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
...iagnosis
...able 1. Histological Subtypes of Penile Carcin...
...tological Subtypes of Penile Carci...
...1. Histological Subtypes of Penile C...
Pathology
...athology
Table 2. Classification of Penile Intra-epithel...
...ormation to Include in Pathology Reports for Peni...
...erns of p16 Expression(A) no staining; (B) mosaic...
...4. Grading Recommendations for Penile...
...ummary of Evidence and Guidelines for the Pat...
...ry of evidence...
Incidence of penile cancer varies...
...d countries have seen a slight increase...
...gy to other HPV-associated cancers, HPV...
...mendations...
...pathological evaluation of penile carcinoma specim...
...ological evaluation of penile carcinoma sp...
...l evaluation of penile carcinoma specimens sho...
Classification Systems
...ication Systems...
...e, Metastasis (TNM) Classification...
...able 5. The Union for International Cancer Co...
...al classification...
...rimary tumour...
...tumour cannot be assessed T0 - No ev...
...onal lymph nodes...
...- Regional lymph nodes cannot be assessed...
...istant metastasis...
...distant metastasis cM1 - Distant metasta...
...gical classification...
...The pT categories correspond to the clinical T ca...
...N - Regional lymph nodes
...- Regional lymph nodes cannot be assessed...
...Distant metastasis...
...etastasis microscopically confirmed...
...stopathological grading...
...differentiation cannot be assessed...
...Stage Grouping...
...UICC TNM 8th edition, stage II was newly subdiv...
...TNM Stage/Prognostic GroupsHaving troubl...
...nce and Guidelines for the Diagnosis and...
...ary of evidenc...
...r distinguishing T1 from T2 disease, magn...
...edicting corporal invasion (T3 disease), M...
...thout artificial erection showed similar accuracy...
...uted tomography (CT), positron emission tomogr...
...guinal ultrasound (US) + fine needle a...
...surgical staging of cN0 patients, DSNB has show...
...de biopsy has been shown to lower...
...maging with flourine-18 fluorodeoxyglucose posit...
Recommendations
...imary tumo...
...detailed physical examination of the pen...
...rform MRI of the penis/primary tumour...
...eatment biopsy of the primary lesion...
...uinal LNs
...a physical examination of both groins. Record the...
...linically node-negative (cN0)...
...ere are no palpable/suspicious nodes (cN0) a...
...T1a G2 disease, also discuss surveillance a...
...cal staging is indicated, offer DS...
...planned, perform inguinal US first,...
...ly node-positive (cN+)...
...a palpable/suspicious node at physical ex...
..., stage the pelvis and exclude distant...
Treatment
Treatmen...
...mary Tumour...
...dence and Guidelines for Local Trea...
...ry of evidence...
...ile intra-epithelial neoplasia progress to in...
...recurrence rates of topical therapies for PeIN are...
...review including retrospective studies on...
...re on frozen section analysis in organ-sparing...
...tance to the resection margin...
Several retrospective series from claims databases...
...ative mean 5-year RFRs are 78.6% after brachythera...
...or neo-adjuvant chemotherapy, poole...
...ecommendations
...and individualised discussion on benefit...
...nts of the higher risk of local recurrence...
Topical thera...
...ess treatment effects after a treatment-free...
...r topical therapy with 5-FU or IQ to pati...
Laser ablation
...ser ablation using carbon dioxide (CO2) or n...
Organ-sparing treatment: surgery (circumc...
...sparing surgery and reconstructive techniques...
...m intra-operative frozen section an...
...e organ-sparing surgery to patients with smal...
...-sparing treatment: radiotherapy (EBRT and brach...
...iotherapy to selected patients with b...
...gery (partial- and total penectomy)...
Offer partial penectomy, with or without re...
...ffer total penectomy with perineal urethrostomy...
...ffer amputative surgery to patients with large loc...
...ltimodal ther...
...n chemotherapy followed by surgery to responders,...
Lymph Nodes
...mph Nodes...
...ations in Radical Inguinal LymphadenectomyHa...
.... Impact of Pre-intra- and Post-operative Fact...
...of Evidence and Guidelines for rILND in...
Summary of evide...
...ILND is the standard for cN1–2 disease. (, 2a)25...
...a significant risk of complications (21â€...
...single study reported on fsILND, fasc...
...eld and lymph node dissection (LND) appe...
...dal management of more than 3–6...
Minimally-invasive approaches for ILND (...
...commendations
...ith cN1 disease offer either ipsilat...
...h cN2 disease offer ipsilateral open radic...
...lly-invasive inguinal LN dissection to patients w...
...r chemotherapy as an alternative approach to...
Complete surgical inguinal and pelvic nodal manag...
...vidence and Guidelines for Prophylactic...
...ummary of evidence...
...actic pelvic lymph node dissection (PLND) in...
...positive inguinal nodes or ENE of cancer in ingu...
...commendatio...
...pen or minimally-invasive prophylactic i...
...surgical inguinal and pelvic nodal management w...
...nce and Guidelines for the Surgical...
...ary of evidence...
...lone will rarely cure patients with cN3 dis...
...cally feasible, upfront surgery is ass...
...t half of the patients with advanced (cN2–cN3)...
...in cN3 patients often requires resection...
...ailable literature includes virtually no...
...mmendation...
...djuvant chemotherapy (NAC) using a cisplati...
...o patients responding to NAC in whom resect...
...ry to patients who have not progress...
...fer video endoscopic inguinal lymphadenectomy. (S...
...mmary of Evidence and Guidelines for...
...ummary of evidence...
...the activity of NAC in patients wit...
...e available evidence favours a cisplatin- a...
...data support the use of adjuvant chemothera...
...ommendations
...er neoadjuvant chemotherapy using a cisplatin-...
...ffer chemotherapy as an alternative a...
...a balanced discussion of risks and benefits of ad...
...ence and Guidelines for Pre- and P...
...mmary of evidence
Adjuvant radiotherapy results in in...
...t conventional radiotherapy doses are of...
...ri-operative chemo-radia...
...-radiation significantly improves l...
...mmendations
...ffer adjuvant radiotherapy (with or witho...
...ive radiotherapy (with or without chemo sen...
...er radiotherapy (with or without chemo sensitisa...
Systemic and Palliative Therapies for Advanced Dis...
...ence and Guidelines for Systemic and Palliative Th...
...mary of evidenc...
...level data support the use of platin...
...ve second-line palliative chemothe...
...II or basket studies assessed anti-epider...
...ommendatio...
...ystemic ther...
...with distant metastatic disease, platinu...
...r bleomycin because of the pulmonary toxicity ris...
...with progressive disease under platinum chemothe...
Radiothera...
...r radiotherapy for symptom control (palliatio...
Follow-Up and Quality of L...
...Unmet Needs of Penile Cancer PatientsHaving tr...
...able 10: Follow-up Regime for Penile Cancer — R...
...Follow-up Regime for Penile Cancer — Reco...
...Evidence and Guidelines for Follow-up an...
Summary of evi...
...eillance is important as early detection of...
...ocal or regional nodal recurrences usually occ...
...cancer has a significant impact on QoL i...
...ry little data on QoL after treatm...
Generally, penile-preserving surgery preserves er...
...to psychological support, counsellin...
...ally, following nodal surgery, patients would...
...ited Kingdom (UK) specialist penile cancer c...
...mmendations...
...iver penile cancer care as part of an extended...
...fter penile cancer treatment, initially...
...sychological impact of penile cancer and its...
...cuss the negative impact of treatments for the...
...ss the potential impact of lymphoedem...
...CO believes that cancer clinical tr...