Penile Cancer

Jing Zeng and Alexander Lin

Background

What is the estimated annual incidence of penile cancer Dx in the U.S.? What % of male cancers does this represent? How is this different in developing countries?

There are ~1,500 new cases/yr of penile cancer in the U.S., representing <1% of male cancers. In developing countries, it can account for 10%–20% of all male cancers.

Name 3 factors associated with the risk of developing penile cancer.

Risk factors for penile cancer:

Lack of circumcision
Phimosis
HPV infection
HIV infection

Others factors that may also be associated include smoking, PUVA therapy, and family Hx.

What causes condyloma acuminata?

Condyloma acuminata, more commonly known as genital warts, are associated with HPV infection. They are usually benign but can undergo malignant transformation.

What is the difference between erythroplasia of Queyrat (EQ) and Bowen Dz?

Both EQ and Bowen Dz are CIS conditions. EQ occurs within the penile mucocutaneous epithelium (glans and prepuce), whereas Bowen Dz occurs within follicle-bearing epithelium (penile shaft).

What are the 2 most common anatomic locations for penile cancer?

The glans and prepuce are the 2 most common locations for penile cancer. Less common locations include the coronal sulcus and the shaft. Lesions can appear as a mass, ulceration, or inflammation.

To what LNs do penile cancers primarily drain to 1^st?

Inguinal LNs are the initial site of nodal involvement in penile cancers → iliac and pelvic nodes.

What is the anatomic position of the penis?

The anatomic position of the penis is erect; the descriptors dorsal and ventral refer to the anatomic position.

Approximately what % of men with penile cancer and palpable inguinal LAD have pathologically positive nodal mets?

Overall, ~58% of palpable inguinal nodes in pts with penile cancer are actually positive for cancer mets on pathology. The rest of the nodes are reactive.

In men with penile cancer and clinically negative nodes, what is the likelihood of occult nodal mets?

In men with penile cancer and clinically negative nodes, the likelihood of occult nodal mets depends on the tumor stage, grade, and presence of LVI. Roughly, it can be 11%–20% for T1 lesions and up to 60%–75% for T2-T3 lesions.

What % of men with penile cancer present with DM lesions?

Hematogenous spread of penile cancer is rare until late in the Dz course and is found in only 1%–10% of men at initial presentation.

What are the most common sites for DM in penile cancer?

Lung, liver, and bone are the most common sites for DM in penile cancer.

What is the most common histology in penile cancer?

Squamous cell carcinoma accounts for 95% of penile malignancies. Other histologic subtypes such as sarcoma, urethral tumors, lymphoma, and basal cell carcinoma are extremely rare.

Workup/Staging

What is the workup for penile cancer?

Penile cancer workup: H&P, CBC, chemistry panel, MRI penis/pelvis. Consider PET/CT and inguinal sentinal LN Bx.

How should clinically negative LNs in penile cancer be evaluated?

Clinically negative LNs in penile cancer should be evaluated with CT, MRI, or PET scan, but the FPR and FNR are both high regardless of the imaging modality. Inguinal sentinel LN Bx is promising (FNR 7%).

Should clinically negative nodes in penile cancer undergo inguinal dissection?

The toxicity of inguinal LND should be weighed against the likelihood of occult nodal mets in penile cancer. LND may be considered for ≥T2 tumors or for high-grade lesions. Recent studies suggest that sentinel LN Bx may be a reasonable alternative (Leijte JA et al., JCO 2009).

How should clinically positive LNs in penile cancer be evaluated?

Historically, palpable inguinal LNs in penile cancer can be managed by a 6-wk trial of antibiotics. Newer, alternative approaches include FNA or open Bx.

What is the AJCC 7^th

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