Penile Cancer

Question 1

Penile cancer - most common type

Answer 1

• Squamous cell carcinoma - usually from inner prepuce or glans
• Others - basal CC, sarcomas, melanomas, urethral carcinoma

Question 2

What does penile cancer have strong association with?

Answer 2

• HPV
• 1/3 to 1/2 of cases associated with HPV carcinogenesis

Question 3

RF for penile cancer

Answer 3

• Human papillomavirus infection
• Phimosis
• Smoking
• Lichen sclerosis
• Untreated HIV infection
• Previous psoralen-UV-A photochemotherapy (PUVA) - used for psorasis and cacer

Circumcision is protective

Question 4

Symptoms of penile cancer

Answer 4

• Palpable or ulcerating lesion on penis - most commonly glans
• Painless
• May discharge or be prone to bleeding

Question 5

Signs on exam of penile cancer

Answer 5

• Inguinal lymphadenopathy
• Palpable, painless ulcerating lesion

Question 6

Investigations for ?penile cancer

Answer 6

• Specialist referral - 2WW
• Penile biopsy
• PET-CT to check for inguinal lymphadenopathy (esp if palpable nodes)
• CT chest-abdomen-pelvis for staging - TNM

Question 7

Management of penile cancer

Answer 7

• Complete tumour removal - as much organ preservation as possible
• Surgery, radiotherapy and chemotherapy combined
• Other options inc laser treatment for ablation of tumour and glans resurfacing - complete removal of glandular epithelium to corpus spongiosum

Question 8

Superifical non-invasive penile cancer management

Answer 8

• Topical chemotherapy agents eg imiquimod or 5-fluorouracil
• Long term surveillance

Question 9

Surgical management of penile cancer - margins

Answer 9

2cm tumour free margin recommened, 5mm considered safe

Question 10

Surgical management for invasive disease confined to glans

Answer 10

Organ sparing eg:
* Local excision
* Partial glansectomy
* Total glansectomy with reconstruction (using split skin graft)
* Radical circumcision if purely foreskin

Question 11

Surgical options for invasive penile cancer

Answer 11

• Partial amputation - removing glans +/- portion of underlying corpora + reconstruction
• Total penectomy - removal of glans and underlying corporal bodies + perineal urethrostomy
• Neoadjuvant chemo/radiotherapy may be needed

Question 12

Management for those with inguinal lymph node involvement

Answer 12

• Radical inguinal lymphadenectomy OR
• Neoadjuvant chemo OR
• Radiotherapy

Question 13

Reconstruction options for penile cancer

Answer 13

• Once disease free for suitable time - phallic reconstruction via forearm phalloplasty