Penile Cancer Flashcards
Which age group is penile cancer most common?
Rare urological cancer
> 60 years
What is strongly associated with penile cancer?
Human papillomavirus (HPV) - subtypes 16, 6 and 18
What is the most common type of penile cancer?
SCC - arises form epithelium of the inner prepuce or the glans
What are other types of penile cancer?
Basal cell carcinoma
Sacrcomas
Melanomas
Urethral carcinoma
What are risk factors for penile cancer?
HPV infection
Phimosis, smoking, lichen sclerosis, untreated HIV infection and photo chemotherapy
What is deemed a protective factor for penile cancer?
Childhood circumcision
What are the clinical features of penile cancer?
Palpable or ulcerating lesion on the penis. Most commonly located on the glans. Painless but may have discharge or prone to bleeding.
Exam:
Inguinal lymphadenopathy, distant metastasis uncommon
What are the differential diagnosis for penile cancer?
Infections - herpes simplex or syphilis
Inflammatory conditions - psoriasis, lichen planus or blanaitis
Pre malignant conditions - condyloma acuminatum(genital warts), lichen sclerosus or bowens disease
What are the investigations for penile cancer?
Refer to specialist regional centre:
Penile biposy - confirm diagnosis
PET-CT imaging - confirm any inguinal lymphadenopathy
If inginal lymphadenopathy positive the staging CT abdo-pelvis
Use TNM staging
What is the aim of treatment in penile cancer?
Complete tumour removal and oncological control
Ensure organ perseveration
Requires combination of surgery, radiotherapy and chemotherapy
What are the treatment options for superfical non-invasive disease in penile cancer?
Topical chemotherapy agents. Repeat biposy and long term surveillance.
Other options include: Laser treatment or glans resurfacing
What is the surgical management for invasive disease confined to the glans in penile cancer?
Local excision
Partial glansectomy
Total glansectomy with reconstruction
Radical circumcision - purely foreskin tumours
What are the surgical options for invasive penile cancers not confined to the glans?
Partial amputation with reconstruction
Total penectomy with peroneal urethrostomy
Neoadjuvant radio and chemo may be required +/- radical inguinal lymphadenectomy
What are the reconstruction options in penile cancer?
Phallic reconstruction- forearm phaloplasty
What is the prognosis of penile cancer?
Largely treatable disease
But some may have distant mets at presentation
Overall 5 year survival rate - 70%
