penile cancer
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Etiology
- sexually-transmitted
History
- sexual history of unprotected intercourse with multiple partners (case report)[1]
Clinical manifestations
- polypoid mass on the glans penis (case report with image)[1]
- inguinal lymph nodes may be palpable
- weight loss
Laboratory
- HPV DNA testing of biopsy specimen
Diagnostic procedures
- biopsy of lesion
- sentinel node biopsy (if no palpable inguinal lymph nodes)
- nodes are palpable, ultrasound-guided fine needle aspiration cytology
Radiology
- PET scan, CT scan shows evidence of distant metastasis
- abdominal CT scan & chest x-ray is PET scan not available
- bone scan in symptomatic patients
Management
- category Tis, Ta, T1a (G1, G2)
- carbon dioxide (CO2) or neodymium:yttrium-aluminium-garnet (Nd:YAG) laser surgery
- wide local excision, glans resurfacing, or glans resection, depending on size & location of the tumor
- Mohs' micrographic surgery or photodynamic therapy for well differentiated superficial lesions
- glansectomy, with or without tips amputation or reconstruction
- category T2 (invasion of the corpora)
- partial amputation
- category T3 (invasion of urethra)
- total amputation with perineal urethrostomy
- category T4 (other adjacent structures)
- neoadjuvant chemotherapy followed by surgery in responders
- alternative: external radiation
- local recurrence after conservative therapy
- salvage surgery, consisting of penis-sparing treatment in small recurrences
- larger recurrence: some form of amputation
- organ-preserving treatment in selected patients with T1-2 of glans or coronal sulcus, lesions < 4 cm
- management of regional lymph nodes is fundamental
- lymph node dissection, but not chemotherapy or radiotherapy, is associated with overall survival[2]
- chemotherapy
- neoadjuvant, before surgery
- palliation in advanced or metastatic disease
- 3 courses of cisplatin, fluorouracil
- radiation therapy
- curative radiotherapy may be used for primary tumours of the glans penis & sulcus <4 cm or for palliation
- prophylactic radiotherapy in clinical N0 patients is not indicated
More general terms
References
- ↑ 1.0 1.1 1.2 Husein-El Ahmed H1, Canadas-De la Fuente GA (image) IMAGES IN CLINICAL MEDICINE. Squamous-Cell Carcinoma of the Penis with Human Papillomavirus. N Engl J Med. 2016 Jan 14;374(2):164. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26760087 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMicm1503816
- ↑ 2.0 2.1 Joshi SS, Handorf E, Strauss D et al Treatment Trends and Outcomes for Patients With Lymph Node-Positive Cancer of the Penis. JAMA Oncol. 2018 Mar 1. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29494739 https://jamanetwork.com/journals/jamaoncology/fullarticle/2673834
McCormick B, Pettaway C. Insights Into the Management of Lymph Node-Positive Penile Cancer. JAMA Oncol. 2018 Mar 1. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29494734 https://jamanetwork.com/journals/jamaoncology/fullarticle/2673829 - ↑ Spiess PE; National Comprehensive Cancer Network. New treatment guidelines for penile cancer. J Natl Compr Canc Netw. 2013 May;11(5 Suppl):659-62. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23704237
- ↑ Veeratterapillay R, Teo L, Asterling S, Greene D. Oncologic Outcomes of Penile Cancer Treatment at a UK Supraregional Center. Urology. 2015 May;85(5):1097-101. Epub 2015 Mar 10. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25769781
- ↑ Pagliaro LC, Williams DL, Daliani D et al Neoadjuvant paclitaxel, ifosfamide, and cisplatin chemotherapy for metastatic penile cancer: a phase II study. J Clin Oncol. 2010 Aug 20;28(24):3851-7. Epub 2010 Jul 12. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20625118 Free PMC Article
- ↑ National Cancer Institute Penile Cancer - Health Professional Version https://www.cancer.gov/types/penile/hp