Urology: Penile Cancer

Penile Cancer

Types

  • Squamous Cell Carcinoma (SCC) – 95% (Most Common)
    • Penile Intraepithelial Neoplasia (PeIN) – Precursor to SCC
  • Basal Cell Carcinoma
  • Melanoma
  • Kaposi Sarcoma
  • Lymphoma

Risk Factors

  • Genital Warts
  • UTI
  • Chronic Penile Rash
  • Penile Trauma
  • Urethral Stricture
  • Phimosis
  • HPV
  • HIV
  • Obesity
  • Tobacco

Presentation

  • Penile Lesion – Most are on the Glans, Coronal Sulcus or Prepuce
  • Painless Lump
  • Ulceration
  • Rash
  • Bleeding
  • Balanitis

Diagnosis

  • Requires Biopsy (Punch, Incisional or Excisional)

Penile Carcinoma 1

TNM Staging – AJCC 8
  • TNM
  T N M
I Invades the Outer Layers 1a: No Invasion of Blood Vessels, Lymphatics or Nerves & Not High-Grade (G3) 1b: Invasion of Blood Vessels, Lymphatics or Nerves or High-Grade (G3) 1-2 Ipsilateral Inguinal LN Mets+
II Invades the Corpus Spongiosum ≥ 3 Inguinal LN  
III Invades the Corpus Cavernosum Pelvic LN  
IV Invaded Other Structures (Scrotum, Pubic Bone or Prostate)    
  • Stage
  T N M
I   T1a N0 M0
II A T1b-2 N1 M0
B T3 N0 M0
III A T1-3 N1 M0
B T1-3 N2 M0
IV   T4 Any N M0
Any T N3 M0
Any T Any N M1

Treatment

  • Low-Risk (T1): Limited Excision (Organ-Preserving Treatment)
    • Minimum Margin: 1 mm (Historical 2 cm Margin is No Longer Required)
    • May Also Consider Mohs Micrographic Surgery or Radiation Therapy
  • High-Risk (T2-4): Penile Amputation with Inguinal Lymph Node Dissection
  • Definitive Chemotherapy for Metastatic Disease
  • Indications for Neoadjuvant Chemotherapy:
    • Locally Advanced/Unresectable
    • Bulky Adenopathy
    • Pelvic Nodal Involvement
  • Consider Adjuvant Chemotherapy or Radiation Therapy for High-Risk Factors that Did Not Receive Neoadjuvant Chemotherapy

References

  1. Konan PG, Vodi CC, Dekou AH, Fofana A, Gowé EE, Manzan K. Cancer of the penis associated with HIV: a report of three cases presenting at the CHU cocody, ivory coast. BMC Urol. 2015 Nov 16;15:112. (License: CC BY-4.0)