penile cancer urology

what are the routes of spread for penile cancers

local invasion: superficially at first and then invasion into the shaft of the penis lymphatic spread: spread early to the inguinal nodes hematological spread: -rarely happens, if it does it seeds into the lungs -very late staged disease

bowens disease

squamous cell carcinoma in situ that may involve the shaft of the penis and hairy skin of the inguinal and suprapubic areas

What are the surgical procedures for a primary penile tumor?

Patient may need circumcision Local extension or chemosurgery to partial or total penectomy

What is Phimosis?

the opening in the foreskin that makes washing difficult

what are the most common side of spread for penile cancers?

the superficial inguinal nodes

what is the pathology of penile cancers

-most common type of penile cancer is squamous cell carcinoma -varrucous carcinoma is often seen in people who chew tobacco or use snuff orally "snuff dippers cancer" -warty carcinoma and basaloid carcinoma (less common but highly associated with HPV) -neuroendocrine (rare)

what is the surgical treatment for penile cancers

-penectomy , partial or whole, requires surgical reconstruction after surgery -moh's microsurgery -wide local excision -laser surgery (gives good results and preserves sexual function -circumcision (although results in a higher recurrence rate) -lymohadenectomy (post RT, sampling of nodes as they are resected so they dont take out more than they have to)

what is the clinical presentation of penile cancers

-redness -secondary infection and associated foul -smell -irritation -priapism -sores on the penis -bloody discharge -appear as warty growth or harden ulcers -dysuria -hematuria -palpable inguinal LN 30-45% at presentation, enlarged LN are often related to inflammatory processes phimosis may obscure the primary lesion

What are the two ways to stage penile cancer?

1. Jacksons Staging 2. TNM

What are the 4 distant sites that penile cancer spreads to?

1. Lung 2. Liver 3. Bone 4. Brain

Give some other risk factors for penile cancer:

1. Phimosis 2. Smoking 3. Lichen sclerosis 4. HIV infection 5. Previous Psoralen-UV-A photochemotherapy

What are the 5 symptoms of penile cancer?

1. painless nodule 2. ulcer that does not heal 3. discharge 4. edema/swelling- later stages 5. adenopathy

What are the percentages of histology of penile/urethral cancer?

80% squamous cell carcinoma 15% transitional cell carcinoma 5% adenocarcinoma 1% undifferentiated/mixed carcinomas

What does the management of penile cancer often involve?

A combination of surgery, radiotherapy and chemotherapy

Name 4 chemo drugs active against penile cancer.

Agents active against penile Ca: 1. 5-FU 2. Cisplatin 3. Bleomycin 4. Methotrexate 5. Irinotecan Although metastatic penile cancer is chemosensitive, responses are brief and incomplete, and eventual progression is inevitable.

How does penile cancer usually present?

As a palpable or ulcerating lesion on the penis The lesions are typically painless however may discharge or be prone to bleeding

What is the difference between erythroplasia of Queyrat (EQ) and Bowen Dz?

Both EQ and Bowen Dz are CIS conditions. EQ occurs within the penile mucocutaneous epithelium (glans and prepuce), whereas Bowen Dz occurs within follicle-bearing epithelium (penile shaft).

What procedure early in life can help protect against penile cancer?

Circumcision

What will occur before radiation therapy to the penis?

Circumcision first

What causes condyloma acuminata?

Condyloma acuminata, more commonly known as genital warts, are associated with HPV infection. They are usually benign but can undergo malignant transformation.

What areas have a higher incidence of penile cancer?

South America, Africa and Asia

What are the treatment options for penile cancers?

Surgery Interstitial implants for early stage disease Radiation therapy

what is the TNM staging for penile cancers

T1 = tumor invades the subepithelial connective tissue T2 = tumor invades corpus spongiosum or cavernosum T3 = tumor invades urethra and prostate T4 = tumor invades other adjacent structures N0 = no regional lymph nodes N1 = mets in single superficial inguinal LN N2= mets in multiple or bilateral superficial inguinal nodes N3 = mets in deep inguinal or pelvic lymph nodes unilateral or bilateral M0 = no distant mets M1 = distant mets

What is the pathology of most penile cancers?

Well differentiated squamous cell carcinoma

Types of epithelial penile tumour ?

benign- condylamata aciminate caused by HPV type 6+11 Intermediate= penile intraepithelial neoplasia, carinoma in situ, precaneras

erthroplasia of Queyrat

epidermoid carcinoma in situ that involves the mucosal or mucocutaneous areas of the prepuce or glans appears red, elevated, or ulcerated lesion some patients with erthroplasia of Queyrat have invasive SCC at the time of diagnosis

what are the histological classification in penile cancer

epithelial mesenchymal lymphatic melanocytic

what are the histological classification of penile carcinoma

epithelial is broken down into benign, intermediate penile cis ( carcinoma in situ), -morbus kayra ( erythroplasia of gland penis ), -bowen disease, -bourenoits disease, -leukoplasia of the penis -giant chondylomata -penile intraepithelial neoplasia malignant -squamous cell carcinoma

diagnosis and detection of penile cancers

penile lesions can be seen on examination and documented with biopsy LN should be palpated and thoroughly evaluated. nodal involvement can be confirmed with biopsy or dissection -urinalysis -CBC -chest Xray -clinical exam to assess the primary lesions and inguinal node involvement (30% are palpable at presentation) -biopsy under local anesthetic -CT to determine LN involvement (pelvic and para-aortic) -MRI and ultrasound of penis

Priapism

persistent and painful erection of the penis.

surgical management for primary penile lesions

ranges from local excision or chemosurgery in a small group of highly selected patients, particularly those with small lesions of the prepuce, to a partial or total penectom

Extramammary paget disease

rare intraepithelial apocrine carcinoma. the most common sites are the scrotum, inguinal folds and perineal region

What is the most common histopathology of penile cancer?

well-differentiated squamous cell carcinoma