Surgery for penile cancer
The operation you have depends on the stage of the penile cancer (cancer of the penis) and where it is on the penis. Your surgeon will try to remove all the cancer while keeping as much of the penis as possible.
There are different types of operation. Your surgeon or specialist nurse will talk to you about what surgery involves and the possible effects it may have. It is important to ask them any questions you have and talk about any concerns.
Some operations may cause changes to how your penis looks. They may also affect your sex life. This can be difficult to deal with. Your team will explain any possible changes and give you support to help you cope.
Removing a small cancer
If the cancer is very small and only on the surface of the penis, your doctor may advise having it treated with a laser. This uses heat to destroy the cancer cells.
If laser treatment is not possible, some people may need a small operation. This can involve:
- removing the affected area of the penis and a small area around it
- removing the foreskin (circumcision) if the cancer is only affecting this area.
These can be done under a local or general anaesthetic. You may be able to go home on the same day. Your doctor or nurse can give you more information.
Wide local excision
If the cancer has spread over a bigger area, you usually need an operation called a wide local excision. This means removing the cancer and an area (margin) of healthy-looking tissue around it. This reduces the risk of the cancer coming back.
You usually have this operation under a general anaesthetic, during a short stay in hospital. The wound is usually closed with stitches. But some people have skin taken from another part of the body (a skin graft) to cover the area.
If the cancer is bigger and on the head of the penis (the glans), you usually need to have this area completely removed. The operation is called a glansectomy.
A glansectomy may make the penis shorter and change the shape of the tip of the penis. The surgeon may be able to bring skin up from the shaft of the penis to cover the tip. If this is not possible, they may take skin from somewhere else in the body (a skin graft) to cover it.
You need to stay in hospital for a few days after this operation.
Removing part or all of the penis (penectomy)
If the cancer is large, or affecting too much of the penis, your surgeon may advise you to have a penectomy. This is where part or occasionally all of the penis needs to be removed. They will talk to you about what is involved and how the operation will affect you.
Having surgery to remove part or all of the penis can be very upsetting. The team looking after you will give you lots of support. It is important to talk to your doctor or nurse about your feelings and concerns.
Having a penectomy
If you have all of the penis removed, the surgeon usually makes a small opening between the scrotum and anus (opening at the end of the bowel). They may redirect the tube that carries urine (the urethra) to the opening. You are still in control of passing urine (peeing) but you pass urine sitting down. If it is not possible to redirect the urethra, some people may need to have a tube that goes into the bladder through the tummy (abdomen). This is called a supra-pubic catheter. You attach a bag to the tube on the tummy to collect urine.
Surgery to remove the lymph nodes
You may be advised to have an operation to remove the lymph nodes in the groin. This can be in one or both sides of the groin. The surgeon makes a long cut in the groin and removes the lymph nodes.
After this operation, there is a risk of developing swelling in one or both legs, the scrotum and the penis. This is called lymphoedema. The risk is higher if you also have radiotherapy to the groin.
If you are having a general anaesthetic, you may need tests first to make sure you are well enough for surgery. These can include blood tests and an echocardiogram (ECG) to check your heart. You usually have these at a pre-surgery assessment clinic.
If you smoke, you will be advised to stop or cut down before your operation. This will help you heal faster after surgery.
We have more information on giving up smoking.
How long it takes to recover depends on the surgery you have had. If the cancer is very small, and only a small amount of skin is removed, your wound is likely to heal quickly.
After a glansectomy or partial penectomy
After a glansectomy or partial penectomy, the penis may be swollen and bruised immediately after surgery. This usually gets better after a few days. The nurses will give you regular painkillers until any pain or discomfort goes away.
After surgery to remove part of the penis, some people may find that their urine stream sprays when they pass urine. If you are having problems with passing urine after surgery, talk to your doctor or nurse. They can give you advice about what can help.
After surgery to remove the lymph nodes
If the surgeon also removes the lymph nodes, it may take longer to heal and recover. You will have a tube going into the groin to drain away extra fluid. You may also have tubes going into any wounds to remove extra fluid and help them heal. The tubes are connected to a small bottle, which collects the fluid. A nurse removes the tubes after a few days when fluid stops draining.
Preventing blood clots
The nurses will give you elastic stockings (TED stockings) to wear during the operation and for some time afterwards. This is to prevent blood clots in the legs.
After your operation, the nurses will encourage you to start moving about as soon as possible. This is important to help prevent problems, such as chest infections and blood clots. If your surgery includes a skin graft, you may be advised to rest in bed for the first 24 to 48 hours.
Some men may have a tube going into their bladder. This tube is called a urinary catheter. It allows urine to drain from the bladder to outside the body. Your nurse usually removes it after a few days.
The nurses will check any wounds you have. They will change the dressings to keep the area clean. The stitches usually dissolve by themselves.
If you had a skin graft, the area the skin was taken from (donor site) may need dressings until new skin has formed. Your nurse will talk to you about this.
Your surgeon will talk to you when the results of your operation are ready. This may be during your hospital stay or at an outpatient visit. They will tell you if you need any more treatment.
Macmillan toilet card
You may find it helpful to get a toilet card. This is a card that you can show quickly and easily to staff in shops, pubs and other places. It explains that you have a medical condition and need urgent access to a toilet.
We have a free toilet card you can use.
If the cancer has not spread anywhere else in the body, it may be possible to have an operation to form a new penis. This is called reconstructive surgery. It may be done a year or more after treatment is finished. This is when you have recovered and there are no signs of the cancer coming back. It is very specialised surgery and is only done in a few hospitals in the UK.
The surgeon may take skin and other tissue from your arm or thigh to form a new penis. They can also put a small device into the new penis that will help you get an erection. Your surgeon or nurse will explain what the operation involves, so you know what to expect.
After surgery, your penis may be smaller and you may have scars. Changes in how you look and how your body works can be hard to cope with. This can directly affect your sexuality. It can also affect how you feel about your body (your body image).
It is common to feel overwhelmed by different feelings. It is important to tell your doctor and specialist nurse how you feel, so they can get you the support you need.
Surgery to remove a small cancer
Surgery to remove a small cancer is unlikely to have a direct effect on your sex life.
Surgery to remove part or all of the penis (penectomy)
If your treatment involves surgery to remove part or all of the penis, the effect on your sex life may be a major concern for you. Your cancer team will give you lots of support. They will explain what can be done to help with sexual difficulties.
Men who have part of the penis removed may still get erections. This will depend on how much tissue has been taken away during surgery. Your doctor or nurse can talk to you about this.
If the whole penis has been removed (total penectomy), your sex life will be directly affected. Not having a penis can be very difficult to come to terms with. But you may find new ways to enjoy sexual activity. The areas around the scrotum and testicles will still be sensitive. You may still be able to have orgasms through stroking and other stimulation.
Organisations such as Orchid offer information and support for people with penile cancer.
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 firstname.lastname@example.org
EAU Guidelines: Penile Cancer (accessed 2018). Available from: uroweb.org/guideline/penile-cancer
Penile cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow up (accessed 2018). Available from: www.annalsofoncology.org/article/S0923-7534(19)31556-X/pdf
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.
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