After someone is diagnosed with , doctors will try to figure out if it has spread, and if so, how far. This process is called . 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, in which the cancer hasn’t invaded 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. Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way.

Penile cancer

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 structures 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 such as 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 abnormal the cancer cells look under a microscope. The grade is often expressed as a number, from 1 to 3. The higher the number, the more abnormal the cells look. Higher-grade cancers tend to grow and spread more quickly 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.

 

The system described below is the most recent AJCC system, effective January 2018. It is 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 (as described in How Is Penile Cancer Diagnosed?). 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 is used in the table below.

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

Stages of penile cancer

AJCCstageStage groupingStage description*
0
(0is or 0a)
Tis or Ta
N0
M0
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).

IT1a
N0
M0
The tumor has grown into tissue just below the top layer of skin. It has not grown into nearby blood vessels, lymph vessels, or nerves, and it is 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 is 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).

IIBT3
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).

IIIAT1-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).

IIIBT1-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).

* The following additional categories are not listed on the table above:

  • TX: Main tumor cannot be assessed due to lack of information.
  • T0: No evidence of a primary tumor. The N categories are described in the table above, except for:
  • NX: Regional lymph nodes cannot be assessed due to lack of information.

 

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