Stages and Grades of Penile Cancer

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Staging of penile cancer is performed according to the guidelines recommended by the Union Internationale Contre le Cancer (UICC), which stages the cancer base on the location of the primary tumour, clinical and pathological status of regional lymph nodes, and also the presence of metastasis of cancer.


For treatment planning in patients with penile cancer, the diagnosis must be confirmed by biopsy and also the tumour stage. In fact, invasive penile cancer usually has exogenous growth. The histological subtype and tumour grade are the main determinants of prognosis—the UICC classification grades I to III and also sarcoidal, retrodifferentiated​1​.

Squamous cell carcinoma is more difficult to detect than adenocarcinoma. In fact, this explains the large difference in the incidence of penile cancer among observers​2​. Consequently, there is no convincing prognostic difference between G1 and G2 in cancers of the penis, especially since highly differentiated squamous cell carcinomas of the penis can also have aggressive growth and metastatic spread.

The classification of TNM for penile carcinoma according to the Union Internationale Contre le Cancer or in other words, the UICC is as follows​3​.

Primary Tumor:

Tis: Carcinoma in situ

Ta: Tumor is localised verrucous carcinoma with no invasion

T1: Tumor penetrates the connective tissue of the subepithelium

T1a: no lymphatic involvement and well-differentiated

T1b: lymphatic involvement or poorly differentiated

T2: tumour has entered the cavernous body with or without urethral involvement

T3: Tumor penetrates the corpus cavernosum with or without urethral involvement

T4: Tumor penetrates into other adjacent structures

Regional lymph nodes (N) (clinical):

N0: no obvious or appreciably enlarged inguinal lymph nodes

N1: palpable mobile unilateral lymph node

N2: tactile, mobile, multiple or bilateral inguinal lymph nodes

N3: Fixed inguinal mass or pelvic lymphadenopathy, bilateral or unilateral

Regional lymph nodes (pN) (pathological):

pN0: no metastases to regional lymph nodes

pN1: metastasis to 2 regional lymph nodes

pN2: metastases to 3 or more unilateral or bilateral inguinal lymph nodes

pN3: pelvic lymph node metastases, unilateral or bilateral, or any additional expansion of regional lymph node metastases

Distant metastasis (M):

M0: No metastasis in a distant part

M1: Distant metastasis


  1. 1.
    O’Sullivan B, Brierley J, Byrd D, et al. The TNM classification of malignant tumours-towards common understanding and reasonable expectations. Lancet Oncol. 2017;18(7):849-851. doi:10.1016/S1470-2045(17)30438-2
  2. 2.
    Kakies C, Lopez-Beltran A, Comperat E, et al. Reproducibility of histopathologic tumor grading in penile cancer–results of a European project. Virchows Arch. 2014;464(4):453-461. doi:10.1007/s00428-014-1548-z
  3. 3.
    Dickstein R, Munsell M, Pagliaro L, Pettaway C. Prognostic factors influencing survival from regionally advanced squamous cell carcinoma of the penis after preoperative chemotherapy. BJU Int. 2016;117(1):118-125. doi:10.1111/bju.12946