Attributable to HPV. Source: (Parkin, 2011). International estimates range up to around half
What it is
Penile cancer most often starts on the head of the penis (the glans) or on the foreskin. Most cases are squamous cell carcinomas, which start in the flat skin cells covering the penis.
Because it is rare and affects an intimate part of the body, people sometimes delay seeing a doctor. When it is found early, treatment is very effective and can often preserve the penis.
Symptoms
- A lump, growth or sore that doesn’t heal within 4 weeks
- A thickened or raised area of skin, or a rash that doesn’t go away
- Warty growths
- Itchy or inflamed patches on the skin
- Blood coming from the penis or from under the foreskin
- A discharge with an unpleasant smell
- Difficulty pulling back the foreskin (phimosis)
- A change in the colour of the skin of the penis or foreskin
- A lump in the groin
If you notice any of these changes, see your GP. They are usually caused by something less serious, such as an infection, but it’s important to get them checked.
Causes
Around 4 in 10 penile cancers are caused by long-lasting infection with high-risk HPV, mainly HPV16. The rest are usually linked to long-term inflammation of the skin of the penis, for example from phimosis or lichen sclerosus.
Statistics
Source: Cancer Research UK.
Risk factors
- Age. It mostly affects people over 50
- HPV infection
- Phimosis, a tight foreskin that is hard to pull back, which makes it harder to keep the area clean and can lead to long-term inflammation
- Lichen sclerosus, a long-term skin condition
- Smoking
- A weakened immune system, for example from HIV
- PUVA treatment, a type of light therapy used for psoriasis
- Obesity
- Other sexually transmitted infections, including HIV
How it develops
Penile cancer often develops from a pre-cancerous stage called penile intraepithelial neoplasia (PeIN), where abnormal cells are found only in the top layer of skin. PeIN can be treated before it becomes cancer.
There are two main routes. In HPV-related cancers, the virus’s E6 and E7 proteins drive abnormal growth, and the tumour cells usually show high levels of the protein p16. HPV-independent cancers develop in skin damaged by long-term inflammation and often carry changes in the TP53 gene.
Diagnosis and treatment
Your GP may refer you to a urologist, a specialist in the urinary and genital system, who can take a biopsy. Early changes (PeIN) can be treated with creams, laser or minor surgery.
Treatment for cancer may include surgery, radiotherapy and chemotherapy. Surgeons aim to keep as much of the penis and sexual function as possible.
Prevention
- Get the HPV vaccine if eligible.
- Keep the area clean, including under the foreskin, and see your GP about a tight foreskin.
- Stop smoking.
- Check yourself and see your GP about any change that doesn’t heal within 4 weeks.
Trans men and non-binary people
HPV-related cancer in trans men who have had genital surgery hasn’t been well studied. If you notice any changes, see your GP or gender clinic.
Common misconceptions
"Men can be tested for HPV."
There’s no routine HPV test for people with a penis, so knowing the symptoms is important.
"Penile cancer only affects older men."
It’s most common over 50, but it can happen at any age, and UK rates have risen over the past 20 years.
Support and charities
- Orchid: information and support for penile, testicular and prostate cancer
- Macmillan Cancer Support: practical, emotional and financial support for anyone affected by cancer
NHS guidance
NHS and trusted information