238 - Cancer of the Penis Flashcards Preview

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Flashcards in 238 - Cancer of the Penis Deck (22)
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1

What are the signs/symptoms of metastatic penile cancer? (5)

  • Priapism
  • Palpable mass
  • Pain
  • Hematuria
  • Urethral bleeding

2

List 4 non-HPV related pre-malignant lesions of the penis (4)

These should be biopsied!

  • Lichen sclerosis
    • Pale tissue
    • Urethral stricture
  • Leukoplakia
  • Cutaneous penile horn
  • Pseudoepitheleiomatosis, keratotic, and micaceous balanitits

 

3

What tissue layer separates the superficial and deep inguinal lymph nodes?

Fascia lata of the thigh

4

Which HPV viral protein dysregulates Rb?

E7

 

Results in increased E2F function -> mitogenesis

Body reacts by upregulating p16

 

5

What are the risk factors for penile cancer? (6)

  • Lack of neonatal circumcision
  • Increased number of sexual partners
  • Tobacco use
  • HPV
  • HIV
  • Poor general hygiene

 

Basically, anything that increases the risk of HPV or chronic inflammation

6

What is the best imaging modality for imaging penile tumors?

MRI

7

What is the appropriate management of a patient who presens with advanced stage penile cancer?

Neoadjuvant chemo

Then try to remove the primary tumor/dissect nodes

8

Which CDK inhibitor is a surrogate marker for HPV infection?

p16

 

When Rb is dysregulated by viral protein E7, mitogenesis increases; the body reacts by upregulating p16, a CDK inhibitor that works to try to control mitogenesis

9

List the treatment options for metastatic penile cancer (4)

  • Systemic chemotherapy (TIP)
  • EGFR-targeted therapy
  • Anti-PD1/PDL1 checkpoint inhibition
  • Synthetic long peptide of HPV-16 specific vaccine

 

 

10

What is the gold-standard treatment for invasive penile tumors involving the glans and distal shaft?

Partial penectomy

 

If a 1-2cm tumor-free margine can be achieved and sufficient penile length for standing urination is preserved

Otherwise, total penectomy

 

Lesions involving the proximal shaft will require a total penectomy

11

What is methods are used to evaluate for lymph node involvement of penile cancer?

Physical examination = gold standard in non-obese pt

CT or MRI used in an obese pt and anyone with prior inguinal surgery

12

In patinets with invasive penile cancer, which lymph nodes should be dissected?

BILATERAL inguinal lymph nodes (superficial and deep)

And maybe external illiac (pelvic) nodes

 

 

Dissect nodes to one level above involvement;

If penile cancer is invasive, do bilateral inguinal nodes

If the inguinal nodes are involved, do the external iliac nodes

13

What is the most common type of penile cancer?

Squamous cell carcinoma

50% HPV related, 50% related to chronic inflammation

14

What is the gold-standard treatment for invasive penile tumors involving the proximal shaft?

Total penectomy

 

Penis-preserving procedure impossible in the proximal shaft

15

Which HPV-related penile cancer precursor involves the glans penis?

Erythroplasia of Queyrat

 

Bowen's disease involves the shaft

16

What are the HPV-related precursor lesions to penile cancer (3)

These should be biopsied!

  • Bowen's disease (shaft)
  • Erythroplasia of Queyrat (glans)
  • Bowenoid papulosis
    • Variant of penile intraepithelial neoplasia

 

Bowen's disease and Queyrat are the same thing in different locations - both considered carcinoma in situ

17

Which HPV-related penile cancer precursors involves the shaft of the penis? (2)

Bowen's disease

Bowenoid papulosis

 

Erythroplasia of Queyrat involves the glans penis

18

Which HPV viral protein interacts with the epidermal growth factor receptor and exerts mitogenic influence?

E5

19

Which HPV viral protein dysregulates p53?

E6

20

List the agents used in the TIP chemotherapy regimen

Used for advanced-stage penile cancer, sometimes as neo-adjuvant

Paclitaxel

Ifosfamide

Cisplatin

21

From which anatomical site do most penile cancers arise?

Glans

 

Glans > Prepuce > Shaft

22

What is the most important prognostic factor of penile cancer?

Lymph node involvement

(More nodes = worse prognosis)

Penile cancer will first go to the inguinal lymph nodes, then to the external iliacs