Dr Swati Shah · Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
Shah’s Gastro, Cancer & Robotic Surgery Centre — trained at national cancer centres, fully qualified in surgical oncology, and operating on urological cancers every week.
Dr Swati Shah
MS, DrNB (Surgical Oncology)
Penile Cancer Surgeon · Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
This page is for a man who has been told the lesion on his penis is cancer, and for the wife, son or daughter sitting beside him. It explains what can be preserved and what cannot, what the groin operation is for, and how each choice changes urinary and sexual function afterwards. It is written by Dr Swati Shah, Penile Cancer Surgeon at Apollo Hospital, Bhat, Gandhinagar.
Almost every man who reaches this consultation has been treated for something else first. A sore place under the foreskin, a patch that would not heal, a discharge — and a course of antibiotics, then an antifungal cream, then another course. Months pass that way. By the time a biopsy is finally taken, the conversation is no longer only about the penis; it is also about the lumps in the groin.
That delay is not the patient’s fault and it is not unusual. India carries more penile cancer than any other country, and late presentation is the pattern here rather than the exception. What matters now is that the next set of decisions is made properly and in the right order.
Any ulcer, plaque, warty growth or hard patch on the penis that has been present for more than four weeks should be biopsied, not treated with another cream. That single reflex — one more course of antifungals, review in a month — is the largest single cause of late presentation in this disease.
The warning signs are ordinary-looking, which is exactly the problem. A non-healing ulcer. A thickened or discoloured patch on the glans. Bleeding or a foul discharge from under the foreskin. A foreskin that has suddenly become tight in an adult man when it never was before. Any of these, present beyond a month, is cancer until a biopsy says otherwise.
There is one presentation worth naming separately, because it is missed often. A man attends with lumps in the groin and no obvious problem on the penis. The foreskin must be fully retracted and the glans examined. The primary is hiding underneath it more often than anyone expects.
Four findings on the biopsy report decide the whole plan: the grade, the depth of invasion, whether lymphovascular invasion is present, and whether there is perineural invasion. Together with an examination of both groins by the operating surgeon, these decide whether the nodes need an operation at all.
A punch or incisional biopsy of the primary is taken with the foreskin fully retracted. The report should state the histological subtype, the grade, the depth of invasion, lymphovascular invasion, perineural invasion and HPV or p16 status. If the report you are carrying does not mention lymphovascular invasion, that is worth asking about before treatment is planned — it is one of the findings that decides the groin.
Both groins are then examined by Dr Swati Shah personally, and what she feels is written down: the size of any node, how many, which side, whether it moves, whether the skin over it is involved. A scan does not replace that examination. Where a node can be felt, a needle test — FNAC — is quick, inexpensive and decisive; a positive result moves a man straight onto a definitive nodal pathway and saves him an unnecessary staging procedure.
A clear margin is measured in millimetres, not centimetres. The old rule of removing two centimetres beyond the tumour is obsolete, and that single change is why many men who would once have had an amputation now keep a working penis.
The tumour decides how much is removed, not tradition. Where the disease allows it, Dr Swati Shah uses the smallest operation that will still clear the cancer, and checks the margin on frozen section during the operation rather than waiting a week to find out.
| Operation | Suitable when | What is left afterwards |
|---|---|---|
| Circumcision alone | Disease confined to the foreskin | A normal penis, minus the foreskin |
| Glans resurfacing | Carcinoma in situ and selected very early disease | Full length, altered surface sensation |
| Wide local excision | Small lesions away from the glans tip | Full length, a small defect |
| Glansectomy with a skin graft | Disease confined to the glans — the workhorse operation | Full shaft length, a reconstructed tip, standing micturition, intercourse usually still possible |
| Laser treatment | Selected superficial disease, with reliable follow-up | A normal-looking penis, higher recurrence risk |
Glansectomy with a graft is the operation most men with disease limited to the glans are offered. It preserves the length of the shaft and, with it, standing urination and in most cases penetrative intercourse. What changes is the appearance of the tip and the quality of sensation there. That is a real loss and it is discussed honestly before surgery, not afterwards.
If the final pathology shows the margin was not clear, that is not a disaster — but it must be acted on promptly with a re-excision, not watched.
Partial penectomy is done when no smaller operation can clear the cancer but enough length remains to pass urine standing. Total penectomy with a perineal urethrostomy is done when the tumour reaches the base — after it, urine is passed sitting down, permanently. That is a certainty, not a risk, and it is said plainly before consent.
These are the hardest conversations in this specialty, and Dr Swati Shah does not delegate them or compress them into the pre-operative visit. A man consenting to amputation of this organ is consenting to something that touches his sense of himself, and the commonest complaint afterwards is never about pain. It is “nobody told me it would be like this”.
