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Early Detection, Diagnosis, and Staging for Penile Cancer
Learn about the signs and symptoms of penile cancer, the tests that may be done for it, how it is staged, and the outlook for those with a diagnosis.
Can penile cancer be found early?
Screening is testing for diseases such as cancer in people without symptoms to try to find them early. There are no widely recommended screening tests for penile cancer, but many penile cancers can be found early, when they're small and before they have spread to other parts of the body.
Almost all penile cancers start in the skin, so they're often noticed early. In men who aren’t circumcised, cancers that start under the foreskin may not be seen as quickly, especially if a man has phimosis (constriction of the foreskin). Some penile cancers cause signs or symptoms that could also be caused by a disease other than cancer.
When to see a doctor
Even if a man sees or feels something abnormal, he may not recognize it as something that needs medical attention right away. You should see a doctor if you find a new redness, growth, or other change in your penis, even if it's not painful. Things like warts, blisters, sores, ulcers, white patches, or other abnormal areas need to be checked by a doctor. Most are not cancer, but they may be caused by an infection or some other condition that needs to be treated.
Some men avoid going to the doctor if they see an abnormal area on their penis. In fact, many put off seeking treatment for many months (or longer) after they first notice the problem. Don't let embarrassment or fear keep you from having an abnormal area checked. Most penile cancers are easy to treat in the early stages. If a cancer is found early, it can often be removed with little or no damage to the penis.
What are the signs and symptoms of penile cancer?
The first sign of penile cancer is most often a change in the skin of the penis. This is most likely to be on the glans (tip) of the penis or on the foreskin (in uncircumcised men), but it can also be on the shaft.
Swelling at the end of the penis, especially when the foreskin is constricted, is another possible sign of penile cancer.
These symptoms can be due to other causes, but checking with a doctor is important for your health.
Outlook for penile cancer
After a penile cancer diagnosis, many people want to understand what to expect. Survival rates are a way to measure how many people survive a certain type of cancer over time. Survival rates are often reported as 5-year survival rates, which refer to the percentage of people who live at least 5 years after their cancer diagnosis. Of course, many people live much longer than 5 years (and many are cured). Some people might find this information helpful, while others might prefer to focus more on treatment plans and next steps.
Tests for penile cancer
If you have possible signs or symptoms of penile cancer, have them checked by a doctor. The doctor will examine you, and you might also need some tests to find out what's going on.
If penile cancer is found, you might need other tests to help learn more about it to help guide your treatment.
Medical history and physical exam
The doctor will ask you about your medical history and the details of your symptoms, like when they started and if they've changed. They'll also ask about any possible risk factors you might have.
The doctor will also look at your genital area carefully for possible signs of penile cancer or other health problems. Penile lesions (sores) usually affect the skin on the penis, so a doctor often can find cancers and other problems by looking closely at the penis. The doctor may also look at and feel the lymph nodes in your groin to see if they are swollen.
If symptoms and/or the exam suggest you might have penile cancer, other tests will be needed. These might include a biopsy and imaging tests.
Biopsy
A biopsy is the only sure way to know if an abnormal area is penile cancer. To do this, part or all of the area is removed and sent to a lab. There, it's looked at with a microscope to see if it contains cancer cells. The results are usually available in a few days, but sometimes it might take longer.
To learn more about the tests that might be done on biopsy samples, see How Biopsy and Cytology Samples Are Tested for Cancer.
For these biopsies, only a part of the abnormal area is removed. These types of biopsies are often done for lesions that are larger, ulcerated (the top layer of skin is missing or appears as a sore), or that might have grown deeply into the penis.
- For an incisional biopsy, the doctor uses a scalpel to remove a small part of the abnormal area for testing.
- For a punch biopsy, the doctor uses a tool that looks like a tiny round cookie cutter to remove a deeper sample of skin. The doctor rotates the punch biopsy tool on the skin until it cuts through all the layers of the skin.
These biopsies are usually done with local anesthesia (numbing medicine) in a doctor’s office, clinic, or outpatient surgical center. The area where the sample is removed might need to be stitched together afterward, depending on the size of the biopsy.
In an excisional biopsy, the entire lesion is removed. This type of biopsy is most often used if the abnormal area is small, such as a nodule (lump) or plaque (raised, flat area), and it can be removed without affecting the shape or function of the penis.
These biopsies are usually done in a hospital or outpatient surgical center. Local anesthesia (numbing medicine) or general anesthesia (where you are asleep) may be used. The area where the sample is removed might need to be stitched together afterward.
