Penile Cancer
Penis tumor
Benign tumor
a. Palpilloma
. Location : coronal sulcus
. Small nodul
. No treatment is required
b. Condylomata Acuminata
. Caused by virus
. Is transmitted by sexual intercourse
Treatment
. Circumcision
. Electro coagulation avoid the formation of
the urethra strictures
Penile Cancer
Introduction
- Penile cancer is a disease in with malignant cells form in the tissue
of the penis
- It is most often diagnosis in men over the age of 50
- Penile cancer is rare in most developed nation, where the rate is
less than 1/100000 men per year
Epidemiology
• Penile carcinoma occurs most commonly in the sixth decade of life,
• Rare case reports have in children.
Risk Factors
• Intact foreskin ( Poor hygiene )
• Phimosis (25%) (Smegma accumulation )
• Precancerous lesions are found in 15%-20% of patients
• Human papilloma virus(HPV 16,18)
• Chronic inflammatory conditions (eg, balanoposthitis and
lichen sclerosus et atrophicus)
Pathology
A - Pre cancerous dermatological Lesion
- Cutaneous horn of the penis
- Bowenoid Papulosis of the penis
- Balanitis xerotica obliterans is a white patch originating on the
prepuce or glans
- Giant condylomata acuminata of the prepuce or glans
Pathology
A - Pre cancerous dermatological Lesion
- Human papillomavirus
- Leukoplakia ( occurs in diabetic patients )
Pathology
A - Pre cancerous dermatological Lesion
- Bowen ‘s disease
- Extramammary Paget disease
Pathology
B. CARCINOMA IN SITU
Erythroplasia of Queyrat
- Is a velvety, red lesion with ulcerations that usually involve the glans.
- Microscopic examination shows typical, hyperplastic cells in a disordered
array with vacuolated cytoplasm and mitotic figures.
Pathology
C. INVASIVE CARCINOMA OF THE PENIS
- Squamous Cell Carcinoma 90 % : Most common of penile cancer
- Verrucous Carcinoma 5 – 16 %
- Basal Cell Penile Carcinoma 2 %
- Melanoma 2 %
- Sarcoma ( Kaposi Sarcoma )< 1%
Melanoma
Metastasis
- Invasive carcinoma of the penis begins as an ulcerative or papillary lesion,
which may gradually grow to involve the entire glans or shaft of the penis.
- Buck’s fascia represents a barrier to corporal invasion and hematogenous spread.
- Primary dissemination is via lymphatic channels to the femoral and iliac nodes.
The penile lymphatic drainage is bilateral to both inguinal areas
- Involvement of the femoral nodes may result in skin necrosis and infection
or femoral vessel erosion and hemorrhage.
- Distant metastases are clinically apparent in less than 10% of cases and
may involve lung, liver, bone, or brain.
TNM Classification
T—Primary tumor
TX: Cannot be assessed
T0: No evidence of primary tumor
Tis: Carcinoma in situ
Ta: Noninvasive verrucous carcinoma
T1: Invades subepithelial connective tissue
T2: Invades corpus spongiosum or cavernosum
T3: Invades urethra or prostate
T4: Invades other adjacent structures
N—Regional lymph nodes
NX: Cannot be assessed
N0: No regional lymph node metastasis
N1: Metastasis in single superficial inguinal node
N2: Metastasis in multiple or bilateral superficial inguinal nodes
N3: Metastasis in deep inguinal or pelvic nodes
M—Distant metastasis
MX: Cannot be assessed
M0: No distant metastasis
M1: Distant metastasis present
Source: American Joint Committee on Cancer:TNM Classification—Genitourinary Sites, 1996.
Clinical Finding
A . SYMPTOMS
- Ulcer or a swelling on the penis
- It may appear as an area of erythema, an ulceration, or an exophytic growth.
- Phimosis may obscure the lesion
- Discharge and bleeding from the penile lesion
- irritative and voiding symptoms
- Symptoms referable to metastases are rare
Clinical Findings
B. SIGNS
- The primary lesion should be characterized with respect to size, location, and
potential corporal body involvement. induration or erythema, an ulceration,
a small papule ,pustule ,or exophytic lesion
- Erosion through the prepuce , foul preputial odor , and discharge with or
without bleeding
- Mass, ulceration ,suppuration , or hemorrhage in the inguinal area may be due
nodal metastases
- Urinary retention or urethral fistula due to local corporeal involvement
Clinical Findings
C. LABORATORY FINDINGS
- Anemia
- Leukocytosis
- Hypoalbuminemia
-Azotemia
- Hypercalcemia
Clinical Findings
D. BIOPSY
- Confirmation of the diagnosis of carcinoma of the penis
- Asessment of the depth of invasion
- Presence of vascular invasion and
- Histologic grade of the lesion
Clinical Findings
D. IMAGING
- Rx : Chest Rx for lung metastasis
- Bone scan, and
- CT scan of the abdomen and pelvis.
. Assessment of inguinal and abdominal nodes
. Guided biopsy of enlarged pelvic node
- MRI
. Assesses local staging of the tumor
. Assessment of inguinal and abdominal nodes
Disseminated disease is present in less than 10% of patients at presentation.
Differential Diagnosis
Carcinoma of the penis must be differentiated from several infectious lesions :
- Syphilitic chancre may present as a painless ulceration. Serologic and
darkfield examination should establish the diagnosis. Chancroid typically
appears as a painful ulceration of the penis.
-. Condylomata acuminata appear as exophytic, soft, “grape cluster” lesions
anywhere on the penile shaft or glans.
- Biopsy can distinguish this lesion from carcinoma if any doubt exists.
Treatment
- Surgery
- Radiotherapy
- Chemotherapy
- Biological therapy
- Photodynamic therapy
Treatment
- Surgeries :
. Limited excision strategies
. Mohs surgery
. Laser ablation
. Penectomy )
. Partial amputation
. Total amputation
+ Lymph nodes removal
Treatment
Treatment
Treatment
Treatment
