penile cancer

Question 1

Epidemiology of penile cancer

incidence:

nature

ages

Answer 1

standard incidence of 0.8-1/ 100,000

it’s a very aggressive tumour

affects both Old and Young men

Question 2

RF for penile cancer

Answer 2

• Phimosis
• Chronic inflamation (balanitis Xerotica Obliterans)
• sexual behavior (HPV)
  
  • Mx partners
  • early sex
  • unprotected sex

Question 3

which types if HPV cause penile cancer

Answer 3

High risk: 7, 16, 18, 21

Low risk: 6 & 11

Question 4

prevention for HPV

which ages is it given to

Answer 4

Preventive vaccine against HPV given to 11-12 y/o

Question 5

Histological types of Penile cancer

where can it met to

MET EMMLY’s P in histology

Answer 5

1. Epithelial (majority = SCC)
2. Mesenchymal
3. Melanomas
4. Lymphomas
5. 2ndary met from UB or PCa

Question 6

3 types of Epithelial tumors (BIM)

most common condition for each type

Answer 6

Benign

• (Condyloma acuminata- hpv 6 & 11 from 40% of warts

Intermediate

• (Intraepithelial Neoplasia (carcinoma in situ))

Malignant

• SCC in 95-97% of cases

Question 7

types of intermediate epithelial cancer of the penis

Answer 7

1. Intraepithelial Neoplasia aka PIN/CIS
   
   • erythroplasia of queyrat
   • bowens disease
   • Bowens papilosis
2. Padget’s DIsease = adenocarcinoma
3. Giant condylomata acuminata aka
   
   • Buschke- Lovenstein tumor

Question 8

2016 types subtypes of SCC of the penis

• 4 types of hpv related (big women cum more)
• 3 types of non hpv (virgins usually suck)
• 2 types of PIN SCC

Answer 8

1. HPV related
   
   • Basaloid SCC
   • Warty SCC
   • Clear cell SCC
   • Medullary SCC
2. Non HPV related
   
   • Verrucus SCC
   • Usual SCC
   • Sarcomatoid / spindle SCC (favorable prog)
     
     • 3. Precursor lesions(PIN/CIS)
          
          1. HPV related Warty SCC
          2. Non HPV related Verrucus SCC

Question 9

Clinica features of Penile cancer

Answer 9

• pain in the prepuce
• Dysuria
• Seropurulent discharge develops into foul smelling blood stained discharge over months
• Inguinal LN enlargment

Question 10

how does Penile cancer spread

Answer 10

via Lymph

Question 11

Clinical and Pathological staging of Penile Cancer using TNM 2017

step wise approach

Answer 11

TNM 2017

• N = inguinal LN’sadjacent to external iliac artery_​_which can be
  
  • ​S__uperficial inguinal LN OR
  • Deep inguinal LN
• which then spread to
  
  • Pelvic LN’S
• which then spread to
  
  • Obturator LN

Question 12

What is the 2 step rx of Penile carcinoma

What determines the type treatment of Penile carcinoma

Answer 12

sperm retreival for fertility

STEP 1 = Surgery

type depends on TNM 2017 grading

• Tis, T_A, T₁ = Superficial Penile cancer
  
  • Penis saving surgery
• T_2, - T₄ = Invasive Penile cancer
  
  • Radical surgery (penectomy)

STEP 2 = Dissection of LN

Question 13

which specific method of penis saving surgery are used for superficial penile cancer

Answer 13

1. Circumcision : for tumors of prepuce
2. Wide local excisionn: tumors of glans penis
3. Combo of above (circ and wide excision)
4. Laser therapy

Question 14

Specific methods for Radical surger of Invasive penile cancer

2 steps of total penile amputation

Answer 14

• Partial penile amputartion

or

• Total penile Amputation consists of
  
  1. w/ or w/o emasculation ( testis removal)
  2. Perineal reconstruction of the urethra

Question 15

What determines the type of LN dissection

standard vs BMILD

Answer 15

depends on whether it’s clinically palpable

• N+ve =
  
  • immediate standard LN dissection
• N-ve = Aggressive approach w/ (B mild)
  
  • do not perform sentinal LN biopsy
    
    • Bilateral Modified Inguinal LN Dissection