Penile Cancer
Key Points
Key Points
- Human papilloma virus (HPV) infection is the main risk factor for penile cancer.
- Several other risk factors for penile cancer have been identified, such as phimosis, chronic penile inflammation, lichen sclerosus, smoking, ultraviolet A phototherapy, and low socio-economic status, amongst others.
- Female sexual partners of patients with penile cancer have not been found to have an increased incidence of cervical cancer.
- It is important to recognise the evolving needs of a patient with a diagnosis of penile cancer, even many months following the completion of treatment, and therefore appropriate follow-up and patient support services are also a critical aspect of penile cancer care.
Diagnosis
...gnosis...
...istological Subtypes of Penile Carcino...
...stological Subtypes of Penile Carcin...
Table 1. Histological Subtypes of P...
Pathology
...athology...
...ication of Penile Intra-epithelial N...
Table 3. Information to Include in P...
...re 1. Patterns of p16 Expression(A) no stain...
...e 4. Grading Recommendations for Penil...
...nce and Guidelines for the Pathologica...
...ummary of evidenc...
...penile cancer varies according to geogra...
...d countries have seen a slight increas...
...other HPV-associated cancers, HPV status may in...
...ecommendat...
...ical evaluation of penile carcinoma specimens mus...
...al evaluation of penile carcinoma speci...
...hological evaluation of penile carcinoma specim...
Classification Systems
...assification Sy...
...Node, Metastasis (TNM) Classification...
...Union for International Cancer Contr...
...nical classificati...
...Primary tumour...
...y tumour cannot be assessed T0 -...
...gional lymph nodes...
...- Regional lymph nodes cannot be assess...
...istant metastasis...
...No distant metastasis cM1 - Distant metas...
...cal classification...
...categories correspond to the clinical T categorie...
...egional lymph nodes...
...egional lymph nodes cannot be assesse...
pM - Distant metastasis
...- Distant metastasis microscopically...
...opathological grading...
...GX - Grade of differentiation canno...
...er Stage Grouping
...ICC TNM 8th edition, stage II was newly su...
...le 6. UICC TNM Stage/Prognostic GroupsHav...
...nce and Guidelines for the Diagnosis...
...mmary of evidence...
...inguishing T1 from T2 disease, magnetic resonance...
...ng corporal invasion (T3 disease),...
...with and without artificial erection showed simi...
...phy (CT), positron emission tomography/computed...
Inguinal ultrasound (US) + fine needle aspira...
...or surgical staging of cN0 patients, DSNB has sho...
...ntinel node biopsy has been shown to lower compli...
...ith flourine-18 fluorodeoxyglucose p...
...mendations
...rimary tum...
...erform a detailed physical examinati...
...MRI of the penis/primary tumour (artificial er...
Obtain a pre-treatment biopsy of the primary...
...guinal L...
...a physical examination of both groins. Record th...
...nically node-negative (cN...
...re no palpable/suspicious nodes (cN0)...
...G2 disease, also discuss surveilla...
...aging is indicated, offer DSNB. If DS...
...is planned, perform inguinal US first,...
Clinically node-positive (c...
...re is a palpable/suspicious node at physical exa...
...n cN+ patients, stage the pelvis and...
Treatment
Treatm...
...mary Tumour...
...dence and Guidelines for Local Treatment...
...y of evidence...
...tra-epithelial neoplasia progress to invasive lesi...
...d recurrence rates of topical therapies for PeIN...
...atic review including retrospective...
...literature on frozen section analysis in organ...
...tance to the resection margi...
...ective series from claims databases and high-v...
...he cumulative mean 5-year RFRs are 78.6% afte...
...r neo-adjuvant chemotherapy, pooled objective...
...ommendatio...
Offer a balanced and individualised discussion on...
...form patients of the higher risk of local r...
...ical therapy...
...linically assess treatment effects after a treatme...
...erapy with 5-FU or IQ to patients with biopsy-conf...
...aser ablation
...laser ablation using carbon dioxide (CO2)...
...aring treatment: surgery (circumcision, wide loca...
...er organ-sparing surgery and reconstructive tec...
...-operative frozen section analysis of...
