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Repro / GU > SM_238b: Cancer of the Penis > Flashcards

SM_238b: Cancer of the Penis Flashcards

1
Q

Describe epidemiology of penile carcinoma

A

Epidemiology of penile carcinoma

  • Consistently low annual incidence rates among industrialized countries
  • Prevalence rates are higher in non-industrialized countries
  • Principally in uncircumscribed men
  • Neonatal circumcision virtually eliminates risk of invasive squamous cell carcinoma but not CIS
  • Adult circumcision does not decrease risk
  • Most common between 50-70 years of age
  • African American = Caucasian, Asian American lower, and Hispanic American higher
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2
Q

____ and ____ are risk factors for penile cancer

A

HPV and chronic inflammation are risk factors for penile cancer

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3
Q

Describe signs and symptoms of penile carcinoma

A

Signs and symptoms of penile carcinoma

  • Erythematous precursor lesion
  • Visible and palpable mass: glans (60%), prepuce (23%), shaft (9%)
  • Large and/or atypical appearing wart
  • Frank ulceration
  • Carcinoma in situ
  • Exophytic mass or ulceration
  • Pain
  • Periodic bleeding
  • Purulent discharge
  • 40-80% have palpable inguinal nodes
  • Metastases to lung, liver, bone, brain in 1-10% of patients on presentation
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4
Q

Describe pitfalls of clinical staging of penile cancer

A

Pitfalls of clinical staging of penile cancer

  • 30-60% of palpable nodes are secondary to reactive lymphadenitis: infection, chronic inflammation
  • Up to 60% of palpably normal groins harbor metastatic disease
  • 95% of patients with untreated nodal metastases die within 3 years
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5
Q

Penile cancer most commonly develops from ____, most are ____, half are ____, and half are related to ____

A

Penile cancer most commonly develops from mucosal surface of the glans of penis or inner prepuce, most are squamous cell carcinoma, half are HPV linked, and half are related to chronic inflammatio

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6
Q

Metastatic cancer to penis presents with ____, ____, ____, ____, and ____

A

Metastatic cancer to penis presents with priapism, palpable mass, pain, hematuria, and urethral bleeding

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7
Q

This is ___ of penis

A

This is squamous cell carcinoma of penis

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8
Q

Survival for squamous cell carcinoma of the penis is ____

A

Survival for squamous cell carcinoma of the penis is presence or absence of inguinal lymph node involvement

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9
Q

HPV has ____ and ____ oncoproteins

A

HPV has E6 and E7 oncoproteins

  • E6: prevents p53 from making damaged cells commit suicide
  • E7: binds to Rb and prevents it from stopping damaged cells from growing
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10
Q

____ is a surrogate marker for HPV 16

A

P16INKA4 is a surrogate marker for HPV 16

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11
Q

Squamous cell carcinoma of penis involves overexpression of ___

A

Squamous cell carcinoma of penis involves overexpression of epidermal growth factor receptor (EGFR)

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12
Q

Patients with squamous cell carcinoma of penis who are HPV+ have ___ survival

A

Patients with squamous cell carcinoma of penis who are HPV+ have greater survival

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13
Q

Gardasil is a ___ valent vaccine

A

Gardasil is a 9 valent vaccine

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14
Q

Describe premalignant penile lesions

A

Premalignant penile lesions

  • HPV related: carcinoma in situ (erythroplasia of Queyrat and Bowen’s disease), Bowenoid papules, giant condyloma accuminatum (Bushke-Lowenstein tumor), warty / basiloid / mixed PeIn
  • Non-HPV related: lichen sclerosus, cutaneous penile horn, leukoplakia, pseudoepitheliomatous / keratotic / micacenous balanitis / differentiated PeIN
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15
Q

Describe Bowen’s disease / erythroplasia of Queyrat

A

Bowen’s disease / erythroplasia of Queyrat

  • Considered premalignant lesions or CIS of penis
  • Bowen’s occur mainly on shaft, erythroplasia occurs on glans / prepuce
  • Bowen’s not associated with visceral malignancies
  • Progression to squamous cell carcinoma occurs in 10%
  • Treatments vary
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16
Q