So the certainties are stated first, before any list of risks. After a partial or total penectomy the appearance of the penis is permanently changed and cannot be restored. The urinary stream changes permanently. Sexual function changes permanently: after a partial penectomy intercourse may still be possible, though sensation and appearance are altered; after a total penectomy penetrative intercourse is not possible. After a total penectomy a new opening is made behind the scrotum — a perineal urethrostomy — and urine is passed sitting, for the rest of his life.
Wherever the patient permits it, his wife or partner is counselled in the same sitting. Reconstruction of the penis is technically possible in India but is almost never funded, and it is only considered after the cancer is cleared and a disease-free interval has passed. It is not offered here as a routine expectation, because raising it and then withdrawing it is worse than never raising it.
Whether the lymph nodes in the groin are involved is the strongest single indicator of how penile cancer will behave — stronger than the size of the lesion. This is why the groin is staged actively rather than watched, and why an unstaged groin is the situation nobody can recover from later.
The penis drains to lymph nodes in the fold at the top of each thigh. Cancer cells that leave the primary arrive there first. A man with a small lesion and involved groin nodes is in a more serious position than a man with a larger lesion and clear ones. The T stage of the primary matters mainly because it predicts what the nodes are doing.
| Nodal situation | What is done | Why |
|---|---|---|
| No palpable nodes, lowest-risk primary | Structured three-monthly examination of both groins. No groin operation | The chance of hidden disease is negligible; an operation would be all cost and no benefit |
| No palpable nodes, intermediate or high-risk primary | The groin is staged surgically — this is not optional | A meaningful proportion of these men have disease in nodes that cannot be felt |
| Palpable node, needle test positive, not bulky | Full lymph node dissection on that side; the other groin is staged | Known disease is removed; the opposite side is not assumed clear |
| Bulky, fixed or both-sided nodes | Chemotherapy first, restage, then operate on those who respond | Surgery through fixed disease leaves tumour behind and costs the man a long recovery for nothing |
| Heavy nodal disease found on the groin pathology | Pelvic lymph node dissection on that side is added | Disease that has reached this point travels onward to the pelvis |
One point here is specific to what can actually be delivered in Ahmedabad, and Dr Swati Shah states it rather than glossing over it. The international guideline prefers a sentinel node biopsy for a man with no palpable nodes and an intermediate or high-risk primary — a small, low-morbidity operation that samples the first node the cancer would reach. It depends on a radioactive tracer, a same-day nuclear medicine scan and a trained probe team all being available together, and that combination is not dependable here.
When it cannot be confirmed for the day of surgery, the answer is not to fall back on watching the groin. It is to perform a modified, more limited lymph node dissection instead. Watching an intermediate-risk groin because the tracer was unavailable is the single most consequential mistake in this pathway, and this unit does not make it.
The groin dissection is an open operation, and two technical choices made during it decide whether the leg swells afterwards: preserving the saphenous vein where the cancer allows, and covering the exposed vessels with a muscle flap where the skin is thin.
Where a groin has thin or previously irradiated skin, a plastic surgeon is booked in advance rather than called at six in the evening. Suction drains stay in both groins until the output falls; they are not removed early to shorten an admission, because the fluid collection that follows is worse than the drain.
Before an elective groin dissection, diabetes is brought under control, smoking is stopped and nutrition is corrected. This is not administrative caution — a groin dissection on an unoptimised diabetic is how a wound becomes a three-month problem.
Where the groin nodes are bulky, fixed or present on both sides, chemotherapy is given first, the disease is formally restaged, and surgery follows for the men who have responded. Operating first in this situation usually leaves tumour behind.
This is the commonest situation in Indian practice and the one the European guidelines serve least well, because they are written around early disease with impalpable nodes. One thing is said openly at consent: the large trial designed to settle this sequencing question has not yet reported, so the recommendation rests on smaller studies and expert consensus rather than the highest grade of evidence. Dr Swati Shah says so rather than presenting it as settled.
Recovery after penile cancer surgery runs on two separate clocks — the penis heals in weeks, the groin in months. Knowing which clock you are on prevents most of the distress families describe afterwards.
| Function | First fortnight | By three months | Long term |
|---|---|---|---|
| Passing urine | Catheter for a few days; stream sprays or deviates at first | Settled pattern; sitting to pass urine if a perineal urethrostomy was made | Narrowing at the opening can occur later and is treatable — report straining or spraying early |
| The penile wound or graft | Dressings; graft take is checked at the first review | Healed, appearance settled | Appearance is permanently changed after amputative surgery |
| Sexual function | Not yet relevant; discussed before surgery, not after | Realistic picture emerges | Altered after organ-preserving surgery; not possible penetratively after total penectomy |
| The groin wounds | Drains in; skin edges watched daily — this is when breakdown declares itself | Often still under dressings; this is normal, not failure | Scar and permanent numbness over the upper thigh |
| The legs | Elevation, compression teaching begins | Swelling may begin now rather than at the start | Leg swelling, if it starts, is managed for life rather than cured — skin care, elevation and compression become permanent habits |
Leg swelling deserves a sentence of its own. It is the complication men remember, it often begins weeks after everything else has healed, and every episode of skin infection makes it permanently worse. That is why a physiotherapy referral and a compression garment are arranged before discharge rather than after the first problem, and why any red, hot, painful leg is treated the same week.