If the cancer has spread deep within the penis, nearby lymph nodes usually will need to be checked to see if the cancer has spread to them. (When cancer spreads, it often goes to the nearby lymph nodes first.) This is done to help find the stage (extent) of the cancer after the diagnosis.
The lymph nodes can be checked either with fine needle aspiration or by doing surgery to remove them.
Fine needle aspiration (FNA): To do this type of biopsy, the doctor puts a thin, hollow needle into the lymph node and uses a syringe to pull out cells and a few drops of fluid. Local anesthesia may be used first to numb the area.
If an enlarged lymph node is deep inside your body and the doctor can’t feel it, imaging tests such as ultrasound or CT scans (see below) can be used to guide the needle into the node.
An FNA can be done to see if lymph nodes contain cancer, but it's not used to biopsy areas on the penis itself.
This procedure can be done in a doctor’s office or clinic.
Surgical biopsy: Sometimes, the lymph nodes might be checked during surgery instead of with an FNA. Surgical lymph node biopsies, which include sentinel lymph node biopsy (SLNB) and inguinal lymph node dissection (ILND), are described in Surgery for Penile Cancer.
Imaging tests
Imaging tests are used to create pictures of the inside of the body. Imaging tests can be done for a number of reasons, including:
- To help find out if a suspicious area might be cancer
- To learn how far cancer has spread
- To help determine if treatment is working
Not everyone with penile cancer needs imaging tests. But if the doctor thinks the cancer might have spread, then one or more of these tests may be used to help find the stage of the cancer.
A CT scan combines many x-ray pictures to make detailed cross-sectional images of the inside of the body. It can show how deep the tumor has grown and can also help show if the cancer has spread to lymph nodes or other parts of the body.
CT-guided needle biopsy: CT scans can be used to guide a biopsy needle into an enlarged lymph node or other area that might have cancer. To do this, you stay on the CT table while a doctor moves a biopsy needle through your skin and toward the area to be checked. CT scans are repeated until the needle is inside the area. A biopsy sample is then removed.
MRI scans provide detailed images of soft tissues in the body. Like CT scans, MRIs can show how deep the tumor has grown and if the cancer has spread to lymph nodes or other parts of the body.
MRI scans use radio waves and strong magnets to create the images instead of x-rays, so there is no radiation.
Ultrasound uses sound waves and their echoes to look inside the body. It can be useful to find out how deeply the cancer has spread into the penis. It can also help find enlarged lymph nodes in the groin.
This test is painless and does not expose you to radiation.
For most ultrasound exams, the skin is first lubricated with gel. Then a technician moves the transducer over the skin of the penis.
X-rays might be done on the chest area to see if the cancer has spread to the lungs.
Penile cancer stages
After a penile cancer diagnosis, doctors will try to figure out how far it has grown, including if it has spread to other parts of the body. This process is called staging.
What does the cancer stage mean?
The stage of a cancer describes how much cancer is in the body. It helps determine how serious the cancer is and how best to treat it. Doctors also use a cancer's stage when talking about survival statistics.
The earliest stage of penile cancer is stage 0, which means the cancer hasn’t spread beyond the top layer of skin. The other stages range from I (1) through IV (4). Some stages are divided further using capital letters (A, B, etc.). As a rule, the lower the stage, the less the cancer has spread.
When is cancer staged?
Penile cancer might be staged at different times:
- It is typically given a clinical stage based on the results of a physical exam, biopsy, and any imaging tests that might have been done.
- If surgery has been used to remove the tumor and check nearby lymph nodes for cancer, the pathological stage (also called the surgical stage) can be determined.
The pathological stage is typically more accurate, and it’s what's used in the table below.
How is the stage determined?
The staging system most often used for penile cancer is the American Joint Committee on Cancer (AJCC) TNM system, which is based on several key pieces of information. For more on this, see Cancer Staging.
- The extent of the main tumor (T)
- How far has the cancer grown into the penis, and has it reached nearby tissues or organs?
- The spread to nearby lymph nodes (N)
- Has the cancer spread to nearby lymph nodes (in the groin and pelvic area)? If so, how many are affected?
- The spread (metastasis) to distant sites (M)
- Has the cancer spread to distant parts of the body? The most common sites of spread are distant lymph nodes or organs like the lungs, liver, or bones.
Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced.
Another factor that can affect the stage of some early penile cancers is the grade (G) of the cancer cells. This is a measure of how different the cancer cells look from normal cells. The grade is often noted with a number, from G1 to G3. The higher the number, the more abnormal the cells look. Higher-grade cancers tend to grow and spread faster than lower-grade cancers.
