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
...agnosi...
.... Histological Subtypes of Penile Carcinomas Acc...
...stological Subtypes of Penile Carcin...
...e 1. Histological Subtypes of Penile Car...
Pathology
...thology
...Classification of Penile Intra-epithelial N...
...Information to Include in Pathology Re...
...atterns of p16 Expression(A) no stainin...
...ading Recommendations for Penile SCCHaving tro...
...vidence and Guidelines for the Pathological...
...y of evidence...
...penile cancer varies according to geographic...
...tern developed countries have seen a slight increa...
...to other HPV-associated cancers, HPV status m...
Recommendatio...
...cal evaluation of penile carcinoma specime...
...ogical evaluation of penile carcinoma...
...ological evaluation of penile carcinoma...
Classification Systems
...assification Syste...
...Metastasis (TNM) Classification...
...ion for International Cancer Control...
Clinical classificati...
...Primary tumour...
TX - Primary tumour cannot be assessed T0 - N...
...- Regional lymp...
...- Regional lymph nodes cannot be as...
...- Distant metastasi...
...cM0 - No distant metastasis cM1 - Distant m...
...logical classification...
...T categories correspond to the clinical T c...
...N - Regional lymph n...
...nal lymph nodes cannot be assessed pN0...
...- Distant metastasis
...M1 - Distant metastasis microscopically co...
...istopathological gra...
...of differentiation cannot be assesse...
...r Stage Groupi...
...ICC TNM 8th edition, stage II was newly...
...6. UICC TNM Stage/Prognostic GroupsHaving...
...ummary of Evidence and Guidelines for...
...y of evidence
...guishing T1 from T2 disease, magnetic res...
...corporal invasion (T3 disease), MRI showed...
...nd without artificial erection showed sim...
...raphy (CT), positron emission tomography/compute...
...l ultrasound (US) + fine needle aspir...
...gical staging of cN0 patients, DSNB has shown...
...nel node biopsy has been shown to lower...
...with flourine-18 fluorodeoxyglucose...
...ommendation...
Primary tu...
...orm a detailed physical examination of...
...of the penis/primary tumour (artificial erect...
...e-treatment biopsy of the primary lesi...
...uinal LNs
...hysical examination of both groins. Rec...
...node-negative (cN0)...
...are no palpable/suspicious nodes (...
...ase of T1a G2 disease, also discuss...
...surgical staging is indicated, offer...
...ed, perform inguinal US first, with fine...
...lly node-positive (cN+)
...alpable/suspicious node at physical...
...patients, stage the pelvis and exclude d...
Treatment
...atment
...imary Tumour
...Evidence and Guidelines for Local Treatm...
...ary of evidence...
...ra-epithelial neoplasia progress to invasive lesi...
...currence rates of topical therapies for P...
...c review including retrospective studie...
...rrent literature on frozen section an...
...umour distance to the resect...
...veral retrospective series from claims databases...
...mean 5-year RFRs are 78.6% after brachyth...
...-adjuvant chemotherapy, pooled objec...
...mendations...
...ed and individualised discussion on benefits a...
...patients of the higher risk of local rec...
...pical therapy...
...sess treatment effects after a treatment...
...therapy with 5-FU or IQ to patients w...
Laser ablatio...
...ablation using carbon dioxide (CO2...
...an-sparing treatment: surgery (circumcisi...
...ffer organ-sparing surgery and reconstruct...
...form intra-operative frozen section analysis of...
...e organ-sparing surgery to patients with small...
...an-sparing treatment: radiotherapy (EBRT and bra...
...otherapy to selected patients with...
Amputative surgery (partial- and total penectomy)
...al penectomy, with or without reconstruction, to...
...ffer total penectomy with perineal ure...
...tative surgery to patients with large local...
...ultimodal the...
...n chemotherapy followed by surgery...
Lymph Nodes
...ymph Nodes...
...ons in Radical Inguinal LymphadenectomyHaving...
...act of Pre-intra- and Post-operative Factors...
...idence and Guidelines for rILND in cN1–...
Summary of evid...
...l ILND is the standard for cN1–2 disease. (...
...carries a significant risk of complications (...
...reported on fsILND, fascial-sparing ILND...
...h node yield and lymph node dissection (...
...anagement of more than 3–6 months m...
...nvasive approaches for ILND (video end...
...mmendations...
...nts with cN1 disease offer either ipsilateral...
...ients with cN2 disease offer ipsilateral...
...ly-invasive inguinal LN dissection to patients w...
...herapy as an alternative approach to upfront...
...surgical inguinal and pelvic nodal management wit...
...mmary of Evidence and Guidelines for Prophyl...
...ry of evidence
...lactic pelvic lymph node dissection (P...
...e or more positive inguinal nodes or ENE of ca...
...mmendation...
...en or minimally-invasive prophylacti...
...omplete surgical inguinal and pelvic...
...dence and Guidelines for the Surgica...
...mmary of evidence
...ry alone will rarely cure patients wit...
...ically feasible, upfront surgery is associated...
...alf of the patients with advanced (c...
...in cN3 patients often requires res...
...e literature includes virtually no cN3 pat...
...ecommendations...
Offer neoadjuvant chemotherapy (NAC) using a c...
...r surgery to patients responding to NAC in whom re...
...y to patients who have not progressed dur...
...ot offer video endoscopic inguinal lymphadene...
...f Evidence and Guidelines for Neoadjuvant and Adju...
...y of evidence
...ort the activity of NAC in patients with clinical...
...lable evidence favours a cisplatin- and t...
...upport the use of adjuvant chemother...
...ecommendatio...
...r neoadjuvant chemotherapy using a...
...hemotherapy as an alternative approach...
...lanced discussion of risks and benefit...
...Evidence and Guidelines for Pre- and Post-Opera...
...y of evidence...
...radiotherapy results in increased OS if great...
...uvant conventional radiotherapy doses are of...
...eri-operative chemo-radiation...
...n significantly improves loco-regional...
...mmendations...
...radiotherapy (with or without chemo sensitisa...
...initive radiotherapy (with or without che...
...ffer radiotherapy (with or without c...
...lliative Therapies for Advanced Disease...
...mary of Evidence and Guidelines fo...
...ummary of eviden...
...ta support the use of platinum-based chemot...
...nd-line palliative chemotherapy regimen...
...se II or basket studies assessed anti-epidermal...
...ecommendations...
...ic therapies...
...patients with distant metastatic disease,...
...omycin because of the pulmonary toxi...
...nts with progressive disease under plati...
...diotherap...
Offer radiotherapy for symptom control (p...
...-Up and Quality of Life (QoL)...
...eeds of Penile Cancer PatientsHaving trou...
...e 10: Follow-up Regime for Penile Cancer —...
...10: Follow-up Regime for Penile Cancer — Recom...
...mary of Evidence and Guidelines for Follow-up and...
...ary of evidenc...
...low-up surveillance is important as early detecti...
...or regional nodal recurrences usually...
...as a significant impact on QoL in man...
...y little data on QoL after treatment for penile...
...penile-preserving surgery preserves erectile...
...ological support, counselling and...
...y, following nodal surgery, patients would be refe...
...Kingdom (UK) specialist penile cance...
...mendations...
...ile cancer care as part of an extend...
...n after penile cancer treatment, initially t...
...the psychological impact of penile ca...
...cuss the negative impact of treatment...
...ntial impact of lymphoedema as a con...
...CO believes that cancer clinical trials...