Penile and Testicular Carcinoma Flashcards
where is penile cancer most common
rare in the UK, more common in the far east and africa (poor hygiene)
is penile cancer more common in circumcised or uncircumcised individuals
rare in circumcised individuals
phimosis
- inability to retract the foreskin
- associated with BXO
name 2 pre malignant cutaenous penile lesions
- BXO
- leukoplakia
BXO
- white patches, fissuring, bleeding and scarring that usually affects the tip of the glans
- the urethra may narrow, resulting in poor urine flow and requiring dilatation
- can cause phimosis
how is BXO treated
circumcision and glans resurfacing
leukoplakia in the penis
- pre malignant lesion
- abnormal white spots that may form around the urethra opening
what is the peak age for penile SCC
80
causes of penile SCC
- poor hygiene
- there is an association with HPV 16
name 2 forms of penile SCC in situ
- Bowen’s
- erythroplasia of queyrat
Bowen’s disease
- CIS
- red patches on the genitalia
erythroplasia of queyrat
- CIS
- a form of Bowen’s disease
- occurs on the glans, prepuce or shaft of penis
what are Bowen’s disease and EoQ precursors for and associated with
precursors for invasive SCC and associated with HPV 16
which tumours can be managed with circumcision
those on the prepuce
treatment for penile CIS
topical 5 fluourouracil (cytotoxic)
when does most invasive SCC present
delayed - most have already spread to a lymph node
presentation of invasive penile SCC
- red area/mass/nodule on the penis
- can ulcerate
- phimosis
- itching, fungating mass
- foul smell
- advanced cases may cause haematuria
investigation of a primary penile tumour
- physical examination
- cytological and histological diagnosis
- US
- MRI if US inconclusive
investigation of lymph nodes
radonuclide sentinel node biopsy
investigation of metastases
CT, bone scan in symptomatic patients
where does lymph from the penis, testis and scrotum drain
- Lymph from the scrotum & most of the penis (not the glans) drains to the superficial inguinal lymph nodes found in the superficial fascia in the groin
- Lymph from the testis drains to the lumbar nodes around the abdominal aorta
outline the arterial blood supply to the penis and scrotum
- Blood supply to the penis is via the deep arteries of the penis; branches of the internal pudendal artery (from the internal iliac)
- Blood supply to the scrotum is via the internal pudendal and branches from the external iliac artery
staging of penile invasive SCC
TNM
management of invasive penile SCC
total or partial penectomy and reconstruction
what does inguinal node infiltation suggest
poorer prognosis
chemotherapy options
5FU and cisplatin
mangement options of invasive penile SCC
- radiotherapy if early
- surgery and lymph node dissection if late
what is the most common malignancy in males aged 14-44
testicular tumour
incidence of contralateral testicular tumours
5%
most common type of testicular tumours
germ cell tumours
- seminomatous - 55%
- non-seminomatous (NSGCT) - 33%
- teratoma is a histological division
- mixed germ cell tumour
- and lymphoma
what age does seminoma occur in
30-55, rare before puberty
macroscopic appearance of seminoma
- solid, homogenous, pale - potato tumour
- large tumour cells with abdundant clear cytoplasm
- the stormal infiltrate is variable, but when present is an adverse prognostic feature
spread of seminoma tumours
- rarely spread beyond the testes - are a more localized tumour
- can spread to para aortic lymph nodes
- via blood to lungs and liver
what marker is used to monitor seminoma
Placental ALP
what treatment option are seminomas very sensitive to
radiotherapy!! 95% v good prognosis
what is the most common histological subtype of NSCT
teratoma
peak incidence of teratoma
20-30 years
describe the nature of teratomas
they are a more aggressive tumour, they spread earlier
describe the macroscopic appearance of teratomas
varied: solid area, cyst, haemorrhage, necrosis
describe the histology of teratomas
multiple tissue types
treatment of teratoma
chemosensitive -even in v advanced disease
features of testicular tumour
- painless, insensitive testicular swelling
- 2y hydrocele
- gynaecomastia
- systemic features of malignancy
- 10% present with metastases
how may metastases from testicular tumours present
- lymph nodes
- dyspnoea due to lung infiltration
risk factors for testicular tumour
- UNDESCENDED TESTES
- infant hernia
- infertility
intial imaging of testicular tumour
US - 95% sensitivity and specificity
staging investigations for testicular tumour
CXR, CT
markers for testicular tumours
- AFP - marker of yolk sac components secreted by non-seminomatous germ cell tumours
- ßHCG - marker of trophoblastic components
- LDH - marker of tumour burden
- PLAP
what is PLAP a marker for
seminoma
markers in seminoma
- AFP always 0
- HCG 10%
markers in teratoma
60% ßHCG raised and AFP 70% raised
when are markers used in testicular tumour
used in diagnosis, repsonse to therapy, detecting early recurrence
staging of testicular tumours
- TNM and AJCC
- includes serum tumour marker
what does pTX mean on testicular tumour staging
tumour cannot be elevated
serum tumour staging - SX and S0
- SX - cannot be evaluated
- S0 - normal
treatment of testicular tumours
- rapid orchidectomy
- chemo and radio options
what treatment are seminomas particularly sensitive to
radiotherapy
what treatment are teratomas sensitive to
chemotherapy
which lymph nodes would you maybe want to dissect in testicular tumours
- retroperitoneal lymph nodes (abdominal) - residual LN may harbor tumour
- note dissection means removal and biopsy
what may surgery in the retroperitoneal space (eg lymph node dissection) cause
fibrosis - may need a stent
describe the process of orchiectomy
- approach via an inguinal incision
- ligate the cord fairly high up
- may insert a prosthesis teste
- there are indications for a contralateral biopsy, as there is a risk of cancer
compare the prognosis of teratoma and seminoma
teratoma is worse
