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
...ble 1. Histological Subtypes of Penile...
...1. Histological Subtypes of Penile...
...tological Subtypes of Penile Carcinoma...
Pathology
...Pathology...
...Table 2. Classi...
...ation to Include in Pathology Reports for P...
...terns of p16 Expression (A) no staining; (B)...
...e 4. Grading Recommendations for Penil...
...Summary of Evi...
...S...
...penile cancer varies according to geographical lo...
...estern developed countries have seen a slight inc...
...other HPV-associated cancers, HPV status may...
...Recommendations...
The pathological evaluation of penile car...
...cal evaluation of penile carcinoma sp...
...athological evaluation of penile carcinoma spe...
Classification Systems
...Cla...
...Tumor, Node, Metastas...
...Table...
...Clinical...
...T - Primary tumour...
...- Primary tumour cannot be assessed...
...N - Regional l...
...NX - Regional lymph nodes cannot be assessed...
...M - Distant metastasis...
...cM0 - No distant metastasis cM1 - Distant me...
...e pT categories correspond to the clinical T c...
...NX - Regional lymph nodes cannot be assess...
...etastasis microscopically confirmed...
...G - Histopa...
...GX - Grade of differentiation cannot be asses...
...Cancer...
...M 8th edition, stage II was newly subdivi...
...e 6. UICC TNM Stage/Prognostic Groups...
...Summary of Evidence...
...Summary of...
...ing T1 from T2 disease, magnetic resonance...
For predicting corporal invasion (T3 diseas...
...nd without artificial erection showed si...
...ed tomography (CT), positron emission tomograp...
Inguinal ultrasound (US) + fine nee...
...gical staging of cN0 patients, DSNB has s...
...biopsy has been shown to lower co...
...h flourine-18 fluorodeoxyglucose po...
...Recommendations...
...Primary tum...
...a detailed physical examination of the pen...
...the penis/primary tumour (artificial er...
...pre-treatment biopsy of the primary lesio...
...Inguinal LNs
...al examination of both groins. Record the...
...Clinically...
...are no palpable/suspicious nodes (cN0) at physical...
...T1a G2 disease, also discuss surveillance as an a...
...en surgical staging is indicated, offe...
...planned, perform inguinal US first, with fine n...
...Clinically...
...is a palpable/suspicious node at physi...
...patients, stage the pelvis and exclude distant...
Treatment
...Treatment...
...P...
...Summary o...
...Summary of evi...
Penile intra-epithelial neoplasia...
...and recurrence rates of topical the...
...view including retrospective studies on organ-spa...
...literature on frozen section analysis in or...
...mour distance to the resection ma...
...ral retrospective series from claims...
The cumulative mean 5-year RFRs are 78.6% a...
...chemotherapy, pooled objective response rate (ORR...
...r a balanced and individualised discuss...
Inform patients of the higher risk of local recu...
...nically assess treatment effects after a...
...l therapy with 5-FU or IQ to patients with bio...
...Laser ablation...
...ablation using carbon dioxide (CO2) or neody...
...Organ...
...organ-sparing surgery and reconstructiv...
...intra-operative frozen section analysis of resecti...
...alvage organ-sparing surgery to patients wi...
...rapy to selected patients with biopsy-confirmed T1...
...Ampu...
...ffer partial penectomy, with or wit...
...er total penectomy with perineal urethrostomy...
...ive surgery to patients with large local recurren...
...Multimodal the...
...duction chemotherapy followed by su...
Lymph Nodes
...Lym...
.... Variations in Radical Inguinal L...
...e 8. Impact of Pre-intra- and Post-o...
...Summary of Ev...
...Summary of evidence...
...ILND is the standard for cN1–2 d...
rILND carries a significant risk of...
...single study reported on fsILND, fascial-sparin...
...node yield and lymph node dissection (LND) a...
...l management of more than 3–6 months...
...mally-invasive approaches for ILND (video...
...Recommendatio...
...atients with cN1 disease offer eithe...
...ts with cN2 disease offer ipsilateral op...
...imally-invasive inguinal LN dissection to patient...
...fer chemotherapy as an alternative approach to up...
...al inguinal and pelvic nodal managem...
...Summary of Evidence an...
...vic lymph node dissection (PLND) in m...
...more positive inguinal nodes or ENE of ca...
...Recommendations...
...n or minimally-invasive prophylactic ipsilatera...
...l inguinal and pelvic nodal manage...
...Summary of E...
...Summary...
...one will rarely cure patients with cN3 disease...
...en when technically feasible, upfr...
...ut half of the patients with advance...
...guinal LND in cN3 patients often requires resec...
...e available literature includes vir...
...Recommendations...
...t chemotherapy (NAC) using a cisplatin- and taxan...
...surgery to patients responding to...
...er surgery to patients who have not progress...
...offer video endoscopic inguinal lympha...
...Summary of Evid...
...Summary of evidence...
...ults support the activity of NAC in patients...
...ble evidence favours a cisplatin- and taxane-base...
...ited data support the use of adjuvant chemotherap...
...Recom...
Offer neoadjuvant chemotherapy using a cisplat...
...chemotherapy as an alternative approach to up...
...ve a balanced discussion of risks and benefits of...
...Summary of Evi...
...Summary of evidence...
Adjuvant radiotherapy results in increased OS if g...
...t conventional radiotherapy doses a...
...Peri-operative c...
Chemo-radiation significantly improves lo...
...Recommendations...
Offer adjuvant radiotherapy (with or withou...
...finitive radiotherapy (with or without chemo...
...py (with or without chemo sensitisation) to cN3...
...Systemic and...
...Summary o...
...Summary of evide...
...data support the use of platinum-based chemothera...
...fective second-line palliative chemo...
...II or basket studies assessed ant...
...Recommendation...
...System...
...fer patients with distant metastatic disease, p...
...offer bleomycin because of the pulmona...
...tients with progressive disease under pla...
...Radiothe...
...otherapy for symptom control (palliation) in...
...Follow-Up and Qu...
...9: Unmet Needs of Penile Cancer Patients...
...: Follow-up Regime for Penile Cancer — Rec...
...ow-up Regime for Penile Cancer — Recommendati...
...Summary of E...
...Summary of evide...
...ollow-up surveillance is important as...
...gional nodal recurrences usually occur wi...
...nile cancer has a significant impact...
...little data on QoL after treatment for p...
...ile-preserving surgery preserves erectile...
...o psychological support, counselling...
...lowing nodal surgery, patients would be referre...
...ingdom (UK) specialist penile cance...
...Recommendations...
...ile cancer care as part of an exte...
...llow-up men after penile cancer treatment, i...
...scuss the psychological impact of penile cancer an...
...negative impact of treatments for the p...
...ss the potential impact of lymphoedema a...
...believes that cancer clinical trials are...