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penile cancer

Etiology: - sexually-transmitted - papillomavirus 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 Special laboratory: - 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

General

malignant neoplasm of male genital organ penile disorder

References

  1. 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. PMID: 26760087 http://www.nejm.org/doi/full/10.1056/NEJMicm1503816
  2. 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: 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: 29494734 https://jamanetwork.com/journals/jamaoncology/fullarticle/2673829
  3. 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: 23704237
  4. 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: 25769781
  5. 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: 20625118 Free PMC Article
  6. National Cancer Institute Penile Cancer - Health Professional Version https://www.cancer.gov/types/penile/hp