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Uro Onc > Penile > Flashcards

Penile Flashcards

1
Q

PeCa

Localized Workup

4

A
  • History including assessment of risk factors (balanitis, chronic inflammation, trauma, lack of neonatal circumcision, lichen sclerosus, poor hygiene, STIs)
  • PE including documentation of diameter, location, number, morphology (papillary, ulcerous, flat or nodular), distance from other structures and lymph node exam
  • Biopsy (punch, excisional or incisional)
  • Test for HPV status
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2
Q

PeCa

Tis or Ta Treatment

5

A
  • Topical therapy (p)
  • Wide local excision (p)
  • Laser therapy
  • Complete glansectomy
  • Mohs surgery (select pts)
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3
Q

PeCa

Low grade T1 treatment

6

A
  • Wide local excision (p)
  • Partial penectomy (p)
  • Glansectomy (select pts)
  • Mohs surgery (select pts)
  • Laser therapy (select pts)
  • RT (select pts)
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4
Q

PeCa

High grade T1 treatment

5

A
  • Wide local excision (p)
  • Partial penectomy (p)
  • Total penectomy (p)
  • RT (select pts)
  • Chemo/ RT (select pts)
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5
Q

PeCa

T2-T4 treatment

4

A
  • Parital penectomy (p)
  • Total penectomy (p)
  • RT (select pts)
  • Chemo/RT (select pts)
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6
Q

PeCa

Non-palpable Inguinal LN treatment

2

A
  • Low risk pt (Tis, Ta, T1a): surveillance
  • Int/ High risk pt (T1b or higher): CT C/A/P and bilateral inguinal LND or bilateral dynamic sentinel node biopsy
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7
Q

PeCa

Palpable small (<4cm) unilateral Inguinal LN treatment

3

A
  • CT C/A/P
  • Low risk pt (T1a, Ta, T1a): fine needle aspiration/percutaneous biopsy; if negative, excisional biopsy. If positive NAC w/TIP and bilateral ILND
  • Int/ High risk pt (T1b or higher): NAC w/TIP and bilateral ILND
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8
Q

PeCa

Enlarged pelvic LN treamtent

4

A
  • Percutaneous biopsy
  • If negative, observe
  • If positive and surgical candidate, NAC w/TIP following by rpt img. if response, consolidation surgery. if progression, systemic therapy.
  • If positive and non-surgical candidate, chemo/RT.
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9
Q

PeCa

Palpable large or fixed Inguinal LN treatment

2

A
  • Unilateral large LN: Percutaneous biopsy: if negative excisional biopsy. If positive NAC w/TIP and bilateral ILND +/- PLND or bilateral ILND or RT or Chemo/RT
  • Unilateral fixed LN or bilateral LNs: Percutaneous biopsy: if negative excisional biopsy. If positive NAC w/TIP (and if responsive) bilateral ILND and PLND (p) or RT or Chemo/RT
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10
Q

PeCa

post-op pN2 or pN3 Treatment

4

A
  • Consider PLND
  • Adjuvant chemotherapy (if no NAC)
  • If pelvic node, + adjuvant RT
  • Chemo/RT
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11
Q

PeCa

Local Inguinal recurrence

2

A
  • No prior ILND or RT: Percutaneous biopsy, then treat according to stage
  • Prior ILND or RT: Chemotherapy followed by ILND or ILND or Chemo/RT (if no RT)
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12
Q

PeCa

Metastatic PeCa treatment

3

A
  • Systemic therapy
  • Response or stable: consolidation surgery
  • No response or progression: second-line systemic therapy or RT for local control
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13
Q

PeCa

Topical Therapy

2

A
  • Imiquimod 5%: 3/week at night for 4-16 weeks
  • 5-FU cream 5%: BID for 2-6 weeks
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14
Q

PeCa

Laser therpay

3

A
  • CO2: 10,600nm, 5-10W, continuous or superpulse 100-200Hz, 0.1mm penetration, 1-5mm spot size
  • Nd:YAG: 1,064nm, 40W, pulse 1ms/ 10-40 Hz, 3-4mm penetration, 1-5mm spot size
  • KTP: 532nm, 5-10W, pulse 10-20ms/ 2Hz, 1-2mm penetration, 400-600um fiber size
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15
Q

