Penis & scrotum



Topic Completed: 30 December 2019

Minor changes: 8 July 2021

Copyright: 2003-2021,, Inc.

PubMed Search: Staging of penile carcinoma[TI]

Debra L. Zynger, M.D.
Page views in 2020: 3,416
Page views in 2021 to date: 2,643
Cite this page: Zynger D. Staging-penis. website. Accessed October 15th, 2021.
Definition / general
  • All carcinomas of the penis are covered by this staging system
  • These topics are not covered: penile urethral carcinoma, sarcoma and melanoma
Essential features
  • AJCC 7th edition staging was sunset on December 31, 2017; as of January 1, 2018, use of the 8th edition is mandatory
Primary tumor (pT)
  • pTX: cannot be assessed
  • pT0: no evidence of primary tumor
  • pTa: noninvasive carcinoma (broad pushing penetration is permitted)
  • pTis: carcinoma in situ
  • pT1a: subepithelial invasion without lymphovascular invasion, perineural invasion or grade 3
  • pT1b: subepithelial invasion with lymphovascular invasion, perineural invasion or grade 3
  • pT2: invasion of corpus spongiosum
  • pT3: invasion of corpus cavernosum
  • pT4: invasion of adjacent structures including scrotum, prostate and pubic bone
Regional lymph nodes (pN)
  • pNX: cannot be assessed
  • pN0: no regional lymph node metastasis
  • pN1: metastasis in 1 or 2 unilateral inguinal node(s)
  • pN2: metastasis in 3 or more unilateral inguinal nodes OR bilateral inguinal nodes
  • pN3: extranodal extension OR metastasis to pelvic lymph node

  • Regional lymph nodes include superficial / deep inguinal and pelvic (external iliac, internal iliac / hypogastric, obturator, pelvic NOS)
Distant metastasis (pM)
  • pM1: distant metastasis

  • Distant metastasis includes common iliac and aortic / caval lymph nodes
AJCC prognostic stage groups
Stage group 0is:  Tis  N0  M0
Stage group 0a:  Ta  N0  M0
Stage group I:  T1a  N0  M0
Stage group IIA:  T1b - 2  N0  M0
Stage group IIB:  T3  N0  M0
Stage group IIIA:  T1 - 3  N1  M0
Stage group IIIB:  T1 - 3  N2  M0
Stage group IV:  T4  N1 - 3, X  M0
 T1 - 4, X  N3  M0
 T1 - 4, X  N1 - 3, X  M1
Registry data collection variables
  • Histologic subtype
  • Size of largest node metastasis
  • Total number of nodes removed
  • Presence of high risk HPV
  • p16 immunohistochemical expression
  • Urethral mucosal invasion
Histologic grade (G)
  • GX: cannot be assessed
  • G1: well differentiated
  • G2: moderately differentiated
  • G3: poorly differentiated
Histopathologic type
  • Non HPV related squamous cell carcinoma
    • Usual type
    • Pseudoglandular
    • Verrucous
    • Cuniculatum
    • Papillary, NOS
    • Adenosquamous
    • Sarcomatoid
    • Mixed
  • HPV related squamous cell carcinoma
    • Basaloid
    • Papillary basaloid
    • Warty
    • Warty basaloid
    • Clear cell
  • Rare other types of squamous cell carcinoma
Gross images

Contributed by Debra Zynger, M.D.





pT3 partial penectomy

pT3 penectomy

Microscopic (histologic) images

Contributed by Debra Zynger, M.D.

CIS / PeIN (pTis)

Subepithelial invasion (pT1a)

Perineural invasion (pT1b)

Perineural invasion (pT1b)

Invasion of corpora spongiosum (pT2)

Inguinal lymph node metastasis (pN1)

Board review style question #1

    A 72 year old man has a penectomy revealing squamous cell carcinoma with corpus cavernosum invasion, shown here. Which is the correct pT category for this tumor?

  1. pT1a
  2. pT1b
  3. pT2
  4. pT3
  5. pT4
Board review style answer #1
D. pT3. Corpus cavernosum invasion is classified as pT3.

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Reference: Pathologic TNM staging of penis carcinoma (AJCC 8th edition)
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