Penile Cancer Flashcards
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.
Association with penile cancer
HPV especially 16, 6 and 18
Accounts for around one third to a half of all cases.
Types of penile cancer
SCC (95%) arising from the epithelium of the inner prepuce
BCC
Sarcoma
Melanomas
Urethral carcinoma
Risk factors
HPV infection
Phimosis
Smoking
Lichen sclerosis
Untread HIV infection
Previous Psoralen-UV-A-Photochemotherapy PUVA
Circumcision is deemed protective
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.
Examination findings
Inguinal lymphadenopathy in 30-60% of cases
Distant metastases are uncommon at presentatin.
Dx
Herpes simplex
Syphilis
Psoriasis
Lichen planus
Balanitis
Condyloma acuminatum, Bowens disease and Lichen sclerosis are premalignant conditions
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
Management
Usually a combination of surgery, radiotherapy and chemotherapy
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)
Surgical management
Most will need surgery.
Traditionally a 2cm tumour-free margin has been recommended, but a 5mm margin is considered safe.
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.
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.
Treatment of penile cancer with inguinal node involvement.
Radical inguinal lymphadenectomy
Neoadjuvant chemotherapy or radiotherapy
Reconstruction options
Once disease free phallic reconstruction is possible by forearm phalloplasty
