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GUIDELINES ON PENILE CANCER

Source: www.huanet.gr
Topic: Penis
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Sort Desciption: Penile carcinoma is an uncommon malignant disease with an incidence ranging from 0.1 to 7.9 per 100,000 males. In Europe, the incidence is 0.1 0.9 and in the US, 0.7 0.9 per 100,000 (1). ...

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Penile carcinoma is an uncommon malignant disease with an incidence ranging from 0.1 to 7.9 per 100,000 males. In Europe, the incidence is 0.1â 0.9 and in the US, 0.7â 0.9 per 100,000 (1). In some areas, such as Asia, Africa and South America, penile carcinoma accounts for as many as 10â 20% of male cancers. Phimosis and chronic irritation processes related to poor hygiene are commonly associated with this tumour, whereas neonatal circumcision gives protection against the disease. There is strong evidence that human papilloma virus types 16 and 18 are associated with penile carcinoma in as many as 50% of cases, as well as with penile carcinoma in situ (2)

Penile carcinoma essentially metastasizes via the lymphatics and develops mainly through the embolization mechanism instead of lymphatic permeation. Distant metastases are very rare and are a result of vascular dissemination (3). Spreading essentially develops in a stepwise fashion: first there is inguinal lymphatic spread, followed by pelvic and lastly distant metastases. As a consequence, it is extremely rare to observe patients with positive pelvic nodes or distant metastasis without inguinal lymph node involvement. The localization of the primary tumour appears in the glans in 48% of cases, prepuce in 21%, both glans and prepuce in 9%, coronal sulcus in 6% and less than 2% in the shaft (4). Palpable inguinal nodes are present at diagnosis in 58% of patients (range 20â 96%) (4). Of these patients, 17â 45% actually have nodal metastases and the remaining patients have inflammatory disease secondary to infection of the primary tumour. The likelihood of bilateral involvement is considerable due to the large number of penile lymphatics in the subcutaneous tissue. Approximately 20% of patients with metastases to two or more nodes also have pelvic nodal involvement (5). Among patients with non-palpable nodes, around 20% harbour nodal micrometastases

Depth of invasion, tumour grade, vascular and lymphatic involvement and growth patterns, and their associations are related to the occurrence of nodal metastases (6â 10)

An overall 5-year survival rate of 52% has been reported: 66% in patients with negative lymph nodes and 27% in patients with positive nodes (4,5,7,11,12). Most patients are elderly and the neoplasm has a slow growth rate. Death from cancer is usually a consequence of local complications, such as infection, haemorrhage of the ulcerated tumour or ulcerated inguinal metastases

There are still many controversies regarding the management of penile cancer. Treatment of the primary tumour tends to be organ preserving in order to maintain sexual function (13). Another point of debate relates to the need and extent of lymphadenectomy in clinically node-negative patients. Also, social and cultural habits seem to be important factors related to penile cancer, exemplified by the fact that 44â 90% of patients suffer from phimosis at presentation (3) and that there is a documented association between human papilloma virus and penile carcinoma (2)

All these factors, together with the low incidence of penile cancer in countries with good socio- economic conditions and the absence of large or randomized trials, have an important influence in the management of the disease. ...

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