PeCa

Wide Local Excision

3

A
  • cTis, cTa, cT1
  • May require split- or full-thickness skin graft
  • May re-resect for positive margins
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16
Q

PeCa

Glansectomy

2

A
  • Negative margins should be confirmed with frozen sections of cavernosal bed and urethral stump
  • May create neoglans with split- or full-thickness skin graft
17
Q

PeCa

Mohs Microsurgery

3

A
  • Thin layers of cancerous skin are resected and veiwed microscopically until tissue layer is negative for tumor
  • Preferred for superficial lesions on proximal shaft to avoid penectomy in low-risk lesions
  • Success rate declines with higher stage disease
18
Q

PeCa

Partial Penectomy

2

A
  • Must provide functional penile stump and negative margins
  • Functional stump is 3-4cm
19
Q

PeCa

Tis, Ta and T1 staging

4

A
  • Tis -> Carcinoma in situ
  • Ta -> Non-invasive SCC
  • T1a -> Invades LP without LVI, PNI or HG
  • T1b -> Invades LP with LVI, PNI or HG
20
Q

PeCa

T2 Staging

1

A

T2 -> Invades Corpora Spongiosum +/- urethral invasion

21
Q

PeCa

T3 Staging

1

A

T3 -> Invades Corpora Cavernosum +/- urethral invasion

22
Q

PeCa

T4 Staging

1

A

T4 -> Invades adjacent structures

23
Q

PeCa

cN Staging

3

A
  • cN1 -> Single palpable mobile unilateral inguinal LN
  • cN2 -> Multiple palpable moble unilateral inguinal LNs or bilateral LNs
  • cN3 -> Palpable fixed inguinal LN mass or pelvic LAD
24
Q

PeCa

pN Staging

3

A
  • pN1 -> 2 or less unilateral inguinal LNs without ENE
  • pN2 -> 3 or more unilateral inguinal LNs or bilateral LNs
  • pN3 -> ENE or pelvic LN
25
Q

PeCa

M Staging

1

A

M1 -> Distant metastasis

26
Q

PeCa

Primary Radiation Treatment (penile preserving)

3

A
  • <4cm: circumcison then brachytherapy or EBRT +/- chemotherapy
  • consider ppx radiation to inguinal LNs
  • > 4cm circumcision then Chemo/RT (select cases) covering inguinal and pelvic LNs with penile boost or brachytherapy (select cases)
27
Q

PeCa

Primary Radiation Treatment (unresectable)

1

A
  • circumcision then Chemo/RT covering inguinal and pelvic LNs with penile boost
28
Q

PeCa

Radiation s/p positive surgical margin

4

A
  • Microscopic disease: EBRT to primary site and scar
  • Gross disease: Chemo/RT covering inguinal and pelvic LNs with penile boost
  • Consider LN treatment if no LND or inadequate LND
  • Brachytherapy (select cases)
29
Q

PeCa

Adjuvant Chemo/RT

4

A
  • Positive inguinal or pelvic LNs
  • Consider for pN2-3 or local recurrence
  • COnsider boost for gross noes or areas of ENE
  • Consider for positive margin
30
Q

PeCa

Karposi Sarcoma

4

A
  • HIV: Treat with HAART therapy
  • Immunosuppressed (transplant): Reduce immunosuppresive medications
  • Unresponsive: Local therapy (laser, wide excision, topical, cryotherapy)
  • Metastatic: comination chemotherapy
31
Q

PeCa

Lymph Node Involvement

2

A
  • Most predictive is LVI
  • Other factors include superficially growth pattern, grade, tumor thickness, involvement of corporal tissue and urethra
32
Q

PeCa

Stage 0-I

3

A
  • Stage 0is- Tis N0 M0
  • Stage 0a- Ta N0 M0
  • Stage I- T1a N0 M0
33
Q

PeCa

Stage II

2

A
  • Stage IIa - T1b-T2 N0 M0
  • Stage IIb - T3 N0 M0
34
Q

PeCa

Stage III

2

A
  • Stage IIIa - T1-3 N0-1 M0
  • Stage IIIb - T1-3 N2 M0
35
Q

PeCa

Stage IV

1

A
  • Stage IV - T1-4 N 0-3 M0-1

Uro Onc (23 decks)

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