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
2
Q
PeCa
Tis or Ta Treatment
5
A
- Topical therapy (p)
- Wide local excision (p)
- Laser therapy
- Complete glansectomy
- Mohs surgery (select pts)
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)
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)
5
Q
PeCa
T2-T4 treatment
4
A
- Parital penectomy (p)
- Total penectomy (p)
- RT (select pts)
- Chemo/RT (select pts)
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
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
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.
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
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
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)
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
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
14
Q
PeCa
Laser therapy
3
A
- CO2: 10,600nm, 5-10W, continuous or superpulse 100-200Hz, 0.1mm penetration, 1-5mm spot size
- KTP: 532nm, 5-10W, pulse 10-20ms/ 2Hz, 1-2mm penetration, 400-600um fiber size
- Nd:YAG: 1,064nm, 40W, pulse 1ms/ 10-40 Hz, 3-4mm penetration, 1-5mm spot size
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
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
# PeCa
M Staging
| 1
M1 -> Distant metastasis
26
# PeCa
Primary Radiation Treatment (penile preserving)
| 3
* <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
# PeCa
Primary Radiation Treatment (unresectable)
| 1
* circumcision then Chemo/RT covering inguinal and pelvic LNs with penile boost
28
# PeCa
Radiation s/p positive surgical margin
| 4
* 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
# PeCa
Adjuvant Chemo/RT
| 4
* 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
# PeCa
Karposi Sarcoma
| 4
* HIV: Treat with HAART therapy
* Immunosuppressed (transplant): Reduce immunosuppresive medications
* Unresponsive: Local therapy (laser, wide excision, topical, cryotherapy)
* Metastatic: comination chemotherapy
31
# PeCa
Lymph Node Involvement
| 2
* Most predictive is LVI
* Other factors include superficially growth pattern, grade, tumor thickness, involvement of corporal tissue and urethra
32
# PeCa
Stage 0-I
| 3
* Stage 0is- Tis N0 M0
* Stage 0a- Ta N0 M0
* Stage I- T1a N0 M0
33
# PeCa
Stage II
| 2
* Stage IIa - T1b-T2 N0 M0
* Stage IIb - T3 N0 M0
34
# PeCa
Stage III
| 2
* Stage IIIa - T1-3 N0-1 M0
* Stage IIIb - T1-3 N2 M0
35
# PeCa
Stage IV
| 1
* Stage IV - T1-4 N 0-3 M0-1
