Staging and grading of penile cancer

Staging of penile cancer

The stage of penile cancer (cancer of the penis) describes:

where the cancer is
how far it has grown into the penis
if it has spread to other areas of the body.

Sometimes it also includes the grade of the tumour. The grade describes how the cancer cells look under a microscope.

Knowing the stage and grade of the cancer helps you and your specialist doctor decide on the best treatment for you.

Your doctor may also use other terms to describe the stage of the cancer. These include the following:

Early means a cancer that has not spread outside the penis.
Locally advanced means the cancer has spread more deeply into the penis and the lymph nodes in the groin.
Secondary cancer means the cancer has spread to other parts of the body.

We understand that waiting to know the stage and grade of your cancer can be a worrying time. We're here if you need someone to talk to. You can:

Call the Macmillan Support Line on 0808 808 00 00.
Chat to our specialists online.

TNM staging

The most commonly used staging system is the TNM system:

T describes where the tumour (cancer) is on the penis, the size of the tumour and how far it has grown.
N describes if the cancer has spread to any lymph nodes.
M describes if the cancer has spread to other parts of the body (metastases or secondary cancer).

Tumour

The T stages are sometimes split further to give more detailed information, or to include the grade:

Tis or carcinoma in situ (CIS) means the cancer cells are only in the top layer of skin.
Ta means the cancer looks like a wart, but is still only in the top layer of skin.
T1a means the tumour has grown into tissue just below the top layer of skin, but not any further. It is also a grade 1 or 2 tumour (see below).
T1b means the tumour has grown into blood vessels, lymph vessels or nerves, or it is a grade 3 tumour (see below).
T2 means the tumour has grown into the spongy tissue of the penis. It may also have grown into the urethra.
T3 means the tumour has grown more deeply into the penis. It may also have grown into the urethra.
T4 means the tumour has spread more deeply into the penis and into nearby areas such as the scrotum.
Tx means the tumour cannot be assessed or seen clearly on scans.

Nodes

There are 4 N stages:

N0 means there is no cancer in the lymph nodes.
N1 means there is cancer in 1 lymph node in the groin.
N2 means the cancer is in at least 2 lymph nodes in the groin, or in lymph nodes on both sides of the groin.
N3 means the cancer has spread into the tissue around the groin lymph nodes or has spread to lymph nodes in the pelvis.
Nx means the lymph nodes cannot be assessed or seen clearly on scans.

Metastasis

There are 2 M stages:

M0 means the cancer has not spread to other parts of the body.
M1 means the cancer has spread to other parts of the body, such as the liver or the lungs.

Grading of penile cancer

The grade of a cancer is based on how the cancer cells look under a microscope. It gives an idea of how quickly the cancer might grow and how likely it is to spread.

Cancer of the penis is graded from 1 to 4. It can also be described as low-grade or high-grade.

Low-grade (grade 1 and 2) means the cancer cells look similar to normal cells. They are likely to be slow-growing and less likely to spread.
High-grade (grade 3 and 4) means the cancer cells do not look like normal cells. They are likely to grow more quickly and spread.

Related pages

Causes and risk factors of penile cancer

About our information

References

Below is a sample of the sources used in our penile cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

EAU Guidelines: Penile Cancer. Available from: uroweb.org/guideline/penile-cancer (accessed May 2022).

Penile cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow up. Available from: www.annalsofoncology.org/article/S0923-7534(19)31556-X/pdf (accessed May 2022).

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Ursula McGovern, Consultant Medical Oncologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

use plain English
explain medical words
use short sentences
use illustrations to explain text
structure the information clearly
make sure important points are clear.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.