Penile cancer

Question 1

What are the risk factors for penile cancer?

Answer 1

• Poor hygiene
• phimosis
• pre-malignant condition (bowens disease, leukoplakia, pagers disease)
• HPV
• some correlation with cervical cancer in partner but this is not well understood.
• foreskin

Question 2

Why does having a foreskin increase the risk of penile cancer?

Answer 2

Having a foreskin leads to retention of smegma (urinary products and epidermal cells), poorer hygiene and also phimosis.

risk is greater in those who do not have it removed, or in those who have it removed later in life. Needs to be removed in the neo-natal period to have the greatest impact on decreasing the risk of getting penile cancer.

phimosis is found in 25-75% of patients with scc

Question 3

What is the signs and symptoms of penile cancer?

Answer 3

• obvious visible mass (pain, bleeding, discharge, ulceration)

Question 4

What are the patterns of spread for penile cancer? (local, lymphatic and distant)

Answer 4

Local: wide surface extension, invades deep into the urethra and copra cavernosa.

Lymphatics: Spreads early to the pelvic and inguinal nodes. Inguinal nodes can ulcerate.

Distant: blood borne spread to the lungs, skin and bone. Uncommon for it to spread to the bladder or prostate.

Question 5

What are the different histologies of penile cancer?

Answer 5

• Overwhelmingly SCC

- Also may have BCC, melanoma, karposi’s sarcoma.

Question 6

What is the staging for penile cancer?

Answer 6

TNM or Jacksons

Question 7

What is the TNM staging?

Answer 7

TNM
T1: Superficial <1cm diameter
T2: Superficial but large
T3: Invades underlying tissues 
T4: Invades the local tissues e.g. copora cavernosa or urethra.

Question 8

What is the Jacksons staging?

Answer 8

1 - tumour confined to the glands/propus
2- tumour extends into the shaft but doesn’t involve LNs
3 - tumour extends into the shaft and has metastatic LNs but is operable
4 - tumour has inoperable LNS/ mets.

Question 9

What are the surgical options for penile cancer?

Answer 9

• MOHs micrographic
• Total excision
• Nodal involvement: block destination
• Small lesions: cryosurgery/laser
• Deep lesions: wide local excision/ partial or full amputation.

Question 10

What is the dose fractionation for brachytherapy penile cancer ?

Answer 10

60-65 gy delivered over 6-7 days (HDR)

Question 11

What are the options for RT

Answer 11

• Brachytherapy

- EBRT – superficial, orthovoltage, megavoltage photons or electrons.

Question 12

Where do you set to get to the isocentre of the primary site? What about for nodal XRT?

Answer 12

• Set to mid penis, mid block

- Set to half separation, like any other pelvic tx

Question 13

What are the acute reactions and patient care relating to penile cancer?

Answer 13

• SKIN REACTION (erythema, moist des, subcutaneous swelling - pain)
• urinary discomfort/ dysuria
• diarrhoea
• psychosocial impact

Question 14

What are the late effects of penile cancer?

Answer 14

• Erectile impotence
• Psychosocial impacts
• Ulceration
• Urethral stricture
• telangectasia and fibrosis