★★★★★
“We came from Surendranagar for Treatment of penis cancer. Dr swati shah operated my father and done surgery...After surgery he is very well . From deep down thanking u Dr swati shah. She is best uro gynac cancer surgeon in Ahmedabad Gujarat...”
BHARATKUMAR JADAV · Google review, Gota clinic
Penile cancer is a disease men do not talk about, so there are very few public accounts of it. One family who travelled to Ahmedabad for this operation wrote the following on Google, and it is reproduced exactly as they wrote it.
That is the only review on our Google listings that names this disease, and it is quoted here unedited, spelling and all. We do not substitute reviews from other cancers to make the page look better proved than it is.
Dr Swati Shah’s own explainer on penile cancer surgery, treatment and recovery is below. It is recorded in Hindi.
More patient accounts and short explainers for this line are collected on our testis and penile cancer video testimonials page and in the testis and penile cancer educational videos collection.
From first consultation to full healing, penile cancer treatment at Apollo Hospital, Bhat runs through five stages. Most men complete the first two within a week of making contact.
The cost of penile cancer treatment is driven by two things more than by the operation on the penis itself: whether a groin dissection is needed on one side or both, and whether reconstruction or prolonged groin wound care is required afterwards. Both are settled before scheduling, never during the admission.
What moves an estimate: whether one groin or both are operated on, whether a plastic surgery flap is needed for skin cover, how long the groin drains stay in, whether chemotherapy is given before surgery, and whether there are other medical problems — diabetes above all — that lengthen the stay. The operation on the penis is rarely the expensive part.
Apollo Hospital, Bhat is empanelled with the major insurers and with Ayushman Bharat. Pre-authorisation is done by the hospital’s own team before admission wherever cover exists; send the policy details along with your reports and it is started in parallel with the medical planning. For self-funding families, the estimate is given in writing after the plan is fixed, and the groin decision is the line item that moves it most.
Both groins are examined by a clinician every three months for the first two years, because that is when a recurrence appears and when it is still curable. In Indian practice, more recurrences are found by the patient himself than by the surgeon — so you and your wife are taught how to examine the groins.
Examination beats imaging here. At every visit the penis or the stump, the urethral opening and both groins are examined, the legs are measured, and function is asked about directly rather than left for the patient to raise. Scans are used where the disease was node-positive, and for anything felt that is not clearly benign.
Usually not. Most men with disease limited to the glans keep the length of the shaft through a glansectomy with a graft. Total removal is reserved for tumours reaching the base. Ask specifically whether organ-preserving surgery is possible in your case — the answer is yes more often than families expect.
After organ-preserving surgery and after most partial penectomies, yes. After a total penectomy, no — urine is passed sitting, through an opening made behind the scrotum, permanently.
After organ-preserving surgery, usually yes, with altered sensation and appearance. After a partial penectomy it may still be possible. After a total penectomy penetrative intercourse is not possible. This is discussed with your wife present wherever you allow it.
Because in penile cancer, disease in nodes that cannot be felt is common enough that waiting for a lump to appear costs men their lives. If your biopsy shows higher grade or invasion into vessels or nerves, the groin is staged surgically.
It may, and if it does it is managed lifelong rather than cured. That is why the saphenous vein is preserved where possible, why compression and physiotherapy start before discharge, and why every skin infection in that leg is treated immediately.
A few weeks to control diabetes, stop smoking and correct nutrition before a groin dissection is time well spent and is often advised. A few more months of cream on an undiagnosed ulcer is not.
Dr Swati Shah I Robotic Uro Oncologist I Prostate, Kidney, Bladder Cancer specialist
Gota, Ahmedabad, Gujarat
Directions to the Gota clinic
Dr Swati Shah Uro Oncologist I Prostate, Bladder, Kidney Cancer I Robotic surgeon
Apollo Hospital, Bhat, Gandhinagar, Gujarat
Directions to Apollo Hospital, Bhat
Telephone and WhatsApp: +91 63590 11009
Dr Swati Shah consults at the Gota OPD in Ahmedabad and operates at Apollo Hospital, Bhat, Gandhinagar. Men travelling from Saurashtra, north Gujarat and Rajasthan are usually able to complete the consultation and the tests in a single visit if they call ahead.
Two questions decide everything in penile cancer: how much of the penis has to be removed, and what is done about the lymph nodes in the groin. They are separate decisions, they are made at different moments, and only one of them decides survival. This page explains both before you are asked to sign anything. Call +91 63590 11009 WhatsApp Dr Swati Shah's team
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