...salvage organ-sparing surgery to p...
...gan-sparing treatment: radiotherapy (EBRT...
...er radiotherapy to selected patients...
...tative surgery (partial- and total penectomy)
...al penectomy, with or without reconstruction, to p...
...er total penectomy with perineal urethrostomy to...
...e surgery to patients with large loc...
Multimodal th...
...r induction chemotherapy followed by surgery to re...
Lymph Nodes
Lymph Nod...
...ble 7. Variations in Radical Inguinal Lymphadenect...
...le 8. Impact of Pre-intra- and Post-oper...
...ummary of Evidence and Guidelines f...
...y of evidence...
...ILND is the standard for cN1–2 diseas...
...ies a significant risk of complications (21...
...le study reported on fsILND, fascial-sparin...
...ymph node yield and lymph node disse...
...in nodal management of more than 3–6 months...
...y-invasive approaches for ILND (video endoscopi...
...mendations...
...with cN1 disease offer either ipsi...
...with cN2 disease offer ipsilateral...
...inimally-invasive inguinal LN dissec...
...fer chemotherapy as an alternative appro...
...e surgical inguinal and pelvic nod...
Summary of Evidence and Guidelines fo...
...ary of evidence...
...hylactic pelvic lymph node dissection...
...or more positive inguinal nodes or ENE of cancer...
...commendati...
...n or minimally-invasive prophylactic ipsilateral p...
...surgical inguinal and pelvic nodal m...
...ummary of Evidence and Guidelines for...
...mmary of evidence
...ne will rarely cure patients with cN3 diseas...
...technically feasible, upfront sur...
...half of the patients with advanced (cN...
...cN3 patients often requires resection...
...e literature includes virtually no cN3 pat...
...ommendations
...ffer neoadjuvant chemotherapy (NAC) using a cispl...
...patients responding to NAC in whom resec...
...er surgery to patients who have not prog...
...fer video endoscopic inguinal lymphadenec...
...of Evidence and Guidelines for Neo...
...y of evidence...
...ults support the activity of NAC in patien...
The available evidence favours a cisplatin...
...a support the use of adjuvant chemotherapy...
...mendations...
...oadjuvant chemotherapy using a cisplat...
...motherapy as an alternative approac...
...anced discussion of risks and benefits of adjuvant...
...y of Evidence and Guidelines for Pre- and Post-Ope...
...mary of evidence
...uvant radiotherapy results in increased OS...
...uvant conventional radiotherapy doses are ofte...
...erative chemo-radiat...
...ation significantly improves loco-regional contro...
...ecommendat...
...vant radiotherapy (with or without chemo...
...initive radiotherapy (with or without c...
...py (with or without chemo sensitisati...
...emic and Palliative Therapies for Advanced Dise...
...ary of Evidence and Guidelines for Systemi...
...mary of evidence...
...level data support the use of platinum-based ch...
...econd-line palliative chemotherapy re...
...itial phase II or basket studies assessed anti-...
...commendati...
...temic therapie...
...nts with distant metastatic disease, platinum-b...
...ffer bleomycin because of the pulmonary toxi...
...ith progressive disease under platinum chemothe...
...adiotherap...
...iotherapy for symptom control (palliation)...
...ollow-Up and Quality of Life (QoL)...
...Unmet Needs of Penile Cancer PatientsHaving troub...
...able 10: Follow-up Regime for Penil...
...10: Follow-up Regime for Penile Cancer — Recom...
...dence and Guidelines for Follow-up and QoL...
...mary of evidence...
...ow-up surveillance is important as early dete...
...r regional nodal recurrences usually occur w...
...has a significant impact on QoL in m...
...little data on QoL after treatment for p...
...enile-preserving surgery preserves erectile functi...
...ss to psychological support, counselling...
...deally, following nodal surgery, patients would be...
...d Kingdom (UK) specialist penile cancer...
...mmendations...
...le cancer care as part of an extended multi-...
...low-up men after penile cancer treat...
...scuss the psychological impact of penile canc...
...e negative impact of treatments for the prim...
...uss the potential impact of lymphoedema as...
...elieves that cancer clinical trials are vita...