238 - Cancer of the Penis Flashcards
What are the signs/symptoms of metastatic penile cancer? (5)
- Priapism
- Palpable mass
- Pain
- Hematuria
- Urethral bleeding
List 4 non-HPV related pre-malignant lesions of the penis (4)
These should be biopsied!
- Lichen sclerosis
- Pale tissue
- Urethral stricture
- Leukoplakia
- Cutaneous penile horn
- Pseudoepitheleiomatosis, keratotic, and micaceous balanitits
What tissue layer separates the superficial and deep inguinal lymph nodes?
Fascia lata of the thigh
Which HPV viral protein dysregulates Rb?
E7
- Results in increased E2F function -> mitogenesis*
- Body reacts by upregulating p16*
What are the risk factors for penile cancer? (6)
- Lack of neonatal circumcision
- Increased number of sexual partners
- Tobacco use
- HPV
- HIV
- Poor general hygiene
Basically, anything that increases the risk of HPV or chronic inflammation
What is the best imaging modality for imaging penile tumors?
MRI
What is the appropriate management of a patient who presens with advanced stage penile cancer?
Neoadjuvant chemo
Then try to remove the primary tumor/dissect nodes
Which CDK inhibitor is a surrogate marker for HPV infection?
p16
When Rb is dysregulated by viral protein E7, mitogenesis increases; the body reacts by upregulating p16, a CDK inhibitor that works to try to control mitogenesis
List the treatment options for metastatic penile cancer (4)
- Systemic chemotherapy (TIP)
- EGFR-targeted therapy
- Anti-PD1/PDL1 checkpoint inhibition
- Synthetic long peptide of HPV-16 specific vaccine
What is the gold-standard treatment for invasive penile tumors involving the glans and distal shaft?
Partial penectomy
- If a 1-2cm tumor-free margine can be achieved and sufficient penile length for standing urination is preserved*
- Otherwise, total penectomy*
- Lesions involving the proximal shaft will require a total penectomy*
What is methods are used to evaluate for lymph node involvement of penile cancer?
Physical examination = gold standard in non-obese pt
CT or MRI used in an obese pt and anyone with prior inguinal surgery
In patinets with invasive penile cancer, which lymph nodes should be dissected?
BILATERAL inguinal lymph nodes (superficial and deep)
And maybe external illiac (pelvic) nodes
- Dissect nodes to one level above involvement;*
- If penile cancer is invasive, do bilateral inguinal nodes*
- If the inguinal nodes are involved, do the external iliac nodes*
What is the most common type of penile cancer?
Squamous cell carcinoma
50% HPV related, 50% related to chronic inflammation
What is the gold-standard treatment for invasive penile tumors involving the proximal shaft?
Total penectomy
Penis-preserving procedure impossible in the proximal shaft
Which HPV-related penile cancer precursor involves the glans penis?
Erythroplasia of Queyrat
Bowen’s disease involves the shaft
What are the HPV-related precursor lesions to penile cancer (3)
These should be biopsied!
- Bowen’s disease (shaft)
- Erythroplasia of Queyrat (glans)
- Bowenoid papulosis
- Variant of penile intraepithelial neoplasia
Bowen’s disease and Queyrat are the same thing in different locations - both considered carcinoma in situ
Which HPV-related penile cancer precursors involves the shaft of the penis? (2)
Bowen’s disease
Bowenoid papulosis
Erythroplasia of Queyrat involves the glans penis
Which HPV viral protein interacts with the epidermal growth factor receptor and exerts mitogenic influence?
E5
Which HPV viral protein dysregulates p53?
E6
List the agents used in the TIP chemotherapy regimen
Used for advanced-stage penile cancer, sometimes as neo-adjuvant
Paclitaxel
Ifosfamide
Cisplatin
From which anatomical site do most penile cancers arise?
Glans
Glans > Prepuce > Shaft
What is the most important prognostic factor of penile cancer?
Lymph node involvement
(More nodes = worse prognosis)
Penile cancer will first go to the inguinal lymph nodes, then to the external iliacs
