penile cancer

Question 1

incidence of penile cancer

Answer 1

• high in south America and Africa
• very rare

Question 2

risk factors (5)

Answer 2

• age
• genital warts (condylomas)
• humanpapillomarvirus infection 16, 18, 31, 33
• phimosis (foreskin cant retract) + lack of circumsicsion
• chronic inflammatory conditions - penile lichen sclerosis

Question 3

HPV

Answer 3

found in 50% penile cancers

Question 4

penile lichen sclerosis

Answer 4

chronic inflammatory conditions

Question 5

Lifestyle risk factors (5)

Answer 5

• tobacco smoking
• obesity
• poor penile hygeina - smegma retention
• low socioeconomic status
• carcinogenic - UV-A phototherapy - look for those with psoriasis

Question 6

pathology / types

Answer 6

squamous cell carcinoma (95%):
arise from squamous cells of the:
- glans
- preputial skin (foreskin)
- keritinized penile shaft

subdivided into:
- basaloid
- warty
- papillary
- verrucous
- sarcomatoid
- adenosquamous

other:
- basal cell neoplasms
- blood vessel tumours
- melanomas
- ductal + lobular neoplasms

Question 7

staging

Answer 7

NODES
pNX - Unknown
pN0- No lymph node metastases
pN1- Cancer in 1 or 2 lymph nodes in the groin (inguinal).
pN2- Cancer in 3 or more lymph nodes in the groin (inguinal) or cancer in lymph nodes on both sides of the groin.
pN3- one or both of the following:
> Metastases in pelvic lymph nodes
> Metastases grown into surrounding tissues

METASTASES
M0- Cancer has not spread to other tissues/organs
M1- Cancer has spread to other tissues/organs

Question 8

presentation (5)

Answer 8

• painless lump on penis
• under foreskin - purulent discharge - thick, milky
• less commonly - ulcerative lesions on glans or prepuce (foreskin)
• often delayed presentation from embarrassment
• large lesions can obstruct urethra

Question 9

methods to use for diagnosis and staging

Answer 9

Diagnosis:
Biopsy penile lesion
Excision – whole lesion
Incision – partial (if large)

staging:
CT scan (Nodes & Metastases)
MRI (local staging)
PET scan (Nodes & Metastases)

Question 10

prevention of penile cancer

Answer 10

• circumsiscion
• HPV vaccine
• condom use
• good personal hygeine

Question 11

pre-malignant or pre-invasive treatment - Ta, Tis T1

Answer 11

pre-malignant or pre-invasive:
- circumcision / topical treatment
- Topical chemotherapy with 5-fluorouracil (5-FU) or immunotherapy with imiquimod
- laser
- crytotherapy - freezing it off

Question 12

localised cancer treatment - (T1-T2-T3)

Answer 12

• glans resurfacing - removal of disease + reconstruction)
• partial penectomy (partial removal of penis)
• total penectomy (full removal of penis) + perineal urethrostomy

Question 13

treatment of the nodes involved

Answer 13

Risk of lymph node metastasis:
cN0: 9% in T1 (grade 2) vs. 23% T1 (G3 or >T1)
cN+: 80% have metastatic disease

Radical inguinal lymphadenectomy (removing lymph nodes in groin):
>50% have complications
- Skin breaks down - infection dehiscence, necrosis
- Lymphoedema, lymphocele, Lymph leakage
- DVT
- Nerve damage

Question 14

advanced treatment - metastases

Answer 14

• Surgery – Palliative for management of the mass/infection/fistula
• Radiotherapy – palliation
• Chemotherapy – Vinflunine, Cisplatin & irinotecan,