Penile Cancer

Question 1

What is the peak incidence of penile cancer?

Answer 1

> 70y

Question 2

Name 3 risk factors for penile cancer?

Answer 2

Genital warts
HPV 16 & 18 (in 50%)
Phimosis

Question 3

What nodes does penile cancer generally affect first?

Answer 3

Inguinal nodes
Bilateral nodal involvement is common
Superficial inguinal —> deep inguinal —> pelvic

Question 4

What percentage of pts with involved inguinal nodes also have involved pelvic nodes?

Answer 4

20-30%

Question 5

What investigations should be performed?

Answer 5

Physical exam recording diameter of lesion, location, morphology, relationship to other structures, colour & boundaries of lesion, penile length

MRI with intracavernosal injection of prostaglandin E1

Pelvic CT

Nodal Ix according to stage

Question 6

How would you Ix a pt with impalpable nodes?

Answer 6

Low risk (T1G1): surveillance only

Intermediate risk (T1G2): DSNB

High risk (>T2): DSNB +- inguinal LN dissection

Question 7

How would you Ix palpable nodes?

Answer 7

FNA biopsy

PET/CT if node +ve

Question 8

What is the histological type in >95%?

Answer 8

Squamous cell carcinoma

Question 9

What T stage is a tumour that invaded the urethra?

Answer 9

T3

T1: invades subepithelial tissue
   1a: no LVSI, G1-2
   1b: with LVSI, G3-4
T2 invades corpus spongiosum/corpora cavernosa 
T3: invades urethra
T4: invades other adjacent structures

Question 10

What T stage is a tumour that is invading into the corpus cavernosa?

Answer 10

T2

T1: invades subepithelial tissue
   1a: no LVSI, G1-2
   1b: with LVSI, G3-4
T2 invades corpus spongiosum/corpora cavernosa 
T3: invades urethra
T4: invades other adjacent structures

Question 11

What N stage would a penile cancer with bilateral mobile inguinal nodes be?

Answer 11

N2

N1: palpable mobile unilateral inguinal LN

N2: palpable mobile multiple or bilateral inguinal LN

N3: fixed inguinal nodal mass or pelvic LN