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After penile cancer has been diagnosed, tests are done to find out if cancer cells have spread within the penis or to other parts of the body. There are three ways that cancer spreads in the body. The following stages are used for penile cancer: Stage 0 (Carcinoma in Situ) Stage I Stage II Stage III Stage IV

After penile cancer has been diagnosed, tests are done to find out if cancer cells have spread within the penis or to other parts of the body.

The process used to find out if cancer has spread within the penis or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.

There are three ways that cancer spreads in the body.

The three ways that cancer spreads in the body are:

• Through tissue. Cancer invades the surrounding normal tissue.
• Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
• Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

The following stages are used for penile cancer:

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found on the surface of the skin of the penis. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed and spread to connective tissue just under the skin of the penis.

Stage II

In stage II, cancer has spread to:

• connective tissue just under the skin of the penis and to one lymph node in the groin. or
• erectile tissue (spongy tissue that fills with blood to make an erection) and may have spread to one lymph node in the groin.

Stage III

In stage III, cancer has spread to:

• connective tissue or erectile tissue of the penis and to more than one lymph node on one or both sides of the groin; or
• the urethra or prostate, and may have spread to one or more lymph nodes on one or both sides of the groin.

Stage IV

In stage IV, cancer has spread:

• to tissues near the penis and may have spread to lymph nodes in the groin or pelvis; or
• anywhere in or near the penis and to one or more lymph nodes deep in the pelvis or groin; or
• to distant parts of the body.

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