Bowenoid papules are ___

A

Bowenoid papules are a variant of penile intraepithelial neoplasia

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17
Q

Giant condyloma acuminata is ___

A

Giant condyloma acuminata is Bushke-Lowenstein tumor

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18
Q

This is ___

A

This is undifferentiated pelvic intraepithelial neoplasia

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19
Q
A
20
Q

Lichen sclerosis involves ____ and ____

A

Lichen sclerosis involves meatal stenosis and urethral stricture

21
Q

This is a ____

A

This is a cutaneous penile horn

22
Q

This is ___

A

This is leukoplakia of the penis

23
Q

This is ____

A

This is pseudoepitheliomatous, keratotic, and micaceous balanitis

24
Q

This is ___

A

This is differentiated penile intraepithelial neoplasia

25
Q

Primary surgical management of superficial lesions of penis (Ta, T1) is ___

A

Primary surgical management of superficial lesions of penis (Ta, T1) is conservative excision

  • Recurrence rates: 8-11%
26
Q

Verrucous carcinoma of penis is caused by ____

A

Verrucous carcinoma of penis is caused by HPV 6 and 11

27
Q

____ for invasive cancer of penis has lower recurrence rate than ____

A

Total penectomy and perineal urethrostomy for invasive cancer of penis has lower recurrence rate than partial penectomy

28
Q

Describe determination of stage of penile cancer

A

Determination of stage of penile cancer

  • Superficial vs invasive
  • Inguinal lymph node involvement
  • Pelvic lymph node involvement
  • Non-nodal visceral metastases
29
Q

Soft tissue detail of penile tumors is best imaged by ___

A

Soft tissue detail of penile tumors is best imaged by MRI

30
Q

___ should be performed expeditiously for penile cancer if indicated

A

Bilateral inguinal lymph node dissection should be performed expeditiously for penile cancer if indicated

31
Q

Describe regional lymph nodes for penis

A

Regional lymph nodes for penis

  • First echolon drainage is to superficial ad deep inguinal lymph nodes and may occur bilaterally
  • Second echelon drainage is from inguinal lymph nodes to ipsilateral external iliac nodules
32
Q

Lymphadenectomy is ___

A

Lymphadenectomy is both diagnostic and curative

  • Performed one level above positivity
  • Indications: persistent palpable inguinal adenopathy, poorly differentiated tumor, stage T2 or greater, angiolymphatic invasion
33
Q

___ yields better survival than therapeutic lymphadenectomy

A

Prophylactic lymphadenectomy yields better survival than therapeutic lymphadenectomy

  • 18% of clinically normal nodes contain tumor
34
Q

Sentinel lymph node mapping is performed with ___

A

Sentinel lymph node mapping is performed with radioactive sulfur colloid + vital dye injection

35
Q

Describe implications of inguinal and / or pelvic node involvement

A

Implications of inguinal and / or pelvic node involvement

  • Recurrence will manifest within first 2 years
  • Prognosis: bilateral inguinal nodes, > 2 inguinal nodes, extracapsular tumor, pelvic nodes
36
Q

Advanced stage penile cancer should be treated with ___

A

Advanced stage penile cancer should be treated with neoadjuvant chemoradiation

  • Indicated for unresectable local tumor or distant metastatic disease
  • Lung, liver, and bone are the most common sites of extranodel metastases
37
Q

Metastatic penile cancer may also be treated with ____ and ____

A

Metastatic penile cancer may also be treated with EGFR inhibition and PD-1/PD-L1 inhibition

38
Q

Lichen sclerosis ___ HPV related

A

Lichen sclerosis is NOT HPV related

39
Q

Most penile cancers arise from the ____

A

Most penile cancers arise from the glans

40
Q

HPV-16 ___ protein interacts with EGF receptors to activate mitogenic signaling pathways

A

HPV-16 E5 protein interacts with EGF receptors to activate mitogenic signaling pathways

41
Q

HPV-16 E6 protein negatively affects the cell cycle regulator ____

A

HPV-16 E6 protein negatively affects the cell cycle regulator p53

42
Q

Bowenoid papulosis is ___

A

Bowenoid papulosis is HPV-related

43
Q

Pelvic intraepithelial neoplasia involving the glans penis is called ____

A

Pelvic intraepithelial neoplasia involving the glans penis is called erythroplasia of Queyrat

44
Q

____ is the best management option for invasive penile cancer involving the proximal shaft

A

Total penectomy is the best management option for invasive penile cancer involving the proximal shaft

45
Q

___ provides best soft tissue detail of penile cancers

A

MRI provides best soft tissue detail of penile cancers

46
Q

Describe femoral triangle

A

Femoral triangle

  • Superior: inguinal ligament
  • Medial: adductor longus
  • Lateral: sartorius
47
Q

____, ____, and ____ comprise TIP chemotherapy regimen used for advanced stage penile cancer

A

Paclitaxel, ifosfamide, and cisplatin comprise TIP chemotherapy regimen used for advanced stage penile cancer

Repro / GU (46 decks)

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