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
Diagnosis
...Histological Subtypes of Penile Carcin...
...Histological Subtypes of Penile Carcinoma...
...Histological Subtypes of Penile Carcin...
Pathology
...hology
...2. Classification of Penile Intra-epithel...
...e 3. Information to Include in Patho...
...gure 1. Patterns of p16 Expression(A) n...
...ng Recommendations for Penile SCCHaving tro...
...vidence and Guidelines for the Pat...
...ry of evidence...
...of penile cancer varies according to geo...
...developed countries have seen a slight increase...
...logy to other HPV-associated cancers, HPV stat...
...mmendations...
...ogical evaluation of penile carcinoma s...
...pathological evaluation of penile carci...
...thological evaluation of penile carcin...
Classification Systems
...lassification Sys...
...or, Node, Metastasis (TNM) Classificatio...
...e Union for International Cancer Control (UICC)/A...
...al classification
...Primary tumour...
...mary tumour cannot be assessed T0 - No evid...
...gional lymph nod...
...al lymph nodes cannot be assessed c...
...- Distant metasta...
...o distant metastasis cM1 - Distant metasta...
Pathological classific...
...tegories correspond to the clinical T categ...
...- Regional lymph...
...Regional lymph nodes cannot be assessed pN...
...- Distant metastas...
...- Distant metastasis microscopically con...
G - Histopathological...
...Grade of differentiation cannot be asse...
...ncer Stage Gro...
...UICC TNM 8th edition, stage II was newly su...
...le 6. UICC TNM Stage/Prognostic Group...
...mary of Evidence and Guidelines fo...
...ummary of eviden...
...hing T1 from T2 disease, magnetic res...
...r predicting corporal invasion (T3 disease), MR...
...hout artificial erection showed similar accuracy i...
...raphy (CT), positron emission tomography/co...
...uinal ultrasound (US) + fine needle aspirat...
For surgical staging of cN0 patients, DSNB...
...nel node biopsy has been shown to lower c...
...with flourine-18 fluorodeoxyglucose p...
Recommendat...
...rimary tumou...
...rm a detailed physical examination of the...
...m MRI of the penis/primary tumour (artific...
...a pre-treatment biopsy of the prim...
...inal LNs...
...hysical examination of both groins....
...ally node-negative (c...
...e no palpable/suspicious nodes (cN0) a...
...case of T1a G2 disease, also discuss surveillance...
...aging is indicated, offer DSNB. If DS...
...f DSNB is planned, perform inguinal...
...linically node-positive (c...
...there is a palpable/suspicious node at phy...
...nts, stage the pelvis and exclude distant metas...
Treatment
...reatment...
...ary Tumour...
...mary of Evidence and Guidelines fo...
...y of evidence...
Penile intra-epithelial neoplasia progress...
...and recurrence rates of topical therapies for P...
...stematic review including retrospecti...
...literature on frozen section analysis...
...stance to the resection margin...
...ral retrospective series from claims databases an...
...ean 5-year RFRs are 78.6% after br...
...juvant chemotherapy, pooled objective res...
...ecommendati...
...anced and individualised discussion on b...
...ients of the higher risk of local recurren...
...cal therapy...
...s treatment effects after a treatment-...
...l therapy with 5-FU or IQ to patients with biopsy-...
...r ablation
...ser ablation using carbon dioxide (CO2) or neodymi...
...sparing treatment: surgery (circumc...
...ffer organ-sparing surgery and reconstructive...
...form intra-operative frozen section analy...
...fer salvage organ-sparing surgery to pa...
...ring treatment: radiotherapy (EBRT and...
...er radiotherapy to selected patients with...
...urgery (partial- and total penectomy)...
...tial penectomy, with or without re...
...r total penectomy with perineal urethrostomy to pa...
...utative surgery to patients with lar...
...ltimodal therapy
...fer induction chemotherapy followed by surgery to...
Lymph Nodes
...ph Nodes
...ble 7. Variations in Radical Inguinal Lymphad...
...of Pre-intra- and Post-operative Factors on Mo...
...ary of Evidence and Guidelines for rILND...
...y of evidence...
...cal ILND is the standard for cN1–...
rILND carries a significant risk of complica...
...study reported on fsILND, fascial-sparing IL...
...h node yield and lymph node dissect...
Delay in nodal management of more tha...
...mally-invasive approaches for ILND (video endosc...
Recommendatio...
...n patients with cN1 disease offer...
...tients with cN2 disease offer ipsilater...
Offer minimally-invasive inguinal LN dissect...
...hemotherapy as an alternative approa...
...gical inguinal and pelvic nodal manage...
...ence and Guidelines for Prophylacti...
...ry of evidence
...ophylactic pelvic lymph node dissection (PLND)...
...sitive inguinal nodes or ENE of cancer in inguinal...
Recommenda...
...open or minimally-invasive prophylactic ipsilate...
...ete surgical inguinal and pelvic nodal m...
...mmary of Evidence and Guidelines for...
...mary of eviden...
...alone will rarely cure patients with cN3 di...
...when technically feasible, upfront surg...
...ut half of the patients with advanced (cN2...
...nguinal LND in cN3 patients often requires rese...
The available literature includes virtu...
...ecommendati...
...oadjuvant chemotherapy (NAC) using a cisp...
...surgery to patients responding to NAC in...
...y to patients who have not progressed...
...offer video endoscopic inguinal lymphadene...
Summary of Evidence and Guidelines for Neoa...
...mmary of evide...
...pport the activity of NAC in patie...
...e available evidence favours a cisplatin...
...data support the use of adjuvant chemotherapy to...
...ommendations...
...vant chemotherapy using a cisplatin- and tax...
...r chemotherapy as an alternative approach t...
...balanced discussion of risks and benef...
...nce and Guidelines for Pre- and Post-Operati...
...ary of eviden...
...radiotherapy results in increased OS i...
...nventional radiotherapy doses are often insu...
Peri-operative chemo-radiation
...adiation significantly improves loco...
...ecommendati...
...adjuvant radiotherapy (with or without c...
...ive radiotherapy (with or without chem...
...ffer radiotherapy (with or without c...
...and Palliative Therapies for Advanced Dise...
...Evidence and Guidelines for Systemic and Palli...
...y of evidence...
...el data support the use of platinu...
...tive second-line palliative chemotherapy reg...
...itial phase II or basket studies as...
Recommendat...
...ic therapies...
...ents with distant metastatic disease, pla...
...bleomycin because of the pulmonary toxicity...
...nts with progressive disease under...
...iotherapy
...diotherapy for symptom control (pa...
...and Quality of Life (QoL)...
...nmet Needs of Penile Cancer Patients...
...w-up Regime for Penile Cancer — Recommendations...
...0: Follow-up Regime for Penile Cancer — Recom...
...idence and Guidelines for Follow-up and QoL...
...ummary of evidenc...
...low-up surveillance is important as early d...
...or regional nodal recurrences usually occur...
...has a significant impact on QoL in many ways...
...ry little data on QoL after treatment for penile c...
..., penile-preserving surgery preserves erectile fu...
...s to psychological support, counselling and...
...ally, following nodal surgery, patie...
...United Kingdom (UK) specialist penile cancer c...
...mendations...
...enile cancer care as part of an exten...
...n after penile cancer treatment, initially three...
...cuss the psychological impact of penil...
...iscuss the negative impact of treatments f...
...uss the potential impact of lymphoedema as a conse...
...ieves that cancer clinical trials a...