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