Penile Cancer

Penile cancer is a rare cancer. Around 600 men a year are diagnosed with it in the UK. St George’s University Hospitals NHS Foundation Trust is one of around 15 UK specialist units that treat this cancer. We are referred men with penile cancer from South London, South East England, Wessex and Essex.

Men who smoke, who have had human papilloma virus infection and/or have a tight foreskin are at greater risk of developing penile cancer. It can affect any part of the penis but most commonly involves the foreskin and the head of the penis (glans penis). Men who present with penile cancer also need to be assessed for any spread of the disease to the groin and other lymph nodes.

The penile cancer team includes Urological Surgeons who specialise in this disease, Clinical Nurse Specialists, Oncologists, Radiologists, Histopathologists, Plastic Surgeons, Lymphoedema specialists and Psychologists. This multidisciplinary team meet weekly to review pathology and imaging, and discuss all newly diagnosed patients and plan subsequent treatment. We also work closely with our network of referring hospitals.

What are the tests and treatment?

There have been significant advances in the treatment of penile cancer over the last 10-15 years. St George’s Hospital is one of a number of hospitals in the UK and internationally that have driven this. Surgical techniques have been refined and now complete removal of the tumour with reconstructive surgery (penile preserving surgery) is possible in the majority of cases, minimising the impact on penile appearance and function. Assessing cancer spread with inguinal (groin) dynamic sentinel lymph node sampling has also reduced surgical complications for the majority of patients.

At St George’s Hospital, we participate in international trials and collaborative research to try and improve outcomes in this disease. We are a member of the European Rare Diseases Programme, eUROGEN, whose aim is to improve the care and outcomes of rare diseases across Europe, including penile cancer. We work closely with the charity ORCHID to support men with this disease.

Penile cancer can affect men of any age. The chances of cure are relatively high and treatment is often more successful, with a greater chance of penile preservation, if men present early.

Men will initially meet our team in a dedicated clinic at St George’s Hospital.

We offer penile preserving surgery to around 85% of our patients. Penile preserving surgery involves excision of the cancer followed by reconstruction with a skin graft to try and preserve appearance and function.

We perform dynamic inguinal (groin) sentinel lymph node sampling in most of our patients. This is an operation to sample a few lymph nodes from the groins to assess whether there has been microscopic spread of the cancer, which can occur in about 1 in 5 men. This technique minimises the complications of groin surgery.

Most men do not need further treatment after their penile surgery and groin sampling. A minority will need further nodal surgery, some of which is possible with “keyhole” surgery and they may also need radiotherapy and / or chemotherapy, which is provided by their, or close to, their referring hospital.

Some men who have the additional nodal surgery experience lymphoedema, swelling to their leg and / or genitals. We offer specialist clinics to help manage this

What is Personalised Cancer Care?

 Personalised Cancer Care means your team will support you to take an active role in your cancer care by giving choices and control based on what matters most.

Together with your key workers’ team, like your Clinical Nurse Specialist and Macmillan Support worker, we will aim to help you access the care and support that meets your individual needs from the moment you receive your cancer diagnosis so that you can live as full, healthy and active a life as possible.

You will be invited to complete a Holistic Needs Assessment (HNA) to identify any concerns you may have when you have been diagnosed with cancer. These concerns may be physical, emotional, practical, financial and spiritual.

You will answer a simple set of questions or fill in a checklist about all areas of your life. It is to find out about the concerns you may have. You are often asked to rate how important these concerns are to you. It could help you decide what to discuss first during the assessment.

Once you have completed the assessment, your Clinical Nurse Specialist will discuss your needs, maybe face-to-face in a clinic or over the phone. During the discussion, you and your Clinical Nurse Specialist will agree on the best ways to manage your needs and concerns. They will write down what you have decided in a document called a care plan.  They may write it during the discussion. Or they may make notes and send them to you afterwards. Your care plan will record the following:

• The main concerns you talked about
• Suggestions and actions to help you manage your concerns
• Services that may be able to support you, and any referrals that are made
• What is already being done to help – for example, the services you are already using
• Information about who to contact if you need more help
• The details of other health or social care professionals with whom you have agreed to share the information.

You may not wish to complete the holistic needs assessment at this time. The care you receive will not be affected in any way, and we will be happy to discuss this again in the future

 Health and wellbeing information and support also include:

• Access to the Macmillan Information & Support Centre to find out what support is available in the community, e.g., practical, financial, and how to access it
• Help with understanding cancer and its treatment and how to manage its impact through videos and workshops run by healthcare professionals at St George’s and in the community.
• Attend wellbeing activities which are great opportunities for you and your carers to get together with others affected by cancer