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Penile cancer Flashcards

1
Q

Jewel box

A

jewel box is a device used to protect the penis during XRT there is a hole in the box to put the penis in and the rest is filled with tissue equivalent material

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2
Q

prone jewel box

A

there is an alternative jewel box used to treat the patient prone and the box is filled with water and the penis is inserted in the box

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3
Q

perspex tube

A

perspex tube is a vacuum suction tube that is used to keep the penis in place during radiation treatment

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4
Q

most common presentation of penile cancer

A

most common presentation is a mass 2/3 of patients

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5
Q

presentations of penile cancer

A

Most common presentation symptom is a mass (in ⅔ of patients)
Ulceration is common in half of patients
A growth or sore that doesn’t heal
Change in penis colour
redness/ irritation of the penis
lump/ thickening of penis
Foreskin does not fully pull back
Priapism-painful and persistent ejaculation
Foul smelling discharge or bleeding
Itching or burning under foreskin
Lump in groin
Dysuria
Lymph nodes are usually enlarged at diagnosis

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6
Q

diagnostic methods in penile cancer

A

CT to confirm LN status

biopsy

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7
Q

races more often diagnosed with penile cancer

A

more common in asia, south america and africa

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8
Q

ages most commonly diagnosed with penile cancer

A

58-60 is most common age but also occurs in people <40 in 10% of cases

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9
Q

causes of penile cancer

A

HPV
Phimosis- men who are uncircumcised, penis may be tight, hard to clean leading to inflammation
Poor genital hygiene , a secretion called smegma which may cause cancer
Smoking
Psoriasis treatment
being uncircumsised

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10
Q

prepuce of the penis

A

skin fold that covers the glans penis

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11
Q

prepuce and skin shaft lymphatics

A

drains to superficial inguinal ln

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12
Q

urethra lymphatics

A

Lymphatics of the fossa navicularis and penile urethra follow the lymphatics of the penis to superficial and deep inguinal lymph nodes and pelvic lymph nodes rarely involved in inguinal nodes

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13
Q

where do most penile cancers originate

A

glans penis in 48-60% of cases

also common in the prepuce and the coronal sulcus

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14
Q

most common spread for the penile urethra

A

most common spread is to the inguinal LN

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15
Q

tumours of the penis are usually diagnosed at ____grade and are _____gowing

A

low grade, slow growing

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16
Q

most common site of metastatic spread

A

inguinal Ln

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17
Q

most important prognostic factors

A

stage at diagnosis and lymph node status

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18
Q

prognosis in age groups

A

worse prognosis for patients below 50 and above 65

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19
Q

combined treatment modalities for small and in situ penile cancer

A

topical imiquoid and 5FU (chemo)

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20
Q

surgeries for penile cancer

A

for larger lesions Moh’s surgery (like in skin cancer) and conservative laser surgery may be used

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21
Q

indications for XRT in general for penile cancer

A

best for patients with a lesion <4cm

used for men who want to preserve the penis or for patients who don’t want or are ineligible for surgery

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22
Q

neoadjuvant XRT in penile cancer and indications

A

shrinks tumour before surgery to make it operable

indications : for larger/ mor invasive lesions and for involved LN

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23
Q

adjuvant XRT in penile cancer and indications

A

to destroy cancer cells left behind after SURGERY and to reduce recurrence
used for palliation as well

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24
Q

what is included in the XRT of penis why?

A

inguinal LN are irradiated in addition to the penis as there is a high propensity of inguinal LN involvement

