Penile cancer Flashcards
What is the incidence of penile cancer in Europe and USA?
<1.0/100,000
In what country is penile cancer the most common male malignancy?
Uganda
it is also more common in India and Brazil 8.3/100,000
What are the risk factors for penile cancer?
Phimosis
HPV
Smoking
Penile cancer are caused by HPV in what % of cases?
45%
Penile cancer T1?
Tumour invades subepithelial connective tissue
Penile cancer T1a?
Tumour invades subepithelial connective tissue without lymphovascular invasion and is not poorly differentiated
Penile cancer T1b?
Tumour invades subepithelial connective tissue with lymphovascular invasion or is poorly differentiated
Penile cancer T2?
Tumour invades corpus spongiosum with or without invasion of the urethra
Penile cancer T3?
Tumour invades corpus scavernosum with or without invasion of the urethra
Penile cancer N1?
p?
Palpable mobile unilateral inguinal lymph node
Metastasis in one or two inguinal lymph nodes
Penile cancer N2?
p?
Palpable mobile multiple or bilateral inguinal lymph nodes
Metatstasis in more than two unilataeral inguinal nodes or bilateral inguinal lymph nodes
Penile cancer N3?
p?
Fixed inguinal nodal mass or pelvic lymphadenopathy, unilateral or bilateral
(Metastasis in pelvic lymph node(s), unilatera or bilateral extranodal or extension of regional lymph node metastasis)
How should you treat penile cancer PeIN(CIS),Ta and T1a (G1-2)?
Localised lesion:
Excision/circumcision
Flat lesions: Local destruction (ex YAG or CO2, laser, cryo) Topical therapy (5-FU, imiquimod, fotodynamic therapy)
alternative: resurfacing (with skin graft)
Mentions two methods of topical therapy you can use for superficial penile cancer?
5-FU
imiquimod
How should you treat penile cancer T1aG3, T1b, T2?
Glansectomy
alternative: Brachyradiotherapy (in lesions <4 cm)
How should you treat penile cancer T3?
Partial/total penectomy
How should you treat penile cancer T4
Emasculation
What treatments for superficial penile cancer have the highest local recurrence?
lasers and brachytherapy
What are the chances of sufficient erection after glansectomy or partial amputation?
66,7%
What are the chances of orgasms after glansectomy or partial amputation?
72,2%
What are the chances of restoration of regular sexual intercourse after glansectomy or partial amputation?
55,6%
What are the complications of Radiotherapy for penile cancer?
Stricture of urethra 20-35%
Necrosis of glans 10-20%
Late fibrosis of corpora cavernosa
What is the success rate for radiotherapy of T1aG3, T1b, T2 penile cancer?
70-90%
What professions should be part of at multidisciplinary team treating penile cancer?
Dermatovenerologist Urologist Pathologist Radiologist Medical oncologist Radiotherapeutist
When should you perform sentinel node in penile cancer?
≥ T1G2
What is an alternative to sentinel node in ≥ T1G2 penile cancer?
bilateral modified inguinal lymphadenectomy (mILND)
What is the advantage of sentinel node over bilateral modified inguinal lymphadenectomy (mILND) in ≥ T1G2 penile cancer?
decreased morbidity
How should your treat penile cancer cN1/N2?
radical inguinal lymphadenectomy (rILND)
How should your treat penile cancer cN3?
chemotherapy followed by radical inguinal lymphadenectomy (rILND)
What measures should be taken to decrease morbidity after inguinal lymphadenectomy (ILND)?
Ligation/clips on lymph vessels instead of diathermia
Saphenous vein preservation
Compression stockings
Prophylactic antibiotics until drains are removed
Vacuum dressings
When is chemotherapy given in penile cancer?
Adjuvant p N2-3
Neoadjuvant T4
Palliative
