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
...gnosis...
...stological Subtypes of Penile Carcinomas Accordi...
...stological Subtypes of Penile Carc...
Table 1. Histological Subtypes of Penile Carcinom...
Pathology
Patholo...
...ble 2. Classification of Penile Intra-epithelia...
...able 3. Information to Include in Patholo...
...1. Patterns of p16 Expression(A) no staining; (B...
.... Grading Recommendations for Penile...
...ummary of Evidence and Guidelines for the...
Summary of evidence
...f penile cancer varies according to geogra...
...developed countries have seen a slight incre...
...gy to other HPV-associated cancers, HPV sta...
Recommendations
...e pathological evaluation of penile carcin...
...thological evaluation of penile ca...
...cal evaluation of penile carcinoma specimens sho...
Classification Systems
...sification Systems
...Node, Metastasis (TNM) Classification...
...The Union for International Cancer Control (UI...
...cal classification...
...- Primary tumour
...X - Primary tumour cannot be assess...
...- Regional lymph nodes...
...cNX - Regional lymph nodes canno...
...Distant metastasis...
...No distant metastasis cM1 - Distant metastasis...
Pathological classification
...tegories correspond to the clinical...
...- Regional lymph nodes...
...l lymph nodes cannot be assessed pN0...
...- Distant metasta...
...- Distant metastasis microscopically confirme...
...Histopathological grading...
...- Grade of differentiation cannot...
...r Stage Grouping...
...the UICC TNM 8th edition, stage II was newly su...
...TNM Stage/Prognostic GroupsHaving trou...
...vidence and Guidelines for the Diagnosis and...
...ummary of eviden...
...distinguishing T1 from T2 disease, ma...
...predicting corporal invasion (T3 disease...
...RI with and without artificial erection showed si...
...aphy (CT), positron emission tomography...
...ltrasound (US) + fine needle aspiration cytolog...
...surgical staging of cN0 patients, DSNB...
...e biopsy has been shown to lower compli...
...h flourine-18 fluorodeoxyglucose positron emiss...
...mendations...
...imary tumour
...orm a detailed physical examination of the pen...
...rm MRI of the penis/primary tumour (ar...
...eatment biopsy of the primary lesio...
...guinal LN...
...rm a physical examination of both groins. Rec...
...nically node-negative (cN0)...
...re no palpable/suspicious nodes (cN...
...case of T1a G2 disease, also discuss s...
...cal staging is indicated, offer DSNB. If D...
...s planned, perform inguinal US first, with fine...
...y node-positive (cN+)
...there is a palpable/suspicious nod...
...+ patients, stage the pelvis and e...
Treatment
...eatment...
...ary Tumour
...Evidence and Guidelines for Local Treatment...
Summary of ev...
...e intra-epithelial neoplasia progress to invas...
...nd recurrence rates of topical therapies for...
...tic review including retrospective studies on or...
...rent literature on frozen section analysi...
...stance to the resection margin
...spective series from claims database...
...cumulative mean 5-year RFRs are 78.6% after brac...
...-adjuvant chemotherapy, pooled objective respon...
Recommendatio...
...fer a balanced and individualised di...
...atients of the higher risk of local recurrenc...
...cal therap...
...s treatment effects after a treatme...
...l therapy with 5-FU or IQ to patients wit...
...er ablation...
...aser ablation using carbon dioxide (CO2) or neo...
...reatment: surgery (circumcision, w...
Offer organ-sparing surgery and reconstru...
...m intra-operative frozen section analysis o...
...vage organ-sparing surgery to patients with s...
...reatment: radiotherapy (EBRT and brachytherapy...
...rapy to selected patients with biopsy-con...
...rgery (partial- and total penectomy)...
...artial penectomy, with or without r...
...r total penectomy with perineal urethrostomy t...
...ve surgery to patients with large local...
...imodal therapy...
...ion chemotherapy followed by surgery to responder...
Lymph Nodes
Lymph Node...
...ble 7. Variations in Radical Inguinal Lymphaden...
...ct of Pre-intra- and Post-operative...
...of Evidence and Guidelines for rILND in cN1–2 D...
Summary of evid...
Open radical ILND is the standard f...
...s a significant risk of complications (21â...
...ingle study reported on fsILND, fascial-...
...e yield and lymph node dissection (LND) appea...
...n nodal management of more than 3â€...
...ve approaches for ILND (video endosco...
...ecommendations
...cN1 disease offer either ipsilatera...
...h cN2 disease offer ipsilateral open radical ILND...
...invasive inguinal LN dissection to...
...fer chemotherapy as an alternative approach to upf...
...ical inguinal and pelvic nodal managem...
...nce and Guidelines for Prophylactic...
...y of evidence...
Prophylactic pelvic lymph node diss...
...positive inguinal nodes or ENE of cancer in ingui...
...ommendations
...or minimally-invasive prophylactic...
...l inguinal and pelvic nodal management within 3...
...Evidence and Guidelines for the Surgical Ma...
...mary of evide...
...one will rarely cure patients with cN3 disease. (,...
...chnically feasible, upfront surgery is ass...
...alf of the patients with advanced (cN2...
...al LND in cN3 patients often requir...
...able literature includes virtually no cN3 patien...
...ecommendation...
...eoadjuvant chemotherapy (NAC) using a cisplatin-...
...y to patients responding to NAC in...
...o patients who have not progressed...
...ffer video endoscopic inguinal lymphadenecto...
...of Evidence and Guidelines for Neoadjuvant...
Summary of ev...
...the activity of NAC in patients with clinically in...
...available evidence favours a cisplatin- and taxan...
...support the use of adjuvant chemotherapy to i...
...mmendations...
...uvant chemotherapy using a cisplatin- and taxane-b...
...apy as an alternative approach to upfront sur...
...ced discussion of risks and benefit...
...y of Evidence and Guidelines for Pre- and...
...ummary of evidence...
...vant radiotherapy results in increased OS if...
...uvant conventional radiotherapy doses are of...
...-operative chemo-radi...
...iation significantly improves loco-regional contr...
...mmendations...
...ant radiotherapy (with or without chemo se...
...radiotherapy (with or without chemo sensitisatio...
...rapy (with or without chemo sensitisation) to c...
...lliative Therapies for Advanced Disease...
Summary of Evidence and Guidelines for Systemic...
...mmary of eviden...
Low-level data support the use of platinum-ba...
...d-line palliative chemotherapy regimens are l...
...l phase II or basket studies asses...
...ecommendat...
...ic therapies
...ents with distant metastatic disease, platinu...
...not offer bleomycin because of the pulmo...
...ients with progressive disease under plat...
Radiotherapy
...ffer radiotherapy for symptom control (pallia...
Follow-Up and Quality of Life (Q...
...: Unmet Needs of Penile Cancer PatientsHa...
...e 10: Follow-up Regime for Penile...
...: Follow-up Regime for Penile Canc...
...vidence and Guidelines for Follow-up and Qo...
...ummary of evide...
...llow-up surveillance is important as early detect...
...or regional nodal recurrences usually occur wit...
...cer has a significant impact on QoL in many way...
...here is very little data on QoL after treatment...
...enile-preserving surgery preserves erectile fu...
...sychological support, counselling and psychosexual...
...ng nodal surgery, patients would be referred t...
...United Kingdom (UK) specialist penile c...
...commendati...
...penile cancer care as part of an ext...
...n after penile cancer treatment, initi...
...uss the psychological impact of pe...
...negative impact of treatments for th...
...tential impact of lymphoedema as a...
...lieves that cancer clinical trials are...