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
...Diag...
...Histological Subtypes of Penile Carcinomas Ac...
...tological Subtypes of Penile Carcinomas Ac...
...stological Subtypes of Penile Carcinomas According...
Pathology
...Patholo...
...Ta...
...le 3. Information to Include in Path...
...igure 1. Patterns of p16 Expression(A) no staini...
...le 4. Grading Recommendations for Penile...
...Summary of Ev...
...Summary of evid...
...e of penile cancer varies according to geographic...
...stern developed countries have seen a sligh...
...y to other HPV-associated cancers, HPV status m...
...Recom...
...logical evaluation of penile carcinoma specim...
The pathological evaluation of pen...
...l evaluation of penile carcinoma specimens shoul...
Classification Systems
...Classification System...
...Tumor, No...
...Table 5. The Unio...
...Clinical cla...
T -...
...ary tumour cannot be assessed T0 - No ev...
...N - Reg...
...onal lymph nodes cannot be assessed cN...
...M - Distant metastas...
...stant metastasis cM1 - Distant metastasis...
...Pathological classifica...
...tegories correspond to the clinical T categories...
...pN - Regional ly...
...nal lymph nodes cannot be assessed pN0 - No regi...
...pM - Distant metast...
...metastasis microscopically confirmed...
...G - Histo...
...e of differentiation cannot be asse...
...C...
...C TNM 8th edition, stage II was newly...
...e 6. UICC TNM Stage/Prognostic Groups...
...Summary...
...Summary of e...
...distinguishing T1 from T2 disease, ma...
...g corporal invasion (T3 disease), M...
...ithout artificial erection showed simila...
...ography (CT), positron emission tomography...
...asound (US) + fine needle aspiration cyt...
...rgical staging of cN0 patients, DSNB has shown...
...node biopsy has been shown to lower complicati...
...aging with flourine-18 fluorodeoxyglu...
...Recommendatio...
...Pri...
...m a detailed physical examination of the pen...
...of the penis/primary tumour (artificial e...
...ain a pre-treatment biopsy of the prima...
...Inguinal LNs...
...ical examination of both groins. Record...
...Clinicall...
...palpable/suspicious nodes (cN0) at...
...e of T1a G2 disease, also discuss surve...
...aging is indicated, offer DSNB. If DSN...
...planned, perform inguinal US first,...
...s a palpable/suspicious node at physical...
...nts, stage the pelvis and exclude distant me...
Treatment
...Primary Tumo...
...Summary of evidence...
...thelial neoplasia progress to invasive lesions in...
...ecurrence rates of topical therapies...
...ematic review including retrospective studies...
...rent literature on frozen section analysis in...
...tance to the resection marg...
...trospective series from claims databa...
...ulative mean 5-year RFRs are 78.6% afte...
...o-adjuvant chemotherapy, pooled objective response...
...Recommendations...
...r a balanced and individualised discussio...
...patients of the higher risk of local recurrence wh...
...Topical thera...
...nically assess treatment effects afte...
...topical therapy with 5-FU or IQ to patients wi...
...Laser ablation...
...er ablation using carbon dioxide (CO...
...Organ-sparing treatment:...
...r organ-sparing surgery and reconstructive...
...ra-operative frozen section analysis of resectio...
...salvage organ-sparing surgery to patients with s...
...Organ-spari...
...ffer radiotherapy to selected patients with...
...Amputati...
...tial penectomy, with or without reconst...
...ctomy with perineal urethrostomy to patients...
...amputative surgery to patients with larg...
...Mul...
...ion chemotherapy followed by surgery to responder...
Lymph Nodes
...Lymph Nodes...
...tions in Radical Inguinal LymphadenectomyHaving t...
...ct of Pre-intra- and Post-operative Factors on Mo...
...Summary of Evidence a...
...Summary of...
...ILND is the standard for cN1–2 diseas...
...ies a significant risk of complication...
...reported on fsILND, fascial-sparing...
...ield and lymph node dissection (LND)...
...elay in nodal management of more than 3â€...
...ly-invasive approaches for ILND (vi...
...Recommendations...
...ith cN1 disease offer either ipsilateral:...
...ents with cN2 disease offer ipsilateral open ra...
...r minimally-invasive inguinal LN dissection...
...hemotherapy as an alternative approach to up...
...ical inguinal and pelvic nodal management wi...
...Sum...
...elvic lymph node dissection (PLND) i...
Three or more positive inguinal nodes or ENE of...
...Recommendations...
...or minimally-invasive prophylactic ipsi...
...l inguinal and pelvic nodal management...
...Summary of Evidenc...
...Summary of evid...
...urgery alone will rarely cure patien...
...when technically feasible, upfront surger...
...t half of the patients with advanced (cN2–cN3)...
...inal LND in cN3 patients often req...
...e available literature includes virtually no cN3 p...
...Recommendatio...
...juvant chemotherapy (NAC) using a cisplati...
...urgery to patients responding to NAC in whom r...
...ery to patients who have not progressed...
...offer video endoscopic inguinal lymphadene...
...Summary of Evidence...
...Summary of ev...
...s support the activity of NAC in patients with...
...available evidence favours a cisplatin- and t...
...data support the use of adjuvant chemothera...
...Recommenda...
...r neoadjuvant chemotherapy using a cisplat...
...herapy as an alternative approach to upfront surg...
...ed discussion of risks and benefits of adjuv...
...Summary of evidence...
...therapy results in increased OS if greater...
...entional radiotherapy doses are of...
...Peri-operative ch...
...mo-radiation significantly improves loco-re...
...Recommend...
...adiotherapy (with or without chemo sensitisation)...
...itive radiotherapy (with or without chemo sensi...
...otherapy (with or without chemo sensitisati...
...Systemic and Pallia...
...Summary of Evid...
...Summary of evi...
...upport the use of platinum-based che...
...ective second-line palliative chemother...
...se II or basket studies assessed a...
...Recommend...
...ients with distant metastatic disease,...
...not offer bleomycin because of the p...
...patients with progressive disease under pl...
...Radiotherapy...
...ffer radiotherapy for symptom control (palli...
...Follow...
...: Unmet Needs of Penile Cancer PatientsHaving tro...
...10: Follow-up Regime for Penile Cancer — Reco...
...0: Follow-up Regime for Penile Cancer — Re...
...Summary of...
Summary o...
...veillance is important as early de...
...ional nodal recurrences usually occur within two y...
...er has a significant impact on QoL in many ways an...
...e is very little data on QoL after treatment...
Generally, penile-preserving surgery pr...
...ccess to psychological support, counsell...
...lly, following nodal surgery, patients wou...
...ne United Kingdom (UK) specialist penil...
...Recommend...
...ile cancer care as part of an extended...
...after penile cancer treatment, ini...
...cuss the psychological impact of penile canc...
...tive impact of treatments for the primary t...
...tential impact of lymphoedema as a c...
...that cancer clinical trials are vital to inf...