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Penile cancer is a squamous skin-type cancer, about half of it caused by HPV. Caught early it is usually cured with organ-sparing surgery that has replaced amputation, and HPV vaccination and circumcision prevent it; the hard cases are those with lymph-node spread, where cisplatin-based chemotherapy plus surgery and now immunotherapy are being tested in the InPACT trial.
Penile squamous cell carcinoma arises on the glans or foreskin and follows two pathways: HPV-related (HPV16 predominant, p16-positive, basaloid or warty histology) and HPV-independent (differentiated PeIN linked to lichen sclerosus and chronic inflammation, TP53 and CDKN2A alterations). The disease spreads predictably to inguinal then pelvic nodes, and nodal stage is the dominant prognostic factor. Management has shifted from amputation to organ-sparing surgery for most primary tumours (glansectomy, glans resurfacing, laser, Mohs, or brachytherapy), which preserves function without compromising cure when margins are clear.
The inguinal nodes decide outcome. Dynamic sentinel node biopsy stages clinically node-negative patients with intermediate- or high-risk primaries, sparing most of them a morbid lymphadenectomy; palpable or proven nodal disease is treated with radical inguinal (and, when indicated, pelvic) lymphadenectomy, with adjuvant chemotherapy or chemoradiation for extensive nodal disease. Cisplatin-based combinations (TIP: paclitaxel, ifosfamide, cisplatin) are the standard neoadjuvant and first-line regimens; the international InPACT trial (NCT02305654) is the first randomised study to define the sequence of surgery, chemotherapy and radiotherapy in node-positive disease. Immune checkpoint inhibitors (pembrolizumab, cemiplimab) have produced responses in small series and are being combined with chemotherapy and radiotherapy in trials, and HPV-directed vaccines and cell therapies are being explored.
The EAU-ASCO 2023 collaborative guideline is the current reference. Prevention is straightforward in principle: HPV vaccination of boys, neonatal or childhood circumcision where culturally appropriate, phimosis treatment and smoking cessation.
Rare in high-income countries (well under one per 100,000 men per year) and several times more common in parts of South America, sub-Saharan Africa and South Asia, tracking HPV prevalence, phimosis and low circumcision rates.
Renal cell carcinoma comes from the kidney's filtering cortex, urothelial cancer from the lining of the collecting system and bladder, and the adrenal on top hosts cortical and medullary (neuroblastoma) tumours.
Same organ: Collecting duct carcinoma of the kidney, Renal medullary carcinoma (SMARCB1-deficient), TFE3-rearranged (translocation) renal cell carcinoma, Fumarate hydratase-deficient renal cell carcinoma (HLRCC-associated), Succinate dehydrogenase-deficient renal cell carcinoma, Mucinous tubular and spindle cell carcinoma of the kidney, Eosinophilic solid and cystic renal cell carcinoma, Clear cell papillary renal cell tumour, Urothelial carcinoma of the urethra, Squamous cell carcinoma of the urethra, Adenocarcinoma of the urethra (including clear cell adenocarcinoma), Melanoma of the urethra, Non-muscle-invasive bladder cancer, Muscle-invasive and advanced bladder cancer, Bladder & urothelial cancer, Clear cell renal cell carcinoma, Papillary renal cell carcinoma, Chromophobe renal cell carcinoma, Renal cell carcinoma, Wilms tumour (nephroblastoma), Neuroblastoma (paediatric), Low-risk neuroblastoma (INRG very low and low risk, including stage MS), Intermediate-risk neuroblastoma, High-risk neuroblastoma, Adrenocortical carcinoma, Pheochromocytoma and paraganglioma (PPGL), Urethral cancer, Localised penile cancer (organ-confined, node-negative), Node-positive and metastatic penile cancer, Localised adrenocortical carcinoma (ENSAT stage I to III, resectable), Advanced and metastatic adrenocortical carcinoma (ENSAT stage IV or unresectable), Hereditary pheochromocytoma and paraganglioma (SDHx, VHL, RET, NF1, MAX and TMEM127), Metastatic pheochromocytoma and paraganglioma
Nothing recorded yet.
Nothing recorded yet.
Also on OnCo: Symptoms and red flags · Early detection roadmap.
Organ-sparing treatment where feasible (glansectomy, glans resurfacing, wide local excision, laser or brachytherapy); partial or total penectomy reserved for extensive tumours.
Dynamic sentinel node biopsy (or modified inguinal lymphadenectomy where unavailable); observation only for low-risk primaries.
Radical inguinal lymphadenectomy; pelvic lymphadenectomy and adjuvant chemotherapy or chemoradiation for extensive disease; neoadjuvant TIP for bulky or fixed nodes (InPACT is testing the sequence).
Cisplatin-based chemotherapy (TIP); checkpoint inhibitors in trials or where approved for tumour-agnostic indications; palliative radiotherapy.
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Query for this cancer: (TITLE:"Penile cancer" OR ABSTRACT:"Penile cancer" OR TITLE:"Penile squamous cell carcinoma" OR ABSTRACT:"Penile squamous cell carcinoma" OR TITLE:"Carcinoma of the penis" OR ABSTRACT:"Carcinoma of the penis") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Penile cancer, not a curated reading list.
Bowen's disease and erythroplasia of Queyrat recognised as penile carcinoma in situ.
Horenblas and colleagues (Netherlands Cancer Institute) introduce lymphatic mapping.
Pagliaro and colleagues (JCO 2010) report responses and resectability in bulky nodal disease.
International phase 3 platform for node-positive penile cancer (NCT02305654).
First joint European and American guideline for penile cancer.
The targets of this cancer's medicines and the ones linked to it directly.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.
Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).
Eyebrows and eyelashes usually fall later than scalp hair and come back later, and their absence is felt more than people expect, because they frame the face and keep dust and sweat out of the eyes.
Taxane and anthracycline chemotherapy for triple-negative breast cancer causes hair loss in most people, usually starting after the first or second cycle and almost always growing back; scalp cooling kept more than half the hair in about half of women in a randomised trial and is offered in many UK units.
See all on the product pages:CemiplimabCisplatinIfosfamidePaclitaxel / nab-paclitaxelPembrolizumab·Printable cards in the navigator
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Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record.
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