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25
dose for XRT
for no LN involvement50-55Gy in 2.3-2.5Gy/fx therefore 50/20- 55/23 for + palpable inguinal LN 70-75Gy/ 35-40fx with reducing fields after 50Gy
26
advanced proximal tumour surgery options
emasculation surgeries: (penectomy, scrotectomy,orchiectomy or cyroprostatectomy)
27
surgery for tumours confined to the prepuce
wide circumcision
28
surgery for lesions confined to the glans penis
partial penectomy
29
surgery for stage 3 tumours
can be treated with a partial or total penectomy partial penectomy is chosen if margins of 2cm can be achieved if 2cm margins cannot be achieved then a total penectomy + perineal urethrotomy will be used
30
can a patient still be sexually active with a partial penectomy
yes but 15% of patients with a partial penectomy lose sexual function
31
side effects of XRT in penile cancer
Erythema Dry desquamation Moist desquamation Swelling of subcutaneous tissue of the shaft All of the above occur in virtually all patients Telangiectasia(spider veins) is a common late consequence and is usually asymptomatic Meatal-urethral strictures occur in up to 40% of patients ulceration and necrosis of the skin and shaft are rare complications
32
uses of chemo in penile cancer
Systemic chemo can be used with or without radiation to destroy cancer when cancer cannot be removed by surgery however this is rare Chemo can be used neoadjuvantly to shrink the tumor Chemo can be used adjuvantly to destroy cancer cells left behind and reduce recurrence Can be used in palliation to relieve symptoms
33
chemo agents used in penile cancer
platinum, methotrexate and bleyomyacin
34
methods of chemo administration
topically (cream) or systemically (IV)
35
most common pathology of penile cancer
low grade well differentiated SCC is most common
36
precancerous penile cancers
Bowen Disease Is a squamous cell in situ that involve the shaft of the penis and hairy skin of the inguinal and suprapuic area Erythroplasia of Queyrat Is an epidermoid carcinoma in situ involves the mucosal or mucocutaneous areas of the prepuce or glans Appears as a red , elevated or ulcerated lesion
37
what must be done before the patient can receive penile brachythherapy
patient must be curcumsices first this is to allow for easier access to the penis and for follow up and to reduce tumour volume
38
indications for brachytherapy
early stage disease, tumour <4cm <1cm invasion into the cavernous cavernosum
39
complications of brachy
urethral stricture,ulceration, necrosis, pain, impotence, edema
40
dose of brachy
60Gy with a dose rate of .4-.5Gy/hour
41
what type of bratty is most common in penile treatment (LDR,PDR,HDR?)
PDR
42
urethra cancer in women commonality
very rare only 1600 cases reported ever
43
how long is the female urethra
4cm
44
LN drainage of the female urethra
like the vulva to the superficial and deep inguinal nodes and the external iliacs
45
advanced urethral tumours affect which Ln
INGUINAL AND PELVIC LN
46
Diagnostic methods of urethra cancer
chest radiographs, intravenous urograms and CT of the abdo and pelvis , pelvic exam under anesthetic during a urethroscopy and cystoscopy is done
47
how is the urethra divided for staging
the proximal half and the distal half
48
most important prognostic factors for urethra
tumour size and location is most important
49
anterior urethra (F) cancer is what stages
stage 0,1
50
posterior urethral (F) cancer is what stages
stage2-4
51
treatment fir stage 0 F urethral cancer
open excision, electroexcision, fulguration or laser coagulation can be used for stage 0 or in situ involvement of the distal urethra
52
treatment for stage 1 urethral cancer (F)
interstitial brachy or combined interstitial bratty + EBRT are alternatives to surgery for the distal 1/3 of the urethra
53
treatment for stage 2-4 urethral cancer (F)
prep XRT- with exonerative surgery and urinary diversion
54
what does stage 2-4 urethral cancer usually indicate invasion wise?
that the cancer has invaded the bladder
55
treatment for the urethral meatus in women
meatus is the opening of the ureter radioactive needles are used a dose of 60-70Gy LDR can be given in 6-7 days (.4 Gy/hr)
56
treatment for large urethral tumours in women
large tumours that invade the labia, vagina, base of the bladder cant be treated by implant alone EBRT + implant is recommended the EBRT field should cover the inguinal LN, and cover sup unto L5/S1 to cover the pelvic LN bolus should be added if the inguinal LN are + pelvis is treated to 50Gy boost of 10-15Gy to the electrons is added for LN+ patients treated with photons or electrons
57
treatment of advanced urethral cancer in women
primary tumour is treated with a vaginal cylinder to bring the dose to the urethra to 60Gy interstitial implant is used to boost the dose to 70-80Gy LDR brachy
58
side effects of treatment for female urethral treatment
urethral strictures, incontinence, cystitis and stenosis can also develop
59
divisions of the posterior urethra
membranous urethra that passes through the urogenital diaphragm and the prostatic urethra that passes through the prostate
60
the anterior utethra passes through _______
the corpus spongiosum
61
structural components of the penis
2 corpora cavernous and the corpus spongiosum
62
the divisions of the anterior urethra
fossa navacularis a widening within the glans penis the penile urethra which passes through the pendulous part of the penis the bulbous urethra dilated proximal part of the anterior urethra
63
urethral cancers most common route of spread
direct extension
64
most common symptoms of urethral cancer
most commons urethral obstruction symptoms ex: dysuria, discharge, hematuria, tenderness
65
what 2 diagnostic tests are most vital for penile/ urethral cancer
urethroscopy and cystoscopy
66
most common pathology of urethral cancer
80% diagnosed as SCC
67
What staging system is used for urethral cancer
Ray and associates
68
staging for male urethral cancer
A-tumour extension into lamina proper B-tumour extension into corpus spongosium or prostate C-direct extension to tissues beyond corpus spongosium or beyond prostatic capsule D1-regional mets including inguinal and or pelvic LN D2-distant mets
69
main treatment for the male urethra
surgery

Skin Radiation therapy (40 decks)

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