Penile cancer

What is the cause of penile cancer?

Unknown

________ performed early in life appears to protect against penile cancer, but not true if operation is done in adult life

Circumcision

General etiology

Chronic inflammation

HPV (half of all cases)

AIDS

Penile trauma

Smoking and other tobacco use

Age

Etiology age

Common range 50-70 years

Avg 68

4 out of 5 —> men age 55+

Phimosis

Narrowing of the opening of the prepuce

Common in men with penile carcinoma

Clinical presentation

An area of skin becoming thicker

Changes in the skin color

Lump (may occur under the skin in the groin area as well)

Ulcer (sore) that might bleed

Reddish, velvety rash under foreskin

Small, crusty bumps

Flat, bluish-brown growths

Smelly discharge (fluid) or bleeding under foreskin

50% of patients who present with lymph node involvement are often related to ________

Inflammatory infectious processes

20% of patients with clinically normal inguinal nodes have ________

Metastases

Most common histology

Well-differentiated SCC

Bowen disease

SCC in situ that may involve the shaft of the penis and hairy skin of the inguinal and suprapubic areas

Erythroplasia of Queyrat

Epidermoid carcinoma in situ that involves the mucosal or mucocutaneous areas of the prepuce or glans appears as red, elevated, ulcerated lesions)

Extramammary Paget Disease

Rare epithelial apocrine (releases some of its cytoplasm) carcinoma

The most common sites are scrotum, inguinal folds, and perineal region

Lymphatic drainage is bilateral

True

Lymphatic channels of prepuce and skin of the shaft drain into ________

Superficial inguinal nodes

Lymphatics of penile urethra follow the lymphatics of penis to the ________

Superficial and deep inguinal nodes

Inguinal nodes is the most common site of metastatic spread

True

About 20% of patients with clinically nonpalpable inguinal nodes have ________

Micrometastases

________ is reported in about 35% of all patients and in approximately 50% of those with palpable nodes

Pathologic evidence of nodal metastases

Prognostic indicators

Extent of primary lesion

Lymph node status

• Tumor differentiation is important too

Principle advantage of radiotherapeutic management for penile cancer

High probability of tumor control and low morbidity

Radiation therapy treatment technique

Management of primary tumor and regional lymphatics

or

Nodal management with observation and delayed intervention

EBRT doses

55-70 Gy box or water bath method

5000 cGy inguinal lymph nodes in 5 weeks

Brachytherapy treatment method

A mold is usually in the form of a box or cylinder with a central opening and channels for the placement of radioactive sources (needles or wires) in the periphery of the device. The cylinder and sources should be long enough to prevent underdosage at the tip of the penis

Brachytherapy doses

60-65 Gy at surface of penis

50 Gy at center of penis

60-70 Gy at single/double planed implants