Fifty percent of patients with penile cancer have had symptoms for a year before the diagnosis is made and treatment is started. Many early symptoms resemble benign lesions that can easily lead to delays in the diagnosis.
In patients with changes on the penis that appear to be benign and do not respond to short-term conservative treatment, a biopsy should always be taken. The biopsy should be deep enough to evaluate the depth of invasion (T stage). This is a simple punch biopsy and can be performed by any doctor.
If the patient has phimosis, a radical circumcision must be performed with the biopsy.
Examinations for detected cancer:
- Physical assessment of the primary tumor:
- The diameter of the tumor in millimeters and the depth of invasion is evaluated.
- Prepare a plan for surgery and inform the patient of planned surgery.
Examinations for regional metastasis
Spreading of penile cancer occurs primarily lymphatically to lymph nodes and further to the intrapelvic lyph nodes. Lymph node spreading must be diagnosed as early as possible since it has a significant impact on the cure rate.
- Palpation of the groin. Enlargement of the inguinal nodes may be reactive.
- Ultrasound of lymph nodes with fine needle cytology is done the day before planned surgery.
- The sentinal node for penile cancer is situated near the branch of the superficial epigastric vein and the great saphenous vein. In the last seven years, sentinel node has been performed with isotopes (dynamic sentinel node biopsy). This is beneficial to the patient because the method is surgically minimal with few complications. The biopsy from the sentinel node is usually taken during surgery on the primary tumor. If cancer is present in the biopsy, an extended lymph node dissection is performed as a separate session.
- If there is suspicion of metastasis to intrapelvic lymph nodes on a CT, a robot-assisted laparoscopic iliacal node dissection is performed.