Penile Cancer

Question 1

Types of penile Cancer?
Locations?

Answer 1

SCC (95%)
BCC, Melanoma, Metastasis (Prostate + Lung), Sarcoma

Location.- 50% at the glans, 21% at prepuce

Question 2

Penile Ca RFs

Answer 2

Phimosis, Smoking, UV Light Exposure, Multiple sexual partners, HPV (Type 16 + 18)

Question 3

What role does HPV play in Penile ca

Answer 3

Type 16 and Type 18
- Interact with oncogene and TS Gene (p53 and Rb)

Question 4

PeIN
i)Differentiated versus Undifferentiated
ii) Risk of progression to cancer?

Answer 4

i) Differentiated - Lichen Sclerosus
Undifferentiated - HPV16

ii) 30% risk of progreession to cancer

Question 5

Rx of PeIN

Answer 5

Prepuce - Circumcision
Glans
- Circ +/- WLE
- 5FU/Imiquimod
- CO2 Laser
- Glans Resurfacing

Question 6

Penile SCC Subtypes:
Poor prognosis
Good Prognosis

Answer 6

Poor - Basaloid/Sarcomatoid
Good - Warty/Verrucous/Papillary

Question 7

TNM Penile SCC

Answer 7

Tx, T0
Tis - Carcinoma in situ
T1 - Involving subepithelial connective tissue
T1a - No lymphovascular invasion/ Well differentiated (G1/G2)
T1b - Lymphascular invasion / Poorly differentiated (G3/G4)
T2 - Invades spongiosum
T3 - Invaged Cavernosum
T4 - Invades other structures

Nx, N0
N1 - Singile Regional Node
N2 - Multiple/Bilateral Inguinal Nodes
N3 - Fixed Inguinal Nodes / Pelvic Nodes

Question 8

Penile ca Pattern of LN involvement

Answer 8

Superficial Inguinal -> Deep Ing - > Ipsilateral PLN - > Distant

Question 9

How to stage Penile Ca

Answer 9

Biopsy
CT TAP (if palpable groin nodes)
MR Scan with Intracavernoal Prostacyclin

Question 10

Treatment Options for Penile SCC

Answer 10

Surgery - Penile Conserving versus amputation (5mm Margin)
EBRT
Brachytherapy
Laser
MOHS