Penile cancer grading and staging

Staging penile cancer

Staging means finding out how big the cancer is and if it has spread to other parts of your body. Staging will help your doctor to plan the best treatment for you.

There are two staging systems used to stage penile cancer.

TNM system

• Tumour (T): How deeply the tumour has grown into the penis.
• Node (N): Is there cancer in your lymph nodes?
• Metastasis (M): Has the cancer spread to other parts of your body?

Following the TNM system, your doctor will give your cancer a number, from 1 to 4.

A higher number, such as stage 4, means a more advanced cancer. Some stages are further divided into stage A and B.

Number stages

• Stage 0 or carcinoma in situ (CIS): These early-stage cancer cells are only in the top layers of the skin and look like small lumps or sores.
• Stage 1: The cancer has grown into the tissue below the top layers of the skin.
• Stage 2: Cancer has grown deep into the tissues of the penis below the top layers of the skin, as well as into the blood and lymph vessels but has not spread to lymph nodes or other parts of the body.
• Stage 3: This stage is divided into two.
  • Stage 3A means the penis and one or two lymph nodes have been affected and cancer might have grown into the deeper tissues of the penis, urethra or blood vessels.
  • Stage 3B means the penis and several groin lymph nodes on one or both sides of the groin have been affected. It might also have grown into the deeper tissues of the penis, urethra or blood vessels – but hasn’t spread to other parts of the body.
• Stage 4: The cancer may have spread:
  • To nearby body parts (eg prostate gland), and / or tissues / lymph nodes
  • To distant body parts (eg lungs, liver or bones) and / or lymph nodes

Grading penile cancer

Low-grade cancers usually grow very slowly, while high-grade cancers grow more quickly.

• Grade X: The grade cannot be identified.
• Grade 1 (low grade): The cancer cells look a lot like normal cells.
• Grade 2 (intermediate grade): Some cells look like normal cells but some look abnormal.
• Grade 3 (high grade): The cells look abnormal and do not resemble normal cells.