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Skin Radiation therapy > Penile cancer > Flashcards

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
Q

dose for XRT

A

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

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26
Q

advanced proximal tumour surgery options

A

emasculation surgeries: (penectomy, scrotectomy,orchiectomy or cyroprostatectomy)

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27
Q

surgery for tumours confined to the prepuce

A

wide circumcision

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28
Q

surgery for lesions confined to the glans penis

A

partial penectomy

29
Q

surgery for stage 3 tumours

A

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
Q

can a patient still be sexually active with a partial penectomy

A

yes but 15% of patients with a partial penectomy lose sexual function

31
Q

side effects of XRT in penile cancer

A

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
Q

uses of chemo in penile cancer

A

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
Q

chemo agents used in penile cancer

A

platinum, methotrexate and bleyomyacin

34
Q

methods of chemo administration

A

topically (cream) or systemically (IV)

35
Q

most common pathology of penile cancer

A

low grade well differentiated SCC is most common

36
Q

precancerous penile cancers

A

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
Q

what must be done before the patient can receive penile brachythherapy

A

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
Q

indications for brachytherapy

A

early stage disease, tumour <4cm <1cm invasion into the cavernous cavernosum

39
Q

complications of brachy

A

urethral stricture,ulceration, necrosis, pain, impotence, edema

40
Q

dose of brachy

A

60Gy with a dose rate of .4-.5Gy/hour

41
Q

what type of bratty is most common in penile treatment (LDR,PDR,HDR?)

A

PDR

42
Q

urethra cancer in women commonality

A

very rare only 1600 cases reported ever

43
Q

how long is the female urethra

A

4cm

44
Q

LN drainage of the female urethra

A

like the vulva to the superficial and deep inguinal nodes and the external iliacs

45
Q

advanced urethral tumours affect which Ln

A

INGUINAL AND PELVIC LN

46
Q

Diagnostic methods of urethra cancer

A

chest radiographs, intravenous urograms and CT of the abdo and pelvis , pelvic exam under anesthetic during a urethroscopy and cystoscopy is done

47
Q

how is the urethra divided for staging

A

the proximal half and the distal half

48
Q

most important prognostic factors for urethra

A

tumour size and location is most important

49
Q

anterior urethra (F) cancer is what stages

A

stage 0,1

50
Q

posterior urethral (F) cancer is what stages

A

stage2-4

51
Q

treatment fir stage 0 F urethral cancer

A

open excision, electroexcision, fulguration or laser coagulation can be used for stage 0 or in situ involvement of the distal urethra

52
Q

treatment for stage 1 urethral cancer (F)

A

interstitial brachy or combined interstitial bratty + EBRT are alternatives to surgery for the distal 1/3 of the urethra

53
Q

treatment for stage 2-4 urethral cancer (F)

A

prep XRT- with exonerative surgery and urinary diversion

54
Q

what does stage 2-4 urethral cancer usually indicate invasion wise?

A

that the cancer has invaded the bladder

55
Q

treatment for the urethral meatus in women

A

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
Q

treatment for large urethral tumours in women

A

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
Q

treatment of advanced urethral cancer in women

A

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
Q

side effects of treatment for female urethral treatment

A

urethral strictures, incontinence, cystitis and stenosis can also develop

59
Q

divisions of the posterior urethra

A

membranous urethra that passes through the urogenital diaphragm and the prostatic urethra that passes through the prostate

60
Q

the anterior utethra passes through _______

A

the corpus spongiosum

61
Q

structural components of the penis

A

2 corpora cavernous and the corpus spongiosum

62
Q

the divisions of the anterior urethra

A

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
Q

urethral cancers most common route of spread

A

direct extension

64
Q

most common symptoms of urethral cancer

A

most commons urethral obstruction symptoms ex: dysuria, discharge, hematuria, tenderness

65
Q

what 2 diagnostic tests are most vital for penile/ urethral cancer

A

urethroscopy and cystoscopy

66
Q

most common pathology of urethral cancer

A

80% diagnosed as SCC

67
Q

What staging system is used for urethral cancer

A

Ray and associates

68
Q

staging for male urethral cancer

A

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
Q

main treatment for the male urethra

A

surgery

Skin Radiation therapy (40 decks)

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