Penile Cancer Stages

After a man is diagnosed with penile cancer, doctors will try to figure out if it has spread, and if so, how far. This process is called staging. 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 also use capital letters (A, B, etc.).  As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means cancer has spread more. Cancers with similar stages tend to have a similar outlook and are often treated in much the same way.

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 3 key pieces of information:

• 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 lung, 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 cancers is the grade 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 1 to 3. The higher the number, the more abnormal the cells look. Higher-grade cancers tend to grow and spread faster than lower-grade cancers.

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. For more on this, see Cancer Staging.

The system described below is the most recent AJCC system, effective January 2018. It's 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.

Penile cancer 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 check nearby lymph nodes for cancer, the pathologic stage (also called the surgical stage) can be determined. The pathologic stage is typically more accurate, and is what's used in the table below.

Penile cancer staging can be complex, so ask your doctor to explain your stage to you in a way you understand.

Stages of penile cancer

AJCC stage	Stage grouping	Stage description*
0 (0is or 0a)	Tis or Ta N0 M0	Also called carcinoma in situ or CIS. The tumor is only in the top layer of the skin and has not grown any deeper (Tis or Ta). The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
I	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 (grade 3) (T1a). The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
IIA	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 (grade 3) (T1b). The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
	OR
	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).
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).
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).
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).
IV	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).