TNM Staging for Penile cancer:
The stage of cancer shows its size and whether it has spread to other areas. Knowing the stage helps your doctor choose the best treatment plan for you.
Besides the stage, your treatment will also depend on the type of cancer, the exact location on your penis, and any other health issues you may have.
Your test results and scans will give information about the stage of your cancer, but sometimes doctors may need to wait until after surgery to know the exact stage.
Doctors commonly use the TNM staging system for penile cancer, where “TNM” stands for Tumor, Node, and Metastasis.
Tumour (T)
The “Tumor (T)” part of staging describes the size and extent of the tumor in penile cancer.
There are different stages for the tumor size in penile cancer:
– TX: The tumor cannot be measured.
– T0: No tumor is found.
– Tis (also called carcinoma in situ or CIS): This is the earliest stage, where cancer cells are only in the top layer of the skin. These areas may look like raised patches or sores (ulcers) of various sizes. This stage can remain unchanged for several years. It is now often referred to as penile intraepithelial neoplasia (PeIN).
– Ta: The tumor looks wart-like (verrucous) and is confined to the top layers of the skin.
– T1: The tumor has grown deeper into the layers beneath the skin. It’s split into T1a and T1b:
– T1a: The tumor hasn’t spread to blood vessels, lymph vessels, or nerves and isn’t high grade (grade 3).
– T1b: The tumor has spread into blood or lymph vessels or nerves, or is a high-grade tumor (grade 3).
– T2: The tumor has spread into the spongy tissue inside the penis (erectile tissue) and may or may not have reached the urethra.
– T3: The tumor has grown into the spongy tissue within the main body of the penis and may or may not have spread to the urethra.
– T4: The tumor has extended into nearby parts of the body, such as the prostate gland, scrotum, or pubic bone.
Doctors may use different names for penile intraepithelial neoplasia (PeIN) based on where it’s located:
– If PeIN is on the head of the penis (glans), it’s called erythroplasia of Queyrat.
– If it’s on the shaft of the penis or other skin areas, it’s known as Bowen’s disease.
( Image showing Ta,T1,T2,T3 and T4 tumors of penile cancer)
Node (N)
The “Node (N)” part of staging shows whether cancer has spread to the lymph nodes.
– Clinical staging: This is when the doctor stages the cancer based on a physical exam, test results, and scans, without surgery. If you don’t have surgery right away, doctors may use clinical staging, often written as cTNM.
– Pathological staging: This is when the doctor stages the cancer by examining the tissue removed during surgery, including lymph nodes if they’re tested. This stage may be written as pTNM.
Both clinical and pathological staging are used. Talk to your doctor about which method was used for your staging to understand your node stage better.
Clinical Staging (before surgery)
– cNX: The nearby lymph nodes can’t be assessed.
– cN0: No lymph nodes in the groin appear enlarged.
– cN1: One lymph node in the groin feels enlarged and moves when touched.
– cN2: Two or more enlarged lymph nodes in the groin that also move when touched. These could be on one or both sides of the groin.
– cN3: One of the following:
– A large lymph node in the groin that doesn’t move.
– Swollen lymph nodes on one or both sides of the pelvis.
Pathological Staging (after surgery)
– pNX: It’s not possible to determine if cancer has spread to lymph nodes.
– pN0: No lymph nodes contain cancer cells.
– pN1: Cancer is in 1 or 2 lymph nodes in the groin (inguinal).
– pN2: Cancer is found in 3 or more lymph nodes in the groin or on both sides of the groin.
– pN3: One or both of the following:
– Cancer in lymph nodes on one or both sides of the pelvis.
– Cancer in a lymph node that has spread into nearby tissues.
Metastasis (M)
The “Metastasis (M)” part of staging shows if cancer has spread to other parts of the body.
There are two stages of metastasis:
– M0: Cancer has not spread to other organs or tissues.
– M1: Cancer has spread to other areas of the body.
Treatment
The stage of your cancer helps your doctor decide on the best treatment for you. Treatment also depends on:
– The type of cancer (the kind of cells where it started)
– The location of the cancer
– Any other health conditions you have
The stage and these factors can also give you an idea of your likely outlook (prognosis).
Treatment options may include:
– Surgery
– Other treatments like laser therapy, freezing (cryotherapy), or chemotherapy creams
– Radiotherapy
– Chemotherapy
– A combination of chemotherapy and radiotherapy (chemoradiotherapy)
You might also have treatment as part of a clinical trial.