Penile Cancer Flashcards Preview

Y3M - Urology > Penile Cancer > Flashcards

Flashcards in Penile Cancer Deck (16)
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1

Epidemiology

Around 630 men diagnosed each year in the UK

Higher rates are seen in Africa, SE Asia and South America

Most commonly diagnosed in men over 60.

2

Association with penile cancer

HPV especially 16, 6 and 18

Accounts for around one third to a half of all cases.

3

Types of penile cancer

SCC (95%) arising from the epithelium of the inner prepuce

BCC

Sarcoma

Melanomas

Urethral carcinoma

4

Risk factors

HPV infection

Phimosis

Smoking

Lichen sclerosis

Untread HIV infection

Previous Psoralen-UV-A-Photochemotherapy PUVA

Circumcision is deemed protective

5

Clinical features

Palpable or ulcerating lesion on the penis

Most commonly located on the glans but can also be found on the foreskin, penile shaft and scrotum.

Typically painless lesions

Lesions can discharge or be prone to bleeding.

6

Examination findings

Inguinal lymphadenopathy in 30-60% of cases

Distant metastases are uncommon at presentatin.

7

Dx

Herpes simplex

Syphilis

Psoriasis

Lichen planus

Balanitis

Condyloma acuminatum, Bowens disease and Lichen sclerosis are premalignant conditions

8

Investigations

Referral to specialist regional centre

Penile biopsy which confirms diagnosis

Once confirmed inguinal lymphadenopathy should be determined. This is usually by PET-CT imaging

CT chest-abdo-pelvis is done if +ve inguing LN

TNM staging is used

9

Management

Usually a combination of surgery, radiotherapy and chemotherapy

10

Medical managements

Superficial non-invasive disease can be treated with topical chemotherapy agents like imiquimod or 5-FU and then have follow-up with repeat biopsy and long term surveillance.

Laser treatment or glans resurfacing (complete removal of the glandular epithelium down to the corpus spongiosum and then graft inserted)

11

Surgical management

Most will need surgery.

Traditionally a 2cm tumour-free margin has been recommended, but a 5mm margin is considered safe.

12

Treatment of invasive disease confined to the glans.

Organ sparing treatment like...

Local excision

Partial glansectomy

Total glansectomy with reconstruction.

Radicl circumcision can be used for purely foreskin tumours.

13

Treatment options for invasive penile cancer that is not confined to the glans.

Partial amputation with reconstruction

Total penectomy  with perineal urethrotomy

Neoadjuvant radiotherapy or chemotherapy may also be required.

14

Treatment of penile cancer with inguinal node involvement.

Radical inguinal lymphadenectomy

Neoadjuvant chemotherapy or radiotherapy

15

Reconstruction options

Once disease free phallic reconstruction is possible by forearm phalloplasty

16

Prognosis of penile cancer

Largely treatable disease

85% 5 year survival rate at T1

Reduced to 12% 5 year if distant metastases

Overall 5 year is around 70%