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CA penis for students education purpose only.pptx
- 1. Carcinoma of penis By: Nusheen afra
- 2. Demographic details: • A42year old , Mr. Moorthy , who works as a security , residing from Triplicane, of socioeconomic class 4.
- 3. Chief complaints: • Hecame to the opd with chief complaints of : • ulcer over the penis for the past 5 months. • Bilateral swelling over groin for past 1 month
- 4. H/o presenting illness: •The patient was apparently normal 5 months ago , after which he noticed ulcer over his penis . • Insidious on onset • Progressive in nature • It was pea size initially and later progressed to present size • Not associated with pain/ difficulty in micturition • Not able to retract penis
- 5. Contd • H/o dischargefor the past 1 month • Which was moderate , purulent in nature • Which he noticed was coming from prepuce • Which was foul smelling • Not blood stained • H/o swelling over his groin on both sides for the past 1 month • Insidious onset , did not notice progress in size. • No other swelling else where in the body
- 6. Contd • No h/otrauma • No h/o fever • No h/o loss of appetite/ weight • No h/o hematuria • No h/o of hemoptysis • No h/o bone pain
- 7. Past h/o: • Noh/o similar episode in past • Not a k/c/o DM / HTN /TB /Bronchial asthma / epilepsy/IHD • NO surgical history in past ( circumcision)
- 8. Personal h/o: • Consumesmixed diet • Not a smoker • Does not consume alcohol • Normal sleep pattern • Normal bowel and bladder habits • Not circumcised in the past • Unmarried • H/o multiple sexual partners since 21 years of age • Poor genital hygiene
- 9. Family h/o: • Nosimilar complaints in the family • Treatment h/o: nil • Allergic h/o : nil
- 10. General examination: • Procedureexplained to patient and consent taken and examined in well lighted and ventilated room • The patient is oriented to time /place /person • No pallor • No cyanosis • No icterus • No clubbing • No pedal edema • B/L Inguinal lymphadenopathy present • No generalised lymphadenopathy
- 11. Vitals: • Temp: 97F •Pulse rate: 72bpm , normal in vol , regular in rhythm, no radio radio delay , no radio-femoral delay , all peripheral pulse palpable • Respiratory rate: 16 breaths per min • BP: 110/70 mmHg , measured in right upper arm in sitting posture
- 12. Local examination • Procedureexplained to patient and consent taken and was exposed from xiphisternum to mid thigh with a male attender by side. • Inspection: • On inspection the ulcer was located over glans penis and prepuce • Size : 5x4cm • Shape : irregular • Margins: ILL defined
- 13. Contd: • Edges: raisedand everted • Floor: unhealthy tissue • Skin surrounding ulcer: edematous • External urethral meatus seen • Dilated veins over the shaft of penis • Rugosity of skin of scrotum • B/L swelling over groin of size approx 4x3 • Cough impulse negative
- 14. Contd • Abdomen isflat • Skin over abdomen normal • Left supraclavicular fossa appears empty
- 15. Palpation: • Not warm, not tender • Inspectory findings confirmed • Size : 5x4 • Margins: ill defined • Edges: raised and everted • Floor: unhealthy tissue • Base: indurated • Surrounding skin not indurated • Ulcer does not bleed on touch
- 16. Contd • B/L inguinalnodes palpable • Right inguinal node is of size 4x3 cm • Left inguinal node is of size 3x2 • Both the nodes were non tender , firm in consistency and mobile • B/L testis palpable and of normal size • No other swelling elsewhere • No organomegaly • Left supraclavicular fossa empty • PR: not done
- 17. Other system examination: •CNS: No focal neurological deficit • RS: B/L air entry present , normal vesicular breath sounds heard , no added sounds • CVS: s1 s2 heard , no added sound / murmurs.
- 18. Diagnosis: • A caseof non healing ulcer involving the glans penis and prepuce with b/L firm mobile inguinal nodes palpable, most probably a squamous cell carcinoma of penis of stage3.
- 19. Investigations: • Baseline : •CBC • BT/CT/INR • VDRL • LFT • RFT • CHEST X-RAY • ECG • USG / CT abdomen
- 20. Specific investigations: • Edgewedge biopsy • MRI pelvis • Sentinel node biopsy ( sentinel node of cabana) • FNAC of inguinal lymph nodes
- 21. Treatment: • Medical Rx: Oral antibiotics for enlarged inguinal lymph nodes. • Surgical Rx: • Partial penectomy with lymph node dissection if not resolved with antibiotics
- 22.