Penile Cancer

Question 1

Most common path of penile cancer?

Answer 1

SCC

Question 2

Penile cancer path that never mets?

Answer 2

Verrucous carcinoma

Question 3

Risks of developing penile cancer?

Answer 3

Uncicrumcised with poor hygiene, HPV 16 and 18, inflammatory syndromes (like BXO, LS, phimosis, etc), and smoking

Question 4

PeIN = penile intraepithelial neoplasia
Path diff vs. undiff

Answer 4

Differentiated = chronic inflammation
Undifferentiated = HPV

Question 5

PeIN of penile shaft or foreskin

Answer 5

Bowen’s disease

Question 6

PeIN of glans

Answer 6

Erythroplasia of Queyrat

Question 7

Penile cancer staging

Answer 7

Tis = PeIN
Ta = no invasion
T1: glans = lamina propria
Foreskin = dermis, lamina propria or dartos
Shaft = connective tissue between epidermis and corpora

T1a = no high grade, no LVI or PNI
T1b = high grade, PNI or LVI

T2 = corpora spongiosum
T3 = corpora cavernosum
T4 = invades adjacent structures

Question 8

Penile cancer nodal staging

Answer 8

N1 - single palpable mobile inguinal LN
N2 - 2 or more palpable inguinal mobile nodes, bilateral mobile inguinal LNs, bulky or non-bulky mobile nodes
N3 - FIXED inguinal LNs (either unilateral or bilateral), or pelvic LNs

Question 9

Treatment of primary lesion in PeIN or Ta

Answer 9

Wide local excision, circumcision, laser tx if can get all dz
Topical therapy for PeIN only - 5-FU or imiquimod

Question 10

Treatment of primary lesion in T1

Answer 10

Low grade dz = penile preservation surgery or laser if can remove completely
High grade = WLE +/- grafting, partial or total penectomy

Question 11

Treatment of primary lesion in T2/T3

Answer 11

Partial or total penectomy
- Intra-op frozen sections
- > 2cm stump for partial with 2cm margins