Tests for Penile Cancer

If you have possible symptoms of penile cancer you should go to a doctor. A physical exam will be done and you might also need some tests to find out what's causing your symptoms.

Medical history and physical exam

The doctor will talk to you about your medical history and the details of your symptoms, like when they started and if they've changed. You'll also discuss any possible risk factors you 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 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 a change is penile cancer. To do this, a small piece of tissue is taken from the changed area 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 may take longer in some cases There are many ways a biopsy can be done:

Incisional biopsy

For an incisional biopsy only a part of the changed area is removed. This type of biopsy is often done for lesions that are big, ulcerated (the top layer of skin is missing or the lesion appears as a sore), or that appear to grow deeply into the penis.

These biopsies are usually done with local anesthesia (numbing medicine) in a doctor’s office, clinic, or outpatient surgical center.

Excisional biopsy

In an excisional biopsy, the entire lesion is removed. This type of biopsy is most often used if the lesion is small, such as a nodule (lump) or plaque (raised, flat area).

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.

Lymph node biopsy

If the cancer has spread deep within the penis, nearby lymph nodes usually will need to be checked for cancer spread. This is done to help find the stage (extent) of the cancer after the diagnosis. These 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 right into the lymph node and uses a syringe to pull out cells and a few drops of fluid. Local anesthesia may be put into the skin over the node to numb the area first.

If the enlarged lymph node is deep inside your body and the doctor can’t feel it, imaging methods such as ultrasound or CT scans can be used to guide the needle into the node.

This type of biopsy is often done to see if enlarged lymph nodes contain cancer. It's not used to sample lesions on the penis itself. This procedure can be done in a doctor’s office or clinic.

Surgical biopsy: In some cases, the lymph nodes are not checked with FNA, but instead surgery is done to remove one or more lymph nodes. These surgical lymph node biopsies, which include sentinel lymph node biopsy and lymphadenectomy, are described in Surgery for Penile Cancer.

To learn more, see Testing Biopsy and Cytology Specimens for Cancer.

Imaging tests

Imaging tests use x-rays, magnetic fields, or sound waves to create pictures of the inside of your body. If the doctor thinks the cancer has spread, then one or more of these tests may be used to help find the stage of the cancer.

Computed tomography (CT)

A CT scan uses x-rays to make detailed cross-sectional images of your body. It can show how big the tumor is and can also help see 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 be cancer spread. To do this, you stay on the CT table while a doctor moves a biopsy needle through your skin and toward the mass. CT scans are repeated until the needle is inside the mass. A biopsy sample is then removed and sent to be checked under a microscope.

Magnetic resonance imaging (MRI)

Like CT scans, MRIs show detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays.

MRI pictures are better if the penis is erect. The doctor might inject a hormone-like substance called prostaglandin into the penis to make it erect.

Ultrasound

Ultrasound uses sound waves to make pictures of internal organs or masses. 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.

Chest x-ray

An x-ray might be done to see if the cancer has spread to the lungs.