238 penis cancer

Question 1

What populations are most susceptible to squamous cell carcinoma of the penis?

Answer 1

uncircumcised African, South American, and Asian populations

Question 2

What are the risk factors for penile SCC?

Answer 2

uncircumcised, sexually active (HPV 16/18), and smoking

Question 3

What are the presentations of 3 HPV-related premalignant penile lesions?

Answer 3

Bowen’s disease: scaly graey-white erythema on shaft of penis
Erythroplasia = velvety, dark red, well demarked lesions on glans/prepuce
Bowenoid Papulosis = little reddish-brown papules

Question 4

Which HPV-related pre-cancerous lesions are in situ carcinomas?

Answer 4

Bowen’s disease, erythroplasia

Bowenoid papulosis often does not progress to invasion

Question 5

What premalignant penile lesions are unrelated to HPV?

Answer 5

lichen sclerosis, leukoplakia, cutaneous penile horn, pseudoepitheliomatous keratotic and micaceous balantis (PKMB), PeIN

Question 6

What is the presentation of penile SCC?

Answer 6

erythema on glans, prepuce, or shaft +/- palpable mass

can be a large/atypical warty lesion or an ulcerative/sessile tumor

Question 7

What defines invasive penile cancer?

Answer 7

involvement of corpora cavernosa and/or corpora spongiosum

Question 8

How are premalignant penile lesions treated?

Answer 8

circ, excision/biopsy, laser fulguration, topical 5-FU, imiquimod, Mohs, and radiation

Question 9

What are the management principles for non-invasive primary penile tumors?

Answer 9

eradication with surgery, radiation, and 5-FU

Question 10

What are the management principles for invasive penile SCC

Answer 10

amputation followed by bilateral regional lymph node dissection

Question 11

What is the treatment regimen for metastatic penile SCC?

Answer 11

triple therapy (paclitaxel, ifosfamide, cisplatin)
also EFGR targeted therapy or anti-PDL/PD1

Question 12

What is the role of E5 protein in carcinogenesis of penile SCC?

Answer 12

E5 overexpression leads to overexpression of EGFR and/or HER proteins

Question 13

What layer of fascia protects corporeal bodies from tumor invasion?

Answer 13

Buck’s fascia

can be penetrated along with the tunica albuginea, leading to vascular invasion

Question 14

What are the boundaries of the femoral triangle?

Answer 14

inguinal ligament (superior)
sartorius muscle (lateral)
adductor longus (medial)

Question 15

What tissue layer separates the superficial and deep inguinal lymph nodes?

Answer 15

fascia lata of the thigh

Question 16

Why is bilateral inguinal lymphadenectomy recommended for patients with invasive penile cancers?

Answer 16

bilateral subclinical involvement is common, so you should check both even if only one side seems involved