penile Flashcards
How is nodal status categorised for penile cancer
N1 - unilateral inguinal nodal involvement
N2 - Multiple mobile or bilateral inguinal nodes
N3 - Fixed inguinal nodal mass or pelvic nodes
What defines a T2 / T3 / T4 penile cancer
T2 - Invasion into corpus spongiosum +/- urethra
T3 - invasion into corpus cavernosum +/- urethra
T4 - invasion into other structures
What defines a T1 penile cancer
T1 - sub epithelial connective tissue involvement
T1a - No LVSI and not poorly differentiated (G1-2)
T1b - LVSI or poorly differentiated (Gr 3-4)
When is sentinel LN biopsy indicated for penile cancer
All except G1 T1
ie for moderately differentiated (Gr2) T1 and above
If negative - surveillance
If positive - ipsilateral inguinal dissection, and if positive proceed to ipsilateral pelvic node dissection
What is the management of penile cancer according to nodal status
N1 - ipsilateral nodal dissection, followed by surveillance
N2 (or ECS) - ipsilateral nodal dissection. If ≥2 nodes, or one with ECS, do pelvic LN dissection followed by adjuvant RT (45/25 to pelvic nodes, 50.4Gy/28 to inguinal nodes), no chemo
N3 - neoadjuvant chemotherapy / CRT, followed by surgery. if residual disease, concurrent chemoRT and boost residual disease to 60Gy if not done neoadjuvantly. otherwise adjuvant chemo (TIP or cisplatin/5FU)
What is the management of a T1-2 penile cancer
T1 G1/2, Small T2 (<4cm)
Penis-preserving surgery
WLE or Laser excision
Total Glansectomy with reconstructive surgery +/- skin graft
EBRT or Brachytherapy
What is the management of a T3 penile cancer
Partial amputation +/- reconstruction
Total penectomy with perineal urethrostomy
What is the management of a T4 penile cancer
Neoadjuvant Cisplatin/capecitabine followed by surgery in responders
Or surgery followed by adj CRT (45Gy/25# with weekly cisplatin)
Large AP fields incl pelvic & inguinal LNs, then Ph2 20Gy/10# boost to primary site
when is primary chemoRT indicated
Irresectable disease
Extensive pelvic lymphadenopathy