Stages of penile cancer
Once the T, N, and M categories (and grade) of the cancer have been determined, this information is combined in a process called stage grouping to assign an overall stage. Penile cancer staging can be complex, so ask your doctor to explain your stage to you in a way you understand.
The system described below is the AJCC system used for squamous cell carcinoma of the penis, which is by far the most common type of penile cancer. Other types of cancer starting on the penis, such as melanomas and sarcomas, are much less common and are staged with different systems.
(0is or 0a) Tis or Ta, N0, M
The tumor is only in the top layer of the skin and has not grown any deeper (Either Tis, which is also called carcinoma in situ (CIS) or penile intraepithelial neoplasia (PeIN), or Ta). The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
T1a, N0, M0
The tumor has grown into tissue just below the top layer of skin. It hasn't grown into nearby blood vessels, lymph vessels, or nerves, and it's not high grade (G3) (T1a).
The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
T1b, N0, M0
The tumor has grown into tissue just below the top layer of skin. It has grown into nearby blood vessels, lymph vessels, or nerves, and/or it's high grade (G3) (T1b).
The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
Stage IIA (T2, N0, M0)
The cancer has grown into the corpus spongiosum (an internal chamber that runs along the bottom and into the head of the penis).
The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
Stage IIB (T3, N0, M0)
The cancer has grown into the corpus cavernosum (either of 2 internal chambers that run along the top of the shaft of the penis).
The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
Stage IIIA (T1-T3, N1, M0)
The tumor has grown into tissue below the top layer of skin and may have grown into the corpus spongiosum and/or the corpus cavernosum (T1 to T3).
The cancer has spread to 1 or 2 nearby inguinal (groin) lymph nodes on the same side of the body (N1). It has not spread to distant parts of the body (M0).
Stage IIIB (T1-T3, N2, M0)
The tumor has grown into tissue below the top layer of skin and may have grown into the corpus spongiosum and/or the corpus cavernosum (T1 to T3).
The cancer has spread to 3 or more nearby inguinal (groin) lymph nodes on the same side of the body, or to inguinal lymph nodes on both sides of the body (N2). It has not spread to distant parts of the body (M0).
T4, Any N, M0
The tumor has grown into nearby structures such as the scrotum, prostate, or pubic bone (T4).
The cancer might or might not have spread to nearby lymph nodes (any N). It has not spread to distant parts of the body (M0).
OR
Any T, N3, M0
The tumor might or might not have grown into deeper layers of the penis or nearby structures (any T).
The cancer has spread to nearby lymph nodes in the pelvis, or it has grown outside of a lymph node and into the surrounding tissue (N3). The cancer has not spread to distant parts of the body (M0).
OR
Any T, Any N, M1
The tumor might or might not have grown into deeper layers of the penis or nearby structures (any T). The cancer might or might not have spread to nearby lymph nodes (any N). The cancer has spread to distant parts of the body (M1).
The following additional categories are not listed above:
- TX: Main tumor cannot be assessed due to lack of information.
- T0: No evidence of a primary tumor.
- NX: Regional lymph nodes cannot be assessed due to lack of information.
Questions to ask if you’re told you have penile cancer
- What type of penile cancer do I have?
- How deep has the cancer grown into my penis? Has it spread to lymph nodes or other organs?
- What is the stage of my cancer, and what does that mean for me?
- Do I need any more tests before we can decide on treatment?
- Do I need to see any other types of doctors?
- How much experience do you have treating this type of cancer?
It’s important to have honest, open discussions with your cancer care team. Keep in mind that doctors aren’t the only ones who can give you information. Other health care professionals, such as nurses and social workers, may have the answers to some of your questions. You should ask any question, no matter how small it might seem. They want to answer all your questions, so you can make informed decisions.
- Written by
- References
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
American Joint Committee on Cancer. Penis. In: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017: 701-714.
Heinlen JE, Ramadan MO, Stratton K, Culkin DJ. Chapter 82: Cancer of the Penis. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa. Elsevier: 2020.
National Cancer Institute. Penile Cancer Treatment (PDQ®)–Patient Version. 2025. Accessed at https://www.cancer.gov/types/penile/patient/penile-treatment-pdq on July 8, 2025.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Penile Cancer. Version 2.2025. Accessed at www.nccn.org on July 8, 2025.
Pettaway CA. Carcinoma of the penis: Clinical presentation, diagnosis, and staging. UpToDate. 2025. Accessed at https://www.uptodate.com/contents/carcinoma-of-the-penis-clinical-presentation-diagnosis-and-staging on July 8, 2025.
Last Revised: September 8, 2025
American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.
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