Physical exam and history
Physical examination is an exam of the body to check general signs of health, including checking the penis for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits, past illnesses, and treatments will also be taken.
Biopsy
To confirm the diagnosis of cancer, the surgeon may require to remove cells or tissues so they can be viewed under a microscope by a pathologist to check for presence of tumor. Tissue samples can be removed in many ways including:
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Incisional biopsy: The removal of part of a lump or a sample of tissue that doesn't look normal.
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Excisional biopsy: The removal of an entire lump or area of tissue that doesn’t look normal.
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Sentinel lymph node biopsy (SLNB): The sentinel lymph node is the first lymph node in a pack of lymph nodes to receive lymphatic drainage from the primary tumor.
The sentinel lymph node is the location where the cancer is likely to spread to from the primary lesion.The procedure starts with the injection of a radioactive substance and/or blue dye near the tumor. From the primary lesion, the substance or dye flow through the lymph ducts to the regional lymph nodes. Patient is checked with specific probes to identify the first lymph node that receives the substance or dye. The node is then removed during surgery. If cancer is found, more lymph nodes might have to be removed to prevent spread and to stage the disease.
Imaging tests (magnetic resonance [MRI], groin ultrasound, CT scan, or PET/CT scan)
They are usually requested in combination with biopsy to stage the disease and to follow-up patients after initial treatment.
MRI of the penis: Is the best investigation for assessing local tumor stage and to define the extension of the disease across penile structures. It is usually carried after injection of medications that facilitate penile erection (papaverine injection) to better demark the infiltration of surrounding tissues and to identify the margins of the lesion/s.
Groin ultrasound: It is used to examine the inguinal lymph nodes that are the first sites to be involved by the cancer when it spreads outside the penis. Ultrasound is also helpful to guide the biopsy of suspicious inguinal lesions.
CT scan and PET/CT scan: They are requested to investigate the spread of the cancer to distant organs such as bones, abdomen organs, lungs, brains etc., but also to follow-up patients after surgical or medical treatments to detect recurrence (see later). Among different molecules that can be used for PET/CT scan, the fluorodeoxyglucose labelled with fluorine-18 (18F-FDG) is the most utilized and the most recommended. Fluorodeoxyglucose is a glucose analog that concentrates in cells that rely upon glucose as an energy source, or in cells whose dependence on glucose. Penile cancer cells are avid of fluorodeoxyglucose. Thus, marking the fluorodeoxyglucose with a tracer (fluorine-18) allows the identification of cancer cells in the human body.
