penile cancer Flashcards
(18 cards)
Epidemiology of penile cancer
incidence:
nature
ages
standard incidence of 0.8-1/ 100,000
it’s a very aggressive tumour
affects both Old and Young men
RF for penile cancer
- Phimosis
- Chronic inflamation (balanitis Xerotica Obliterans)
- sexual behavior (HPV)
- Mx partners
- early sex
- unprotected sex
which types if HPV cause penile cancer
High risk: 7, 16, 18, 21
Low risk: 6 & 11
prevention for HPV
which ages is it given to
Preventive vaccine against HPV given to 11-12 y/o
Histological types of Penile cancer
where can it met to
MET EMMLY’s P in histology
- Epithelial (majority = SCC)
- Mesenchymal
- Melanomas
- Lymphomas
- 2ndary met from UB or PCa
3 types of Epithelial tumors (BIM)
most common condition for each type
Benign
- (Condyloma acuminata- hpv 6 & 11 from 40% of warts
Intermediate
- (Intraepithelial Neoplasia (carcinoma in situ))
Malignant
- SCC in 95-97% of cases
types of intermediate epithelial cancer of the penis
-
Intraepithelial Neoplasia aka PIN/CIS
- erythroplasia of queyrat
- bowens disease
- Bowens papilosis
- Padget’s DIsease = adenocarcinoma
-
Giant condylomata acuminata aka
- Buschke- Lovenstein tumor
2016 types subtypes of SCC of the penis
- 4 types of hpv related (big women cum more)
- 3 types of non hpv (virgins usually suck)
- 2 types of PIN SCC
-
HPV related
- Basaloid SCC
- Warty SCC
- Clear cell SCC
- Medullary SCC
-
Non HPV related
- Verrucus SCC
- Usual SCC
-
Sarcomatoid / spindle SCC (favorable prog)
-
Precursor lesions(PIN/CIS)
- HPV related Warty SCC
- Non HPV related Verrucus SCC
-
Precursor lesions(PIN/CIS)
Clinica features of Penile cancer
- pain in the prepuce
- Dysuria
- Seropurulent discharge develops into foul smelling blood stained discharge over months
- Inguinal LN enlargment
how does Penile cancer spread
via Lymph
Clinical and Pathological staging of Penile Cancer using TNM 2017
step wise approach
TNM 2017
- N = inguinal LN’sadjacent to external iliac artery__which can be
- S__uperficial inguinal LN OR
- Deep inguinal LN
- which then spread to Pelvic LN’S
- which then spread to Obturator LN
What is the 3 step rx of Penile carcinoma
What determines the type treatment of Penile carcinoma
STEP 1! sperm retreival for fertility
STEP 2 = Surgery depends on TNM 2017 grading
- Tis, TA, T1 = Superficial Penile cancer
- Penis saving surgery
- T2, - T4 = Invasive Penile cancer
- Radical surgery (penectomy)
STEP 3 = Dissection of LN
which specific method of penis saving surgery are used for superficial penile cancer
- Wide local excisionn: tumors of glans penis
- Circumcision : for tumors of prepuce
- Combo of above (circ and wide excision)
- Laser therapy
Specific methods for Radical surger of Invasive penile cancer
2 steps of total penile amputation
- Partial penile amputartion
or
-
Total penile Amputation (Penectomy)
- w/ or w/o emasculation ( testis removal)
- Perineal reconstruction of the urethra
What determines the type of LN dissection
standard vs BMILD
depends on whether it’s clinically palpable
- N+ve =
- immediate standard LN dissection
- N-ve = Aggressive approach w/ (B mild)
-
do not perform sentinal LN biopsy
- preffered = Bilateral Modified Inguinal LN Dissection
-
do not perform sentinal LN biopsy
when is Bilateral Modified Inguinal LN Dissection preferred in penile cancer
clinically negative regional lymph nodes
(inguinal LN adjacent to external illiac arrtery)
Tis, TA, T1 = Superficial Penile cancer is treated how?
4 types of rx
Penis saving surgery
- Circumcision : for tumors of prepuce
- Wide local excisionn: tumors of glans penis
- Combo of above (circ and wide excision)
- Laser therapy
T2, - T4 = Invasive Penile cancer is treated how
Radical surgery (penectomy)
- partial penectomy
- total penectomy
- emascualtion and perineal reconstruction
