Penile Cancer

Background

-Malignant lesions that arise from the squamous epithelium of the glans, prepuce, or penile shaft

-Rare

-50-70 y.o is the age of onset

-Risk factors include uncircumcised, history of HIV, history of HPV, smoking, phimosis, balanitis

What type of epithelium do most cancers of the penis arise from?

Squamous epithelium of the epidermis and dermis

Where do lesions usually appear in penile cancer?

On the glans or prepuce

Which oncoproteins can HPV derived cancers interfere with?

E6 and E7 (tumor suppression gene)

What is Carcinoma in situ?

A type of cancer that is localized and has not invaded surrounding tissues.

What is Squamous Cell Carcinoma?

The most common type of carcinoma that invades the corpus spongiosum, with a 20-40% chance of inguinal node involvement.

What type of carcinoma is linked to HPV?

Warty carcinoma.

What is Basaloid Carcinoma?

A type of carcinoma characterized by ulcerative irregular masses related to HPV.

What is Sarcomatoid Carcinoma?

The most aggressive variant of carcinoma.

What is the initial presentation of the condition?

Skin abnormality or palpable lesion

Where do the majority of lesions occur?

On the glans

Are the lesions usually painful?

Usually painless

What percentage of cases present with inguinal adenopathy?

30-60%

What is the percentage of cases that metastasize to other GU organs?

1-10%

What is a focused GU exam?

A focused GU exam is a physical examination that specifically assesses the genitourinary system.

What does a penile exam check for?

A penile exam checks for circumcision status, characteristics of lesions, or any other abnormalities.

What is assessed during an inguinal exam?

An inguinal exam assesses for adenopathy.

Diagnosis

-Tissue biopsy

-Imaging (Ultrasonography, MRI/CT)

Staging

-Use the TNM system

What factors does management depend on for penile carcinoma?

Staging

What treatments can be used for Carcinoma in situ?

Topical therapy, laser ablation, radiation, total glans resurfacing, Mohs surgery

What are some penis preserving interventions for penile carcinoma?

Local excision, glansectomy, laser, radiation, brachytherapy

What are other management options for penile carcinoma?

Partial/total amputation of the penis, inguinal lymphadenectomy, chemotherapy, or radiation