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
...agnosis...
...istological Subtypes of Penile Carcinom...
...1. Histological Subtypes of Penile Carcinomas...
...able 1. Histological Subtypes of Penile Car...
Pathology
Patholog...
...e 2. Classification of Penile Intra...
...le 3. Information to Include in Pathology Repo...
...tterns of p16 Expression(A) no staini...
...Grading Recommendations for Penile...
...y of Evidence and Guidelines for the Pa...
Summary of evidence
...ce of penile cancer varies according to geog...
...eveloped countries have seen a slight incr...
...ogy to other HPV-associated cancers, HPV statu...
Recommendation...
...cal evaluation of penile carcinoma specim...
...evaluation of penile carcinoma specimens must...
...gical evaluation of penile carcinoma spec...
Classification Systems
...ication Systems...
..., Metastasis (TNM) Classificatio...
...able 5. The Union for International C...
...ical classification...
...Primary tumour...
...mary tumour cannot be assessed T0 - No evidence...
...- Regional lymph n...
...Regional lymph nodes cannot be assessed cN0...
M - Distant met...
...No distant metastasis cM1 - Distant metastasis...
Pathological classi...
...categories correspond to the clinical T ca...
...Regional lymph nodes
...NX - Regional lymph nodes cannot be a...
...Distant metastasi...
...metastasis microscopically confirmed...
...pathological grading...
...Grade of differentiation cannot be asse...
...cer Stage Grouping...
...M 8th edition, stage II was newly sub...
...NM Stage/Prognostic GroupsHaving trouble viewing...
...ummary of Evidence and Guidelines...
...y of evidence...
...distinguishing T1 from T2 disease, m...
...g corporal invasion (T3 disease), MRI sho...
...ith and without artificial erection show...
...raphy (CT), positron emission tomography...
...al ultrasound (US) + fine needle aspiratio...
...r surgical staging of cN0 patients, DSNB has...
...l node biopsy has been shown to lo...
...lourine-18 fluorodeoxyglucose positron emission to...
...mendations...
...rimary tumou...
...iled physical examination of the penis...
...erform MRI of the penis/primary tumour...
...btain a pre-treatment biopsy of the pri...
...nguinal LNs
...rm a physical examination of both groins. Record t...
...nically node-negative (cN...
...there are no palpable/suspicious nodes (...
...n case of T1a G2 disease, also discuss su...
...staging is indicated, offer DSNB. If DSNB is...
...B is planned, perform inguinal US first, with fine...
...ally node-positive (cN+)...
...is a palpable/suspicious node at physical...
...ients, stage the pelvis and exclude distant meta...
Treatment
Treatme...
Primary Tu...
...of Evidence and Guidelines for Local Trea...
...mmary of evidence
...nile intra-epithelial neoplasia progress to...
...currence rates of topical therapies for PeIN ar...
...tic review including retrospective studie...
...literature on frozen section analysis in orga...
...our distance to the resection mar...
...eral retrospective series from claim...
...e mean 5-year RFRs are 78.6% after brachytherapy...
...-adjuvant chemotherapy, pooled objective response...
...mendations...
...balanced and individualised discussi...
...ents of the higher risk of local recurren...
...ical therapy...
...cally assess treatment effects after a tr...
...opical therapy with 5-FU or IQ to patients with...
...aser ablation
...aser ablation using carbon dioxide...
...n-sparing treatment: surgery (circumcisio...
...sparing surgery and reconstructive technique...
...rform intra-operative frozen section analysis of...
...organ-sparing surgery to patients wit...
...-sparing treatment: radiotherapy (EBRT...
...therapy to selected patients with biopsy...
...ve surgery (partial- and total penectomy)...
...ial penectomy, with or without reconstructio...
...r total penectomy with perineal ure...
...amputative surgery to patients with large l...
...ultimodal ther...
...n chemotherapy followed by surgery to responders...
Lymph Nodes
...ymph Nodes
...ariations in Radical Inguinal Lymphade...
...pact of Pre-intra- and Post-operative Factors on...
...vidence and Guidelines for rILND i...
...mmary of evidence
...cal ILND is the standard for cN1â€...
rILND carries a significant risk of complic...
...single study reported on fsILND, fascial-sp...
...mph node yield and lymph node diss...
...anagement of more than 3–6 months may affec...
...ve approaches for ILND (video endos...
...mmendations...
...th cN1 disease offer either ipsilateral:...
...ients with cN2 disease offer ipsilateral...
...r minimally-invasive inguinal LN dissectio...
...r chemotherapy as an alternative approach to up...
...te surgical inguinal and pelvic nodal managemen...
Summary of Evidence and Guidelines for Prophyl...
...ummary of evidence
...rophylactic pelvic lymph node dissection (PLND...
...ositive inguinal nodes or ENE of c...
...ommendations...
...fer open or minimally-invasive proph...
...ete surgical inguinal and pelvic nodal management...
...y of Evidence and Guidelines for the S...
...ummary of evid...
...y alone will rarely cure patients wit...
...when technically feasible, upfront sur...
...bout half of the patients with advanced (cN...
...cN3 patients often requires resection of overl...
...available literature includes virtually no cN...
...mendations...
...neoadjuvant chemotherapy (NAC) using a cisplat...
...urgery to patients responding to NAC in whom re...
...surgery to patients who have not progress...
Do not offer video endoscopic inguinal ly...
...ence and Guidelines for Neoadjuvant and Adjuvant...
...mmary of eviden...
...ort the activity of NAC in patients with cl...
...ilable evidence favours a cisplatin- and tax...
...ited data support the use of adjuvan...
...mmendations...
...ant chemotherapy using a cisplatin- and...
...herapy as an alternative approach to upfront su...
...balanced discussion of risks and benef...
...ummary of Evidence and Guidelines for Pre- and...
...ummary of evidence...
...radiotherapy results in increased OS if greater t...
...ional radiotherapy doses are often insufficient f...
...tive chemo-radiation...
...o-radiation significantly improves loco-reg...
...ommendations...
...adjuvant radiotherapy (with or without chemo sen...
...nitive radiotherapy (with or without c...
...radiotherapy (with or without chemo sensitisation...
...lliative Therapies for Advanced Disease...
...vidence and Guidelines for Systemic and Pallia...
...y of evidence
...ow-level data support the use of platinum-based ch...
...ond-line palliative chemotherapy regimens...
...se II or basket studies assessed anti-e...
...ecommendations...
...temic therapies...
Offer patients with distant metastatic disease, pl...
...er bleomycin because of the pulmonary toxicity ri...
...fer patients with progressive disease under pl...
...otherapy...
...herapy for symptom control (palliation) in advance...
...ollow-Up and Quality of...
...9: Unmet Needs of Penile Cancer PatientsHavi...
...ble 10: Follow-up Regime for Penile Cancer —...
...ble 10: Follow-up Regime for Penile Cance...
...of Evidence and Guidelines for Follow...
...y of evidence...
...ollow-up surveillance is important as ea...
...l nodal recurrences usually occur within two y...
...s a significant impact on QoL in many ways and th...
...very little data on QoL after treatment for peni...
...le-preserving surgery preserves erectile...
...ss to psychological support, counselling and psych...
...deally, following nodal surgery, patients would...
...ed Kingdom (UK) specialist penile can...
...ecommendations
...penile cancer care as part of an ex...
...ollow-up men after penile cancer treatment, i...
...the psychological impact of penile cancer a...
...he negative impact of treatments for the...
...the potential impact of lymphoedema as a...
...believes that cancer clinical trials...