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
Diagnos...
...tological Subtypes of Penile Carcino...
...stological Subtypes of Penile Carcinomas Acco...
...ogical Subtypes of Penile Carcinomas Accordin...
Pathology
...hology...
...assification of Penile Intra-epithelial...
...Information to Include in Pathology Repor...
...re 1. Patterns of p16 Expression(A) n...
...ding Recommendations for Penile SCCHaving tro...
...ary of Evidence and Guidelines for the P...
Summary of ev...
...nce of penile cancer varies according to...
...rn developed countries have seen a slight incr...
...alogy to other HPV-associated cancers, HPV status...
...ecommendation...
...hological evaluation of penile carcinoma speci...
...thological evaluation of penile carcinoma spe...
...ical evaluation of penile carcinoma s...
Classification Systems
...ification Systems...
...Metastasis (TNM) Classification...
...ble 5. The Union for International Cancer C...
...ical classification...
...- Primary tu...
...tumour cannot be assessed T0 - No evidence of pr...
...Regional lymph n...
cNX - Regional lymph nodes cannot be assessed...
...tant metastasis...
...stant metastasis cM1 - Distant metastasis...
...ological classification...
...egories correspond to the clinical T cat...
...- Regional lymph nod...
...- Regional lymph nodes cannot be assessed...
...istant metastasis...
...metastasis microscopically confirmed...
...Histopathological grading...
...Grade of differentiation cannot be...
...ancer Stage Groupin...
...8th edition, stage II was newly subdiv...
...ICC TNM Stage/Prognostic GroupsHaving...
...ry of Evidence and Guidelines for the...
...ary of evidence...
...distinguishing T1 from T2 disease, magneti...
...dicting corporal invasion (T3 disease), MRI sh...
...RI with and without artificial erection showed si...
...mputed tomography (CT), positron em...
Inguinal ultrasound (US) + fine needle aspiration...
...ging of cN0 patients, DSNB has shown a high...
...biopsy has been shown to lower complication rates...
...ging with flourine-18 fluorodeoxyglucos...
...mendations...
...mary tumour...
...detailed physical examination of the peni...
...of the penis/primary tumour (artifici...
...pre-treatment biopsy of the primar...
Inguinal L...
...rm a physical examination of both groins. Recor...
...ly node-negative (cN...
...f there are no palpable/suspicious nodes (cN0)...
...G2 disease, also discuss surveillance as an...
...en surgical staging is indicated, offer D...
...f DSNB is planned, perform inguinal U...
...nically node-positive...
...e is a palpable/suspicious node at physical exami...
...nts, stage the pelvis and exclude distant metas...
Treatment
...atment
...ary Tumour...
...dence and Guidelines for Local Treatment of Pe...
...ummary of evidence...
Penile intra-epithelial neoplasia progress t...
...se and recurrence rates of topical therapies fo...
...tematic review including retrospective studie...
...literature on frozen section analysis in...
Tumour distance to the resection marg...
...trospective series from claims databases and high...
...mulative mean 5-year RFRs are 78.6% after...
...ant chemotherapy, pooled objective response r...
...mmendations...
Offer a balanced and individualised discussion on...
...ients of the higher risk of local recurre...
...al therapy...
...ly assess treatment effects after a treatment-free...
...ffer topical therapy with 5-FU or IQ to patients...
...er ablation...
...aser ablation using carbon dioxide (CO2) or neodym...
...gan-sparing treatment: surgery (circumcision, wid...
...sparing surgery and reconstructive...
...operative frozen section analysis of resection...
...organ-sparing surgery to patients with small re...
...ng treatment: radiotherapy (EBRT and brachy...
...apy to selected patients with biopsy-confirme...
...ve surgery (partial- and total penectomy)
...artial penectomy, with or without re...
...r total penectomy with perineal ureth...
...mputative surgery to patients with la...
...modal therapy...
...on chemotherapy followed by surgery to responder...
Lymph Nodes
Lymph Nodes
...Variations in Radical Inguinal Lym...
...pact of Pre-intra- and Post-operative Factors...
Summary of Evidence and Guidelines for rILND in...
...ary of evidence...
...ILND is the standard for cN1–2 dise...
...s a significant risk of complications (21...
...udy reported on fsILND, fascial-sparing I...
...d and lymph node dissection (LND) appear rel...
...lay in nodal management of more than 3–6 mon...
...imally-invasive approaches for ILND (vi...
...mendations...
...n patients with cN1 disease offer eithe...
...h cN2 disease offer ipsilateral open radical I...
...inimally-invasive inguinal LN dissection to patien...
...hemotherapy as an alternative approach...
...ete surgical inguinal and pelvic nodal mana...
...Evidence and Guidelines for Prophylactic Pel...
...ummary of evi...
...lactic pelvic lymph node dissection...
...ee or more positive inguinal nodes or ENE...
...ecommendati...
...pen or minimally-invasive prophylactic ipsilate...
...surgical inguinal and pelvic nodal management wi...
...ary of Evidence and Guidelines for the Surgi...
...ry of evidence...
...ill rarely cure patients with cN3 d...
...n when technically feasible, upfront...
...of the patients with advanced (cN2â€...
...in cN3 patients often requires resection of overl...
...ailable literature includes virtually no cN3 pa...
...commendati...
Offer neoadjuvant chemotherapy (NA...
...ery to patients responding to NAC in w...
...urgery to patients who have not progressed...
...o not offer video endoscopic inguinal...
...ence and Guidelines for Neoadjuvant and Adjuvan...
...ary of eviden...
...ts support the activity of NAC in patient...
...vailable evidence favours a cisplatin- and taxane-...
...mited data support the use of adjuvant che...
...ecommendations
...djuvant chemotherapy using a cisplatin-...
...chemotherapy as an alternative approach to upfron...
...discussion of risks and benefits of...
...y of Evidence and Guidelines for Pr...
...mary of evidenc...
...nt radiotherapy results in increased OS if g...
...nt conventional radiotherapy doses are ofte...
...erative chemo-radiat...
...diation significantly improves loco-regional c...
...mmendations...
...vant radiotherapy (with or without chemo sensitis...
...ffer definitive radiotherapy (with or wi...
...herapy (with or without chemo sensitisation) to...
...emic and Palliative Therapies for Advanced Diseas...
...dence and Guidelines for Systemic and Palliat...
Summary of evide...
...ta support the use of platinum-based chemo...
...tive second-line palliative chemotherapy re...
...al phase II or basket studies assesse...
...mendations...
...emic therapies...
...ents with distant metastatic disease, platinum-...
...bleomycin because of the pulmonary toxicity risk....
Offer patients with progressive disease under pla...
...diothera...
...ffer radiotherapy for symptom control (pall...
...low-Up and Quality of Life (QoL)...
...able 9: Unmet Needs of Penile Cancer Patients...
...10: Follow-up Regime for Penile Cancer —...
...ow-up Regime for Penile Cancer — Recomm...
...of Evidence and Guidelines for Follow-up...
...ary of evidence...
...ow-up surveillance is important as early detection...
...or regional nodal recurrences usually o...
...nile cancer has a significant impact...
...is very little data on QoL after treatment fo...
...e-preserving surgery preserves erectile function,...
...psychological support, counselling and psych...
...owing nodal surgery, patients would be refe...
...Kingdom (UK) specialist penile cancer centre (ref...
...mendations...
...eliver penile cancer care as part of...
...ow-up men after penile cancer treatment, initially...
...uss the psychological impact of penile can...
...scuss the negative impact of treatments fo...
...scuss the potential impact of lymp...
...s that cancer clinical trials are vital to inf...