Penile Cancer

Publication Date: March 10, 2023

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

...gnosis

Table 1. Histological Subtypes of Penile Carc...


...ble 1. Histological Subtypes of Pen...


...able 1. Histological Subtypes of Penile Carcinomas...


Pathology

Pathology

...lassification of Penile Intra-epit...


...able 3. Information to Include in P...


...gure 1. Patterns of p16 Expression(A) no staining;...


...e 4. Grading Recommendations for Penile...


...f Evidence and Guidelines for the Patholo...

...ry of evidenc...

...idence of penile cancer varies according to...

Western developed countries have seen a slight inc...

...logy to other HPV-associated cancers, HPV stat...

...ecommendat...

...thological evaluation of penile carcinoma specim...

The pathological evaluation of peni...

...ogical evaluation of penile carcinoma s...


Classification Systems

...sification Systems

...umor, Node, Metastasis (TNM) Classificatio...

...5. The Union for International Cancer Cont...

...inical classificatio...

...- Primary tu...

...y tumour cannot be assessed T0 - No eviden...

...onal lymph nodes...

...ional lymph nodes cannot be assessed...

...tant metastasis...

...ant metastasis cM1 - Distant metasta...

...cal classification...

...The pT categories correspond to the...

...Regional lymph node...

...pNX - Regional lymph nodes cannot be assessed...

...- Distant metas...

...etastasis microscopically confirmed...

...- Histopathological grading...

...Grade of differentiation cannot be assesse...


...Stage Grouping...

...TNM 8th edition, stage II was newly subd...

...able 6. UICC TNM Stage/Prognostic GroupsHavin...

...idence and Guidelines for the Diagnosis...

...ummary of eviden...

...stinguishing T1 from T2 disease, magnetic resonanc...

...cting corporal invasion (T3 disease), MRI showe...

...ithout artificial erection showed similar ac...

...raphy (CT), positron emission tomography/compu...

...ultrasound (US) + fine needle aspir...

...rgical staging of cN0 patients, DSNB has sh...

...biopsy has been shown to lower complication...

...ourine-18 fluorodeoxyglucose positron emis...

...mmendations

...mary tumour...

...rform a detailed physical examination...

...m MRI of the penis/primary tumour (a...

Obtain a pre-treatment biopsy of the primary...

...inal LNs...

...cal examination of both groins. Record the...

...cally node-negative (cN...

...there are no palpable/suspicious nodes (cN0) at...

...of T1a G2 disease, also discuss surveill...

...al staging is indicated, offer DSNB. I...

...is planned, perform inguinal US first, with fine n...

...ally node-positive (cN+...

...here is a palpable/suspicious node at...

...ts, stage the pelvis and exclude di...


Treatment

...atment...

...imary Tumour

...ence and Guidelines for Local Treatment of...

...ry of evidence...

...nile intra-epithelial neoplasia progre...

...and recurrence rates of topical therapies for...

...iew including retrospective studies o...

...ent literature on frozen section analysis in...

...istance to the resection marg...

...al retrospective series from claims da...

...lative mean 5-year RFRs are 78.6% after...

For neo-adjuvant chemotherapy, pooled objective...

...mendations...

...nced and individualised discussion on benef...

...patients of the higher risk of local recurrence...

...opical thera...

...cally assess treatment effects after a treat...

...therapy with 5-FU or IQ to patients wit...

...er ablation

Offer laser ablation using carbon diox...

...rgan-sparing treatment: surgery (circumcis...

...ffer organ-sparing surgery and reconstructive tec...

...m intra-operative frozen section analysis of res...

...r salvage organ-sparing surgery to patients...

...ring treatment: radiotherapy (EBRT and brachy...

...er radiotherapy to selected patients with bi...

...surgery (partial- and total penectomy)

...partial penectomy, with or without reconstruction,...

...l penectomy with perineal urethrostomy to...

...e surgery to patients with large local recurrence...

...ultimodal the...

...er induction chemotherapy followed...


Lymph Nodes

...mph Nodes

...able 7. Variations in Radical Inguinal Lymphad...


...act of Pre-intra- and Post-operative Fact...


...y of Evidence and Guidelines for rILN...

...ummary of eviden...

...adical ILND is the standard for cN1–...

rILND carries a significant risk of com...

...tudy reported on fsILND, fascial-sparing ILND...

...mph node yield and lymph node dissectio...

...elay in nodal management of more tha...

...invasive approaches for ILND (video endos...

...mmendations...

...ith cN1 disease offer either ipsilateral: Fasc...

...patients with cN2 disease offer ipsilateral op...

Offer minimally-invasive inguinal LN di...

...apy as an alternative approach to upfront s...

...surgical inguinal and pelvic nodal...


...Evidence and Guidelines for Prophylactic Pel...

...ary of evidence...

Prophylactic pelvic lymph node disse...

...positive inguinal nodes or ENE of ca...

...commendations

...fer open or minimally-invasive proph...

...l inguinal and pelvic nodal management wit...


...of Evidence and Guidelines for the Surgica...

...mary of evidenc...

...e will rarely cure patients with cN3 disea...

...technically feasible, upfront surgery is associ...

...half of the patients with advanced (cN2–c...

...in cN3 patients often requires resection...

...le literature includes virtually no cN3 patien...

...ecommendati...

Offer neoadjuvant chemotherapy (NAC) using...

...r surgery to patients responding to...

...ffer surgery to patients who have not progre...

...fer video endoscopic inguinal lymphadenectomy....


...Evidence and Guidelines for Neoadjuvant and Adj...

...y of evidence...

...ort the activity of NAC in patients wi...

...ilable evidence favours a cisplati...

...support the use of adjuvant chemothe...

...mmendations...

...ffer neoadjuvant chemotherapy using a ci...

...erapy as an alternative approach to...

Have a balanced discussion of risks and benefits...

...nce and Guidelines for Pre- and Post-...

...ary of evidence

...ant radiotherapy results in increased OS if gre...

...djuvant conventional radiotherapy doses...

...eri-operative chemo-radia...

...n significantly improves loco-regi...

...mendations...

...ant radiotherapy (with or without c...

...er definitive radiotherapy (with or wit...

Offer radiotherapy (with or without chem...


Systemic and Palliative Therapies for Advanced D...

...of Evidence and Guidelines for Systemic...

...ry of evidenc...

...evel data support the use of platinum-b...

...ive second-line palliative chemother...

...nitial phase II or basket studies assessed a...

...commendations

...mic therapies

...fer patients with distant metastatic...

...t offer bleomycin because of the pulmonary toxici...

...patients with progressive disease under plat...

...adiotherap...

...apy for symptom control (palliation) in advanced...


...and Quality of Life (QoL)...

...Needs of Penile Cancer PatientsHaving tr...

...Follow-up Regime for Penile Cancer ...

...10: Follow-up Regime for Penile Cance...

...of Evidence and Guidelines for Follow-up and...

...ary of evidence

...w-up surveillance is important as early...

...or regional nodal recurrences usually occur within...

Penile cancer has a significant impact o...

...re is very little data on QoL after tr...

...le-preserving surgery preserves erectil...

...chological support, counselling and...

...ollowing nodal surgery, patients would be...

...Kingdom (UK) specialist penile cancer...

Recommenda...

...er penile cancer care as part of an...

...ter penile cancer treatment, initially three-month...

...e psychological impact of penile c...

...e negative impact of treatments for the prima...

...ss the potential impact of lymphoede...

...that cancer clinical trials are vit...