Penis

-Age 60 or older -Uncircumcised men -HPV or other sexually transmitted diseases -Phimosis (a condition where the foreskin of the penis cannot be pulled back over the glans) -Poor personal hygiene -Use of tobacco products 3 || •95% squamous cell; others very rare = melanoma, lymphoma, basal cell and Kaposi's sarcoma. 2 ||
 * Epidemiology: || The incidence of penile cancer is rare. According to the National Cancer Institute, the total number of new cases (estimated) in the United States in 2009 was 1,290. 4 ||
 * Etiology: || The following are risk factors for developing penile carcinoma:
 * Signs & Symptoms: || Signs of penile cancer can include redness, irritation, a sore, or a lump on the penis. 3 ||
 * Diagnostic Procedures: || A physical exam and history should be done. The penis should be assessed for lumps or anything unusual. A biopsy should be done if there is anything questionable seen during the exam to confirm diagnosis. 3 ||
 * Histology: || •most malignant penile tumors are well-differentiated squamous cell carcinoma 1 
 * Lymph Node Drainage: || The lymphatic channels of the prepuce and the skin of the shaft drain into the superficial inguinal nodes located above the fascia lata. The rich anastomotic network of the lymphyatics within the penis and at its base means that, for practical purposes, lymphatic drainage may be considered bilateral. The so called sentinal nodes, located above and medial to the junction of the epigastric and saphenous veins, have been identified as the primary drainage sites in carcinoma of the penis. This group of nodes is of obvious imortance in assessment of tumor extent because, if they are not involved by tumor, a complete nodal dissection may not be necessary. 1 ||
 * Metastatic Spread: || Invasive squamous carcinoma of the penis follows a predictable pattern of metastasis. Lesions of the glans, coronal sulcus, prepuce, and distal shaft spread to the deep inguinal nodes, while lesions of the proximal shaft and base of the penis spread to the more lateral and superficial inguinal nodes. Subsequent spread to the external iliac, obturator, and iliac chains follows. Although “skip” metastases to the pelvic nodes have been reported, reevaluation of old reports and more recent series suggest that pelvic metastases in the absence of inguinal metastases probably do not occur. Metastases to distant sites are infrequent and occur late in the course of the disease. 6 ||
 * Grading: || There is some controversy as to an accepted graging system for penile tumors. Listed here is a proposed grading system. Grade 1: well-differentiated cells, almost undistinguishable from normal squamous cells except for the presence of minimal basal/parabasal cell atypia. Grade 3: tumors predominantly composed of anaplastic cells. Grade 2: all tumors not fitting into criteria described for grade 1 or 3.

Any proportion of grade 3 was equally associated with a significant risk of nodal metastasis. When histologically evaluating penile carcinomas, a careful search of areas of grade 3 is recommended. Any focus of grade 3 should be sufficient to grade the neoplasm as a high-grade tumor. 7 ||
 * Staging: || The AJCC system listed is most commonly used for penile cancer tumors. 6

|| Tumor-free regional nodes imply excellent long-term survival 85% to 90% some of which are cured. 50% survive long term. Pelvic lymph node involement is the worst with less than 20% of patients living. 1 ||
 * Radiation Side Effects: || Erythema, dry or moist desquamation, and swelling of the subcutaneous tissue. Telangiectasia and fibrosis are asymptomatic and are late consequences of radiation. Sterilization 100 cGy. 5 ||
 * Prognosis: || Extent of the primary lesion and status of the lymph nodes are the major prognostic factors.
 * Treatments: || Treatment Recommendations based on stage: 2

||
 * TD5/5: || Testis 100cGy sterilization, Bladder Contracture 6000 cGy, Rectum, Ulcer, stricture 6000 cGy, Skin Acute and chronic dermatitis 5500 cGy, Bone marrow Alplasia, pancytopenia 250 cGy, Spinal cord Infarction, necrosis 4500 cGy, Small Bowel 4500 cGy Ulcer, perforation and hemorrhage. 5 ||
 * Planning Photos || Portals encompassing inguinal and pelvic lymph nodes. 1

|| 1. Chao KS, Perez CA, Brady LW. //Radiation Oncology - Management Decisions.// 2nd ed: 481-488. Philadelphia, PA //:// Lippincott, Williams & Wilkins; 2002. 2. Wang-Chesebro A, Gottschalk A. Cancer of the Penis. In: Hansen EK, Roach M. //Handbook of Evidence-based Radiation Oncology,// 1st ed: 319-324. New York, NY: Springer, 2007. 3. MedicineNet.com. //Penis Cancer.// [|http://www.medicinenet.com/penis_cancer/article.htm]. Accessed January 28, 2010. 4. National Cancer Institute. //Penile Cancer//. [|http://www.cancer.gov/cancertopics/types/penile]. Accessed January 28, 2010. 5. Washington CM, Leaver D, eds. //Principles and Practice of Radiation Therapy, 2 // nd ed: 80. Philadelphia, PA: Mosby Inc, 2004. 6. National Center for Biotechnology Information. //Cancer of the Penis//. [] Accessed January 29, 2010. 7. Chaux A, Torres J, Pfannel R, Barreto J, //et al//. Histologic Grade in Penile Squamous Cell Carcinoma: Visual Estimation Versus Digital Measurement of Proportions of Grades, Adverse Prognosis With any Proportion of Grade 3 and Correlation of a Gleason-like System With Nodal Metastasis. //The American Journal of Surgical Pathology// 2009;33:1042-1048.
 * References**

Ginnie is bright blue. Bridget is green. Sheri is brown. Zack is purple. Change 0 of 0 [|<< First] [|< Previous] [|Next >] [|Last >>]