Penile cancer

Question 1

Penile cancer history questions

Answer 1

HPV status and vaccination
Circumcision status
Ethnicity (higher risk in South America, Southeast Asia, Africa)
Age

Question 2

Penile cancer T staging

Answer 2

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

Question 3

Penile cancer cN staging

Answer 3

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)

Question 4

Penile cancer cM staging

Answer 4

cM0 = no mets
cM1 = distant mets

Question 5

Penile cancer pN staging

Answer 5

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

Question 6

Penile cancer G staging

Answer 6

G1 = well diff
G2 = moderately diff
G3 = poorly diff
G4 = undiff

Question 7

Treatment of Tis (PeIN)

Answer 7

5-FU or imiquimod (but do not repeat if failed)
Laser ablation (CO2 or Nd:YAG)
Organ-sparing surgery
Glansectomy
Mohs

Question 8

Treatment of Ta

Answer 8

5-FU or imiquimod (but do not repeat if failed)
Laser ablation (CO2 or Nd:YAG)
Organ-sparing surgery
Glansectomy
Mohs

Question 9

T1 treatment options

Answer 9

Wide local excision
Partial penectomy
Glansectomy (only if grade 1/2)
Laser ablation (only if grade 1/2)
RT

Question 10

T3 lesion management

Answer 10

Partial penectomy

Question 11

T2 lesion management

Answer 11

Partial penectomy
Total penectomy
Radiotherapy
Chemo/RT

Question 12

Palpable inguinal LN management

Answer 12

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

Question 13

cN2 management

Answer 13

Ipsilateral radical LND
MIS ILND only as part of trial
NAC if cisplatin-eligible

Question 14

When should an ipsilateral pelvic LND be done?

Answer 14

3+ inguinal LNs positive
extranodal extension reported

Question 15

Who can get NAC

Answer 15

bulky mobile ILNDs
cN2
Pelvic LN involvement
cN3

Question 16

Who can get adjuvant radiotherapy

Answer 16

pN2/pN3 disease regardless of NAC

Question 17

Chemo choices

Answer 17

platinum-based if metastatic disease
Bleo should NOT be offered due to pulm risk
experimental protocols if platinum fails

Question 18

General surveillance plan

Answer 18

Self-exam or PE q3months for 2 years
Repeat biopsy if using topical or laser treatment
q6month exams in years 3-5

Question 19

Nonpalpable LN management

Answer 19

Low-risk (T1a or less) = surveillance if G2 or less
Intermediate/high risk (T1b or higher) = staging imaging, bilateral ILND or DSNB

Question 20

Margins of modified LND

Answer 20

remove superficial cluster of LNs around the sapheno-femoral junction ABOVE fascia lata

Question 21

Margins of standard LND

Answer 21

Femoral triangle
-Lateral = sartorious
-Medial = adductor longus
-Base = inguinal ligament

Question 22

Old names for PeIN (Tis)

Answer 22

Erythroplasia of Queyrat
CIS
Bowen’s disease

Question 23

Most common HPV serotype with penile cancer

Answer 23

HPV16

Question 24

What percent of cN0 patients actually have nodal disease?

Answer 24

25%

Question 25

What percent of cN+ status patients have nodal mets?

Answer 25

45-80%

Question 26

Penile lesion Exam

Answer 26

Examine penis and genitalia
Note morphology, size, location, and suspected invasion of masses
Inguinal exam

Question 27

Penile lesion workup

Answer 27

Shared decision making
Biopsy if not clinically obvious or superficial treatment planned
MRI optional

Question 28

Management of cN+ disease

Answer 28

Biopsy before treating and then perform FDG-PET

Question 29

Penile cancer exam

Answer 29

circ status
mass size/location
Inguinal LNs (number, location, size, fixed)