discharge, bleeding, or a change in sensation beneath the foreskin should have urgent urological assessment.
Inguinal lymph node enlargement — firm, enlarged inguinal lymph nodes in a man with a penile lesion suggest lymph node metastasis. Lymph node involvement is present in approximately 25 to 30% of patients at diagnosis and is the most important prognostic factor.
Haematuria — from tumour involvement of the urethral meatus in advanced disease.
Any persistent, non-healing lesion on the penis — lasting more than 4 weeks — requires urgent specialist assessment and biopsy. Do not assume it is a wart, infection, or benign inflammation without confirming this with a tissue biopsy. Delayed diagnosis is the most common reason for poor outcomes in penile cancer.
Diagnosis and staging at KIMS
Biopsy — the only definitive diagnostic test
A biopsy of the penile lesion confirms the histological diagnosis and grade. Punch biopsy of the lesion edge is performed in the outpatient clinic under local anaesthesia. For lesions under the foreskin: circumcision (dorsal slit) combined with biopsy. Histological grade correlates with lymph node metastasis risk — Grade 1 (well-differentiated) rarely metastasises; Grade 3 (poorly differentiated) has a high nodal metastasis rate.
MRI of the penis
The most sensitive investigation for determining the depth of penile tumour invasion — the most critical factor for surgical planning. MRI distinguishes lesions confined to the superficial skin (T1 — appropriate for penile-sparing surgery) from those invading the corpora cavernosa (T2 — may require partial or total penectomy) or urethra (T3).
CT of the abdomen, pelvis, and chest
Staging — identifies enlarged pelvic and paraaortic lymph nodes and distant metastases (lungs, liver). Inguinal lymph node assessment: clinically enlarged nodes may be reactive (from penile infection) or malignant — CT cannot reliably distinguish them; fine needle aspiration (FNAC) of enlarged inguinal nodes is performed.
Treatment — organ-preserving where possible
Penile-intraepithelial neoplasia (PeIN — pre-malignant)
Topical 5-fluorouracil cream, imiquimod cream, CO2 laser ablation, or excision for small lesions. Circumcision for lesions confined to the foreskin.
T1 and T2 tumours — organ-preserving surgical options
Wide local excision with clear margins — for small, localised lesions on the glans. Glansectomy (surgical removal of the glans) — for larger glans lesions, with penile reconstruction using a split-skin graft. These techniques preserve the penile shaft and urethral function while achieving clear oncological margins. At KIMS, penile-sparing surgery is the standard approach for T1 and T2 tumours where oncologically sound margins can be achieved.
Partial penectomy
For tumours involving the distal shaft — the distal penis is amputated with a clear surgical margin (typically 1 to 2cm), leaving sufficient residual shaft for upright urination and sexual function where possible.
Inguinal lymph node management
For clinically node-negative patients with high-risk primary tumour (Grade 2–3, T2 or above): dynamic sentinel node biopsy (DSNB) or modified inguinal lymph node dissection (MILND) to stage the inguinal nodes. For clinically node-positive patients: bilateral inguinal lymph node dissection (therapeutic ILND). Pelvic lymph node dissection for pelvic node involvement. Neoadjuvant or adjuvant chemotherapy (cisplatin-based) for bulky nodal disease.
Book a Penile Cancer Consultation at KIMS — Penile-Sparing Surgery Available. Call 040-4488-5000
Frequently Asked Questions — Penile Cancer
Penile cancer most commonly appears as a persistent, non-healing lesion on the glans (head of the penis) or foreskin — lasting more than 4 weeks. It may look like: a red velvety patch (erythroplasia of Queyrat — pre-malignant), a white thickened patch (leukoplakia), a raised verrucous (wart-like) growth, an irregular ulcer with rolled edges, or a firm lump. The lesion may be painless initially — which is a reason many men delay seeking help, assuming it is benign. Any lesion on the penis that does not resolve within 4 weeks must be biopsied. Self-diagnosis based on appearance is unreliable — condyloma (genital warts from HPV) and penile cancer can appear similar.
Yes — several risk factors are modifiable. Phimosis (tight non-retractile foreskin) is the strongest risk factor in India — circumcision eliminates this risk. However, circumcision is not recommended solely for penile cancer prevention in the general population; maintaining good penile hygiene (regular cleaning under the foreskin) achieves a similar risk reduction without surgery. HPV vaccination (quadrivalent or 9-valent HPV vaccine) significantly reduces the risk of HPV-related penile cancer — vaccination is recommended in adolescent males. Smoking cessation reduces the risk of penile SCC. Any suspicious penile lesion should be biopsied early — early-stage penile cancer is highly curable.
No — and modern penile cancer management has shifted dramatically toward organ-preserving surgery. Early-stage penile cancer (T1 — confined to the skin and superficial dermis) is typically managed with wide local excision, glansectomy with reconstruction, or laser ablation — preserving the penile shaft and urethral function. Partial penectomy (removing only the tumour-bearing distal shaft) is used for larger T2 tumours where penile-sparing excision would leave inadequate margins. Total penectomy — removal of the entire penis with perineal urethrostomy — is reserved for advanced tumours with extensive shaft involvement and is now infrequent at experienced centres with early-detection programmes. At KIMS, the goal is to offer the most conservative oncologically sound surgical approach.
Survival rates for penile cancer depend critically on the nodal status — the most important prognostic factor. For node-negative penile cancer (N0) at diagnosis: 5-year cancer-specific survival above 85 to 90%. For inguinal lymph node involvement (N1 — unilateral, single node): 5-year survival 70 to 80%. For bilateral inguinal node involvement or pelvic node involvement (N3): 5-year survival below 50%. The lesson: the difference between detecting a T1 node-negative penile cancer and a T3 node-positive cancer is the difference between a highly curable disease and a life-threatening one. Early biopsy of any persistent penile lesion is the single most important action.
KIMS Secunderabad — Dr. Neil Narendra Trivedi (MCh Urology KEM Mumbai, Member SIU), penile biopsy and histological grading, MRI penis for local staging, inguinal lymph node FNAC, penile-sparing excision and glansectomy with reconstruction, partial penectomy, inguinal and pelvic lymph node dissection, chemotherapy coordination. MDT tumour board review of every penile cancer case. NABH and NABL accredited. Call 040-4488-5000.