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Pete 3 > Pencil size matters > Flashcards

Pencil size matters Flashcards

1
Q

Risk factors of penile cancer? (general conditions)

A 
Phimosis 
Circumcision reduces risk
Premalignant conditions
e.g. Bowen’s disease, leukoplakia, Paget’s disease
HPV
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2
Q

Risk factors of penile cancer? (Foreskin)

A
  • Not circumcised

- Being in circumcised after neonatal period compared to being circumcised in the neonatal period

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3
Q

Presenting signs and symptoms of penile cancer?

A
  • Obvious (visible) mass
  • Ulceration and bleeding
  • Glans or inner surface of prepuce
  • Discharge
  • Pain
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4
Q

Patterns of spread? (local)

A
  • Wide surface extension
  • Deeper invasion
  • Urethra, corpora cavernosa
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5
Q

Patterns of spread? (lymphatic)

A

-inguinal and regional pelvic nodes

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6
Q

Patterns of spread? (Distant)

A

Uncommon: prostate and bladder

Blood borne to skin, lungs, bone

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7
Q

Histology?

A
  • SCC
  • BCC
  • melanoma
  • Karposi’s sarcoma
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8
Q

Staging?

A
  • TNM

- Jacksons Staging

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9
Q

Surgery options?

A

-Total excision
-Small lesions: Cryosurgery, Laser
-Deeper lesions: Wider excision, Partial or full amputation
Moh’s micrographic, Nodal involvement, Block dissemination

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10
Q

EBRT options?

A
  • Brachytherapy: Interstitial iridium implants
  • EBRT: Superficial, Ortovoltage, MV – Photons, Electrons

Surgery for salvage (very unpopular option)

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11
Q

Brachytherapy options?

A

60-65 GY 6-7 days

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12
Q

Chemotherapy options?

A

-Very limited
(bleomycin, 5-FU, methotrexate,
cisplat)
Some topical options

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13
Q

What is the dose fractionation for the whole shaft? What energy type is used?

A

50-55Gy in 20f, or 60Gy in 30f
(possible boosts 5-10Gy to reduced volume)

MV photons

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14
Q

What is the dose fractionation for bilateral inguinal and pelvic node irradiation? (no gross disease)

A

50Gy in 25-28f if no gross disease

+/- 5Gy to reduced volume

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15
Q

What
is the dose fractionation for
bilateral inguinal
and pelvic node irradiation? (Palpable disease)

A

60-65Gy in 30-36f if palpable disease

+/- 5Gy to reduced volume

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16
Q

Palliative fractionation for penile cancer?

A

30Gy in 10f (MV)

17
Q

For a patient with T3N2M0 Penile SCC, what is the optimal treatment?

A

Total Penectomy + bilateral inguinal node dissection

Post-op local and nodal EBRT

18
Q

What is the treatment technique for a primary lesion?

A

Opposed pair, lateral fields
Perspex or wax block
-> full bolus + homogenous distribution

19
Q

What is the treatment technique for high stage nodal disease?

A

Range of options

  • Opposed pair (Ant & Post)
  • Multiple field conformal
  • IMRT
20
Q

What would be the treatment for a T4N0M0 Penile SCC, where a penectomy has been declined?

A

Definitive EBRT to penis shaft

Up to 70Gy in 35f

21
Q

What is the purpose of ankle stocks?

A

Separate legs to minimise inguinal skin folds

22
Q

What is the CT procedure for penile patients?

A
  • Talk to and ID patient
  • Prepare couch
  • Prepare patient
  • remove pants and shoes
  • Position patient – Straight and Level
  • Make &/or position Perspex/wax block
  • Set isocentre and mark for CT
  • Scan: All of pelvis with good sup and inf margins
  • Photos, set-up notes, and tattoos
23
Q

What is a common problem with treatment set up for penile patients?

A

-swelling may cause difficulty positioning the block

24
Q

What are the acute side effects of EBRT for penile cancer?

A

Erythema, Subcutaneous swelling, Moist desquamation, dysuria, Diarrhoea, Psychosocial impact

25
Q

What are the standard equipment and set up for a penile patient?

A 
Supine, straight & level
Arms on chest
Headrest
Knee-bolster
– small or none
Ankle- &/or Foot-stocks
26
Q

Patient care and management?

A

Urinary discomfort- Monitor fluid intake & Possible catheterisation
Subcutaneous swelling- Possible re-plan, Advise, monitor, and medicate as needed
Moist desquamation- Hygiene!
Diarrhoea- Dietary advice, Imodium
Psychosocial impact- Support

27
Q

Late side effects of EBRT for penile cancer? And patient care?

A
  • Telangiectasia & fibrosis
  • Ulceration and/or tissue necrosis
  • Urethral stricture- Dilation and catheterisation
  • Erectile impotence
  • Psychosocial impact- Psychosocial support
28
Q

Late side effects of EBRT for penile cancer?

A
  • Telangiectasia and fibrosis
  • Ulceration and/or tissue necrosis
  • Urethral stricture
  • Erectile impotence
  • Psychosocial impact

Pete 3 (11 decks)

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