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16 Cards in this Set
- Front
- Back
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What is the Incidence of penile cancer? |
Overall Incidence (Squamous Cell Carcinoma) 0.1 – 8.3 per 100,000 males Europe & USA <1 per 100,000 (Europe 0.0 – 0.9 USA 0.7 – 0.9) UK Asia/Africa/South America 4.2- 8.3 per 100,000
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What are the risk factors for penile cancer? |
Non-Circumcision / Phimosis HPV infection Smoking Age Sexually Transmitted Infections |
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Why does circumcision protect against penile cancer? |
Non-Circumcision / Phimosis Protective effect of circumcision thought to be due to improved hygiene, reduced smegma retention and prevention of phimosis Lowest incidence of penis cancer: Israel Greater resistance to HPV infection in circumcised men Lower incidence of infection or trauma |
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What is the link between penile cancer and HPV? |
Not universal as in Cervical Cancer High Risk HPV DNA variably detected in Penile cancers; 30% to 100% Systematic reviews found 40-48% of penile cancers are HPV related hrHPV types 16, 18 |
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Does smoking cause penile cancer? |
Yes Smoking Consistently reported increases risk Dose depedent Chewing tobacco equally a risk Exact role not clearly known |
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What are the premalignant lesions in penile cancer? |
HPV Related Giantcondyloma(Bushke-LowensteinTumour) coalesce in large exophytic tumour, malignant change 30% (HPV 6&11) Bowen’sDisease Progression 5% HPV 16 Erythroplasia of Queyrat progression 30% Bowenoid papulosis contagious <1% progression Non HPV related LichenSclerosis Leukoplakia 10-20% dysplastic changes |
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What is the treatment of premalignant lesions? |
Pre-treatment biopsy essential Circumcision primary treatment of disease solely confined to foreskin adjuncttoothernon-surgicaltreatments Topical therapy 5FU Imiquimod Laser/Cryotherapy/PDT Surgical excision WLE |
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What is the 2009 TNM clinical classification of penile cancer? |
Tis Carcinoma in situ Ta Non-invasive verrucous carcinoma, not associated with destructive invasion T1 Tumour invades subepithelial connective tissue T1a Tumour invades subepithelial connective tissue without lymphovascular invasion and is not poorly differentiated or undifferentiated (T1G1-2) T1b Tumour invades subepithelial connective tissue without with lymphovascular invasion or is poorly differentiated or undifferentiated (T1G3-4) T2* Tumour invades corpus spongiosum/corpora cavernosa T3 Tumour invades urethra T4 Tumour invades other adjacent structures N1 - 1 ing node N2 - multiple or b/l ing nodes N3 - Fixed ing nod or pelvi node M1 distant mets |
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What are the histological variants of SCC? |
Types of SCC • Classic - Warty (condylomatous) carcinoma - Verrucous carcinoma - Mixed carcinomas (warty basaloid and adenobasaloid carcinoma) • Sarcomatoid Growth patterns of SCC • Superficial spread |
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Is there a role for radiotherapy in penile cancer? |
Small tumours <4cm T1-2 Usually external beam, but brachytherapy available Local failure higher than in partial penectomy, but can achieve local control 70+% Problems with meatal stenosis (20-35%), glans necrosis (10%), skin changes which may make surveillance difficult Rarely given |
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What are the principles and indications of glansectomy? |
Glans penis can be mobilised off corporal heads maintaining maximal penile length with good cosmesis and function Can be resurfaced with SSG or primarily closed with prepuce Partial glansectomy with smaller lesions Suitable for T1 and early T2 disease not infiltrating corpus cavenosal heads |
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What is the 5 year survival for patient with node disease? |
5 year survival of ~80% has been reported in patients with single nodal involvement 95% node negative Vs 53% node positive (Ravi) |
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In a node positive penile cancer patient when is the best time to operate? |
Kroon et al: J Urol 2005 patients Groin dissection after surveillance 3yearsurvival84%vs35% Several studies have similarly shown improved survival in patients undergoing early vs delayed therapeutic node dissections ( Ravi 1993, Srinivas et al 1987, Fraley et al 1989) |
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What are the boundaries and complications of a standard in LND? |
Standard lymphadectomy boundaries: -Inguinal ligament -Apex femoral triangle Significant Morbidity -Wound Infection: 3-70% -Necrosis: 2.5-64% -Seroma: 5-84% -Lymphoedema: 5-100% |
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What are the boundaries of the modified Ing LND? |
Modified lymphadectomy to reduce morbidity of groin node dissection; Catalona 1988 Boundaries Significant Morbidity -Wound Infection: 7% -Necrosis: 4% -Seroma: 14% -Lymphoedema: 18% |
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What is the role of chemotherapy in penile cancer? |
Not clearly established Small non-randomised studies Palliative Neo-adjuvant to down-stage inoperable groin nodes InPACT study due (International Penile Advanced Cancer Trial) |
