Penile Cancer
Mohs microsurgery
is a surgical technique used to treat various skin cancers that allows precise microscopic control of the margins by utilizing tangentially cut frozen-section histology
Can brachytherapy be used?
Yes (interstitial implants) 60-65 Gy in 6-7 days
Corpus Spongiosum
a mass of erectile tissue alongside the corpora cavernosa of the penis and terminating in the glans.
What is the most common site for mets in penile cancer?
the inguinal lymph nodes
Distant mets are?
uncommon
In patients with clinically non palpable inguinal nodes, there is a _____ chance of micrometastasis elsewhere throughout the body.
20%
The 5 year survival rate for stage 3 and some stage 4 penile cancer is?
59%
What is the most common type of penile cancer?
*well- differentiated SCC*
If the cancer has spread to distant body parts, the 5 year survival rate is?
11%
The 5 year survival rate for stage 1 and 2 penile cancer is?
85%
What is the grading system for penile cancer?
Cell differentiation
What are some etiology factors for penile cancer?
Age 60 or older Uncircumcised men HPV or other sexually transmitted diseases Phimosis, a condition where the foreskin of the penis cannot be pulled back over the glans Poor personal hygiene Use of tobacco products
What are some sign and symptoms of penile cancer?
Change in the skin of the penis. Wart-like growth or lesion that may or may not be painful Open sore that won't heal Reddish rash Small crusty bumps Flat blush brown growths Swelling at the end of the penis Persistent, smelly discharge under the foreskin Swollen lymph nodes in the groin if the cancer has spread Palpable inguinal lymph nodes (20%)
What is required for radiation therapy?
Customized bolus EVEN DOSE IS KEY 2.5-3.5Gy per fraction for a total of 50-55Gy 1.8-2 Gy per fraction for a total of 60-65 Gy (last 5-10 Gy boost is given in reduced portals)
What must someone take into account before penile treatments?
Infertility Freezing may be an option
What are diagnostic procedures for penile cancer?
Observation - Patient will go to doctor because of abnormalities and the doctor will be able to tell if it's a lesion Biopsy - FNA CT - nodal involvement MRI Ultrasound
Most carcinomas of the penis start within the?
Preputial area
Penile cancer is ____
Rare
What are some epidemiology factors for penile cancer?
Rare in the U.S., one per one hundred thousand each year or less than 1% of male cancers. Circumcision done early in life has been found to protect against penile cancer however if the procedure is done later in life it has no effect. This can explain higher incidence in areas of the world where circumcision is not routine
What are the OAR for XRT to the penis?
Skin - 55 Gy Rectal - 60 Gy Bladder - 60 Gy testies - 1 Gy (sterile)
What is the most common form of surgery for penile cancer?
Surgery for ALL stages Mohs surgery Laser surgery Cryosurgery Wide local excision Partial or total penectomy
What are some side effects of radiation therapy for penile cancer?
Swelling Erythema Tenderness Oozing peeling burning while urinating Telangiectasia Necrosis narrowing of the urethra fatigue nausea diarrhea
What is the staging system for penile cancer?
TNM
How does penile cancer spread?
The lymphatic drainage of the skin of the shaft and the prepuce channels into the superficial inguinal nodes located above the fascia lata
What are the other types of histologies for penile cancer?
Transitional cell carcinoma Adenocarcinoma Undifferentiated or Mixed Carcinomas
When is chemotherapy used for penile cancer?
Used to treat advanced stage tumors 5FU, Cisplatin and Bleomycin
For the most part, lymphatic drainage can be considered _____
bilateral There is a rich network of lymphatics within the penis and at its base.
Corpora cavernosa
paired dorsal erectile tissue (most abundant tissue of penis)
The _______ nodes are located above the medial to the junction of the epigastric and saphenous vein
sentinel