How is penile cancer diagnosed?

Blood tests – a full blood count (to measure your white blood cells, red blood cells and platelets), tumour markers (to measure chemicals produced by cancer cells) and to check if you have an infection.

Biopsy – the removal of some tissue from the affected area or region for examination under a microscope. In penile cancer, the following biopsies may be used:

• a punch biopsy or elliptical excision of the affected region to remove tissue. This procedure is generally performed under a local anaesthetic.
• a fine needle aspiration biopsy where a local anaesthetic is used to numb the area then a thin needle is inserted into the tumour or lymph node under ultrasound or CT guidance.
• a sentinel lymph node biopsy (under local anaesthetic) to see if cancer cells have spread to lymph nodes near the penis
• removal of the lymph nodes from one or both sides of the groin to see if the cancer has spread. This operation is performed under a general anaesthetic and the nodes are removed through small cuts in the groin.

Ultrasound scan – high-frequency soundwaves are used to create pictures of the inside of your body. For this scan, you will lie down, and a gel will be spread over the affected part of your body. A small device called a transducer is moved over the area by an ultrasound radiographer.

The transducer sends out soundwaves that echo when they encounter something dense, like an organ or tumour. The ultrasound images are then projected onto a computer screen. An ultrasound is painless and takes about 15–20 minutes.

CT (computerised tomography) or MRI (magnetic resonance imaging) scans – special machines are used to scan and create pictures of the inside of your body. Before the scan you may have an injection of dye (called contrast) into one of your veins, which makes the pictures clearer. During the scan, you will need to lie still on an examination table. For a CT scan the table moves in and out of the scanner which is large and round like a doughnut; the scan itself takes about 10 minutes. For an MRI scan the table slides into a large metal tube that is open at both ends; the scan takes a little longer, about 30–90 minutes to perform. Both scans are painless. With an MRI, you may need an injection into the penis with a drug to make it erect. This makes it easier to find a cancer in the penis.

PET (positron emission tomography)–CT scan – a scan combined with a CT scan where you are injected in your arm with a glucose solution containing some radioactive material. Cancer cells show up brighter on the scan because they absorb more glucose than normal cells do.