1. PENILE
CANCER
Jyothis PS
Imaging technologist
Amrita institute of medical science

2. penis is a reproductive organ of men
it situated in the pelvic region
it is devided into two parts
Parts
• Root of the penis (radix)
It is the attached part, consist of :
bulb of penis in the middle.
crus of penis, one on either side of the bulb. It lies
within the superficial perineal pouch.
• Body of the penis (corpus)
It has two surfaces: dorsal (posterosuperior in the
erect penis), and ventral or urethral (facing
downwards and backwards in the flaccid penis). The
ventral surface is marked by a median raphe.

3. Structure
• The human penis is made up of three columns of tissue:
two corpora cavernosa lie next to each other on the
dorsal side and one corpus spongiosum lies between them
on the ventral side.
• The enlarged and bulbous-shaped end of the corpus
spongiosum forms the glans penis, which supports the
foreskin or prepuce, a loose fold of skin that in adults can
retract to expose the glans. The area on the underside of
the penis, where the foreskin is attached, is called the
frenum

4. Dorsal artery of the penis,
Artery deep artery of the penis,
artery of the urethral bulb
Vein Dorsal veins of the penis
Nerve Dorsal nerve of the penis
Superficial inguinal lymph
Lymph
nodes

5. EPIDEMIOLOGY
• Carcinoma of penis is rare
• The annual incidence is less than 1% of
all cancers in men
• male circumcision is highly effective in
preventing the development of penile
carcinoma
• Average age 58-60years (10% occur in
men younger than 40 years)

6. AETIOLOGY
• human papilloma virus (HPV)
• population in whom circumcision is rare there
observed an increased incidence penile
carcinoma.
• viruses (herpes simplex)
• sexually transmitted disease (syphilis)

7. CLINICAL PRESENTATION
• presents of infiltrative or ulcerative or an exophytic
papillary lesion
• Assessment of the primary lesion may be obscured by
the presence of phimosis.
• Secondary infection and associated foul smell are quite
common.
• Urethral obstruction is an unusual symptom of carcinoma
of the penis.
• inguinal lymph node are palpable in some patient
• most common presenting symptom are
mass lesion
pain or itching ,
bleeding ,
groin mass,
urinary symptoms.

8. Natural History
COMMON SITE OF PRIMARY TUMOR
• within the preputial area
• in the glans
• coronal sulcus
• prepuce
• Lesions arising in the skin of the shaft are rare
• slow loco regional progression

9. PATTERN OF SPREAD
• LOCAL SPREAD:
Extensive primary lesions may involve the corpora cavernosa or
even the abdominal wall.
• REGIONAL SPREAD:
The inguinal lymph nodes are the most common site of metastatic
spread. Pathologic evidence of nodal metastases is reported in
about 35% of all patients and in approximately 50% of those with
palpable lymph nodes.
METASTASES
Distant metastases are uncommon (about 10%)
( patients with advanced locoregional disease)usually
occur in patients with inguinal lymph-node involvement

11. DIAGNOSTIC WORK-UP
• General
History
Physical examination
• Special procedures
Endoscopic examination of urethra
Cystoscopy
• Radiographic studies
Standard
Chest radiographs
Computed tomography scan (pelvis and abdomen)
Bone scan (as clinically indicated)
Complementary
Urethrogram
• Laboratory studies
Complete blood count
Blood chemistry profile
Urinalysis

12. staging system proposed by jJACKSON
I Tumor confined to glans and/or prepuce

13. AJCC STAGING SYSTEM
Primary tumor (T)
• TX Primary tumor cannot be assessed
• T0 No evidence of primary tumor
• Tis Carcinoma in situ
• Ta Noninvasive verrucous carcinoma
• T1 Tumor invades subepithelial
connective tissue
• T2 Tumor invades corpus spongiosum
or cavernosum
• T3 Tumor invades urethra or prostate
• T4 Tumor invades other adjacent
structures

14. Regional lymph nodes (N)
• NX Regional lymph nodes cannot be assessed
• N0 No regional lymph-node metastasis
• N1 Metastasis in a single superficial inguinal lymph
node
• N2 Metastasis in multiple or bilateral superficial
inguinal lymph nodes
• N3 Metastasis in deep inguinal or pelvic lymph
node(s), unilateral or bilateral
Distant metastasis (M)
• MX Presence of distant metastasis cannot be
assessed
• M0 No distant metastasis
• M1 Distant metastasis

15. STAGE GROUPING
• stage 0 Tis N0
Ta N0
• I T1 N0
• II T1 N1
T2 N0
T2 N1
• III T1 N2
T2 N2
T3 N0
T3 N1
T3 N2
• IV T4 Any N
Any T N3
Any T Any N M1

16. THANK YOU…