This document appears to be a presentation on recent guidelines for the management of carcinoma of the penis from the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai. It discusses staging of penile cancer according to the 8th AJCC edition and EAU guidelines from 2019. It also covers topics such as sentinel lymph node biopsy techniques, lymph node management, metastatic penile cancer, chemotherapy and radiotherapy options, surveillance after treatment, and management of recurrent disease. The presentation is intended to summarize current best practices for penile cancer treatment and follow-up.

1. RECENT GUIDELINES IN THE
MANAGEMENT OF CA PENIS
Dept of Urology
Govt Royapettah Hospital and Kilpauk Medical College
Chennai
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2. MODERATORS:
Professors:
Prof. Dr. G. Sivasankar, M.S., M.Ch.,
Prof. Dr. A. Senthilvel, M.S., M.Ch.,
Asst Professors:
Dr. J. Sivabalan, M.S., M.Ch.,
Dr. R. Bhargavi, M.S., M.Ch.,
Dr. S. Raju, M.S., M.Ch.,
Dr. K. Muthurathinam, M.S., M.Ch.,
Dr. D. Tamilselvan, M.S., M.Ch.,
Dr. K. Senthilkumar, M.S., M.Ch.
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3. T STAGING
AJCC 8TH
EDITION
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4. T STAGING
AJCC 8TH
EDITION
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5. EAU GUIDELINES – 2019 (T STAGE)
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6. EAU GUIDELINES – 2019 (T STAGE)
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7. SKIN
GRAFTING
AFTER
TUMOUR
EXCISION
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8. GLANS
RECONSTRUCTION
WITH PREPUTIAL
FLAP
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9. PARTIAL
PENECTOMY
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10. MOHS MICROGRAPHIC SURGERY
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11. N STAGING
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12. SENTINEL LYMPH NODE BIOPSY
Described by Cabanas (1977)
Concept - Penile lymphangiographic studies
consistent drainage of the penile lymphatics
into a sentinel node or group of nodes
located at superomedial to SF junction in the area of the superficial epigastric vein.
In this series, when this sentinel node was negative , metastases to other ilioinguinal
lymph nodes did not occur.
SLN positive - indicated the need for complete superficial and deep inguinal
dissection.
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13. SENTINEL LYMPH NODE BIOPSY
False negative - result of anatomic variation in the position of the sentinel node within
the inguinal field.
Thus, biopsies directed to a specific anatomic area can be unreliable in identifying
microscopic metastasis and are no longer recommended.
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14. DYNAMIC SENTINEL LYMPH NODE BIOPSY
Precise localization of the sentinel node with the lowest morbidity of any surgical
staging technique
20% of patients with clinically negative groin harbor occult metastases
Goal : Define where the sentinel lymph node resides by using combination of visual
(vital blue dyes) & gamma emission (hand-held gamma probe) techniques
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15. DSLN BIOPSY- TECHNIQUE
Tc labeled nano colloid sulphur : Around
the lesion, night before Sx
Iso sulphur Blue(Methylene blue):
Intradermal around and into the lesion:
30min before surgery
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16. DSLN BIOPSY- TECHNIQUE
Biopsy - Via small inguinal incisions /
Guided by blue dye and gamma probe
– Record radioactive count
Sensitivity 98%, specificity 90%.
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17. Tis and Ta - LN
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18. T1, G1-2 - LN
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19. T2-T4,
VASCULAR INVASION,
NODULAR GROWTH,
G3.
BILATERAL NEGATIVE 19
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20. T2-T4,
VASCULAR INVASION,
NODULAR GROWTH,
G3
UNILATERAL <4CM 20
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21. T2-T4,
VASCULAR INVASION,
NODULAR GROWTH,
G3
BILATERAL POSITIVE
<4CM
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22. FIXED NODES
≥4CM NODES
PELVIC NODES
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23. STANDARD TEMPLATE INGUINAL DISSECTION
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24. M STAGING
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25. METASTATIC
PENILE
CANCER
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26. CHEMOTHERAPY AND RADIOTHERAPY
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27. CHEMOTHERAPY AND RADIOTHERAPY
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28. EXTERNAL BEAM RADIOTHERAPY
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29. INTERSTITIAL
BRACHYTHERAPY
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30. EAU GUIDELINES – 2019 (SURVEILLANCE)
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32. RECURRENT PENILE LESION
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33. INGUINAL RECURRENCE
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34. NO PRIOR
LYMPHADENECTOMY
OR RT
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35. PRIOR
LYMPHADENECTOMY
OR RT
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36. EAU AND FNAC
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37. EAU AND FNAC
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38. THANK YOU
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