Penile cancer Flashcards
Penile cancer history questions
HPV status and vaccination
Circumcision status
Ethnicity (higher risk in South America, Southeast Asia, Africa)
Age
Penile cancer T staging
Tis = in situ (PeIN)
Ta = noninvasive localized SCC
T1 = invades subepithelial connective tissue
-T1a = no LVI, no PNI, not poorly differentiated
-T1b = LVI or PNI or poorly differentiated
T2 = invades corpus spongiosum +/- urethral invasion
T3 = invades corpus cav3rnosum +/- urethral invasion
T4 = invades other adjacent structures
Sub Sponge Cav Deep
Penile cancer cN staging
cN1 = single mobile solitary inguinal node
cN2 = mobile multiple unilateral or bilateral nodes (2+ or 2 sides)
cN3 = fixed nodal mass or pelvic LNopathy (unilateral or bilateral) (fix3d)
Penile cancer cM staging
cM0 = no mets
cM1 = distant mets
Penile cancer pN staging
pN1 = 1-2 unilateral inguinal nodes (adds one over cN1)
pN2 = 2+ unilateral inguinal nodes or bilateral nodes
pN3 = pelvic nodes or unilateral/bilateral or extranodal extension of regional LN mets
Penile cancer G staging
G1 = well diff
G2 = moderately diff
G3 = poorly diff
G4 = undiff
Treatment of Tis (PeIN)
5-FU or imiquimod (but do not repeat if failed)
Laser ablation (CO2 or Nd:YAG)
Organ-sparing surgery
Glansectomy
Mohs
Treatment of Ta
5-FU or imiquimod (but do not repeat if failed)
Laser ablation (CO2 or Nd:YAG)
Organ-sparing surgery
Glansectomy
Mohs
T1 treatment options
Wide local excision
Partial penectomy
Glansectomy (only if grade 1/2)
Laser ablation (only if grade 1/2)
RT
T3 lesion management
Partial penectomy
T2 lesion management
Partial penectomy
Total penectomy
Radiotherapy
Chemo/RT
Palpable inguinal LN management
Image chest/abd/pel to check pelvic LNs
Unilateral mobile <4cm
-Low risk primary = perc biopsy and surveil if neg
-High risk primary or positive perc biopsy = bilateral LND +/- NAC (TIP)
Unilateral mobile >4cm or fixed or bilateral
-perc biopsy = positive gets TIP and ILND +/- PLND
cN2 management
Ipsilateral radical LND
MIS ILND only as part of trial
NAC if cisplatin-eligible
When should an ipsilateral pelvic LND be done?
3+ inguinal LNs positive
extranodal extension reported
Who can get NAC
bulky mobile ILNDs
cN2
Pelvic LN involvement
cN3
Who can get adjuvant radiotherapy
pN2/pN3 disease regardless of NAC
Chemo choices
platinum-based if metastatic disease
Bleo should NOT be offered due to pulm risk
experimental protocols if platinum fails
General surveillance plan
Self-exam or PE q3months for 2 years
Repeat biopsy if using topical or laser treatment
q6month exams in years 3-5
Nonpalpable LN management
Low-risk (T1a or less) = surveillance if G2 or less
Intermediate/high risk (T1b or higher) = staging imaging, bilateral ILND or DSNB
Margins of modified LND
remove superficial cluster of LNs around the sapheno-femoral junction ABOVE fascia lata
Margins of standard LND
Femoral triangle
-Lateral = sartorious
-Medial = adductor longus
-Base = inguinal ligament
Old names for PeIN (Tis)
Erythroplasia of Queyrat
CIS
Bowen’s disease
Most common HPV serotype with penile cancer
HPV16
What percent of cN0 patients actually have nodal disease?
25%
What percent of cN+ status patients have nodal mets?
45-80%
Penile lesion Exam
Examine penis and genitalia
Note morphology, size, location, and suspected invasion of masses
Inguinal exam
Penile lesion workup
Shared decision making
Biopsy if not clinically obvious or superficial treatment planned
MRI optional
Management of cN+ disease
Biopsy before treating and then perform FDG-PET
Penile cancer exam
circ status
mass size/location
Inguinal LNs (number, location, size, fixed)
