Penile Cancer FRCR C02A Flashcards
Which age group is affected most by penile cancer?
men over age 70 years
What are common malignant cancers of penis
squamous carcinoma
Verrucuous carcinoma
BCC
Kaposi’s sarcoma
melanoma
sarcoma
What RFs are a/w penile cancer
HPV 16, 18: geography, no of sexual partners and circumcision
PHIMOSIS
Does HPV Vaccination provide protection ?
Yes
How does penile cancer spread
First to the Inguinal nodes, then to the pelvic nodes
How is penile cancer diagnosed ?
small lesion with excision and larger lesions with biopsy
What investigations are recommended for staging?
For primary tumor,USG and MRI (with PG E1)
CT/MRI pelvis and CT Chest and Abdomen
How does MRI help in staging?
1.differentiate between cavernosal and spongiosum involvment,assist with planning surgery
when is sentile LN biopsy advised
for T2 tumors or any with G3 histology or vascular invasion
How is CIS of penis treated ?
Local Excision for well defined tumors
sometimes, CIS may be patchy and poorly defined, surgery may be mutilating and difficult reconstruction, RT is advised
how is primary tumor treated (penile cancer)
- small tumors confined to glans/spongiosum: penis preserving strategy: glanectomy, EBRT ,BRachy or laser excisioin
- Cavernosal involvement: Partial penectomy with at least 5 mm margin,10mm for G3 tumors
3.For T3/t4: total penectomy with periurethral urethrostomy
What are acute and long term S/Es of RT for Penile Cancer?
Acute: painfulurethral reaction,moist desquamation
Long term: painful fibrosis,telengiectasia, urethral stricture
How is RT planned for penile cancer?
- Circumcision first
- wax immobilisation block should be made
- Hold penis in vertical position
- achieve full dose RT at skin surface
5.
What RT dose is used for penile cancer?
55 Gy/ 20# or 64 Gy/32 #
what should be done if no e/o nodal disease following staging (sentinel node biopsy for high risk tumors)
Observation
what should be done for pathological nodes following staging for penile cancer
Inguinal Node dissection
for low risk groin: eg only one LN involved withut ECE: no further Rx required
for high risk groin eg.2 LN with ECE: increased risk of local groin rec and pelvic nodal spread 50%, post OP RT is added (groins and Pelvic nodes)
how to treat penile cancer with fixed nodes, pelvic nodes or multiple high risk nodes: Poor PS patients?
NACT or CRT folllowed by surgery depending on response
whats the role of NACT in penile cancer
TIP with Response rate of 50%
How is inguinal region contoured for RT planning?
Volume extends from medial border of iliopsoas muscle laterally, medially the medial border of pectineus, and anterly to the skin, should be extended across midline, lymphatics cross midline
is there role of concurrent ChT in Penile Cancer RT Rx?
Not proven
But weekly cisplatin can be used or 5 FU / Mitomycin
what pelvic RT dose can be given in penile cancer?
45 Gy/ 25# to groin and pelvic volume with weekly cisplatin , groin boosted to 60 Gy / 30# for areas of residual tumor, pelvic nodes selectively boosted to 54 Gy (2 Gy equivalent), depending On OARs constrainst
what are Rx options in metastatic penile Cancer (NCCN 2025)
TIP
Other Recommended Regimens
* 5-FU + cisplatin
* 5-FU + cisplatin + pembrolizumab followed by pembrolizumab maintenance therapy
* 5-FU + carboplatin + pembrolizumab followed by pembrolizumab maintenance therapy
