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Introduction & History.
Introduction & History.
Uncommon disease of older uncircumcised
men.
Etiology
Etiology
• Idiopathic
• Congenital
• Traumatic
• Infections /Infestation HPV
• Autoimmune
• Neoplastic (Benign/Malignant)
• Degenerative
Etiology: Infections causing
malignancy
Viruses
– HPV Ca Cx, Penis , anus , vagina, vulva
– Hepatitis B-Liver
– Epstein-Barr virus (EBV)-nasopharyngeal cancer, Burkitt
lymphoma, Hodgkin lymphoma, Ca. Stomach
– HIV- Kaposi sarcoma cervical cancer,non-Hodgkin lymphoma, Anal
cancer,Hodgkin disease,Lung cancer,Cancers of the mouth and throat,skin
cancer,Liver cancer
• Human herpes virus 8 (HHV-8)
– Kaposi’s Sarcoma
• Human T-lymphotrophic virus-1 (HTLV-1)
– T-cell leukemia/lymphoma (ATL).
• Merkel cell polyomavirus (MCV) Merkel cell carcinoma
Etiology: Infections causing
malignancy
• Bacteria
– Helicobacter pylori- Ca. Stomach, Lymphoma
of stomach
• Parasites-
– Liver Fluke (Opisthorchis viverrini and Clonorchis sinensis)
- Cholangiocarcinoma
– Schistosoma haematobium -Bladder cancer
Etiology: premalignant lesions
AKA Penile intraepithelial neoplasia (PIN),
• Erythroplasia of Queyrat
• Bowen disease
• Bowenoid papulosis.
Erythroplasia of Queyrat
• Bright red, well-demarcated, velvety plaque or
plaques that involve the glans, coronal sulcus, or
prepuce.
• Risk for progression to invasive carcinoma- up to
10%.
• Predisposing factors-
– lack of circumcision,
– poor hygiene
– chronic infection.
• Several HPV serotypes have been isolated from
this disease, including HPV 8, 16, 18, 39, and 51.
Bowen disease
Bowen disease
• A sharply marginated, erythematous, scaly patch
or plaque on the shaft of the penis.
• A pigmented variant exists
• Risk for progression to invasive carcinoma- up to
10%.
• Ulceration may signal an invasive lesion
• Predisposing factors-
– Exposure to ultraviolet light,
– chemical carcinogens,
– arsenic.
– HPV types 16, 18, and 57b
Bowenoid Papulosis
• Seen predominantly in young, sexually active
males.
• solitary or multiple, rapidly growing, red-brown to
violaceous, flat-topped papules that may coalesce
into larger plaques on the penile shaft or the
perineum.
• The papules are nonpruritic, range in size from 2-
10 mm, and usually lack scale.
• Progression to squamous cell carcinoma, the rate
(2.6%) .
All three PINs
• Diagnosis-Biopsy .
• Treatment-removal or destruction of the lesion-
– topical therapy, cryotherapy, laser ablation,
radiotherapy, diathermy, surgical excision (including
partial penectomy), and Mohs micrographic surgery
– opical therapy with either 5-fluorouracil(5-FU)
or imiquimod
– photodynamic therapy
Other etiological factors
• Phimosis
• HPV infection
• associated with spousal cervical cancerassociated with
spousal cervical cancer
• poor hygiene.
• Smegma retention
• Chronic balanitis
• Ultraviolet light exposure
• Chemical carcinogen exposure
• Cigarette smoking
• HIV infection
• Immunosuppression.
Pathophysiology
Pathophysiology
• Invasive squamous cell carcinomas -well-
differentiated neoplasm
– Exophytic
– Verrucous
– Flat
Clinical Features
Clinical Features
• Demography
• Symptoms
• Signs
• Prognosis
• Complications
Demography
Demography
• In US 1% of all cancers in males.
• Higher incidence inUganda, Brazil,
Jamaica, Mexico, India, and Haiti.
Symptoms & Signs
Symptoms & Signs
• An ulcerated mass on glans .
• Followed by the prepuce, coronal sulcus,
and shaft.
• penile pain, malignant priapism, discharge,
and difficulty voiding.
• Lymphadenopathy Lymphadenopathy
Differential diagnoses
Differential diagnoses
• HPV infection
• Atypical herpes simplex infection
• Malignant cutaneous adnexal tumors
• Sarcomas
• Amelanotic melanoma
Prognosis
Prognosis
• Locally advanced, aggressive disease.
• Survival is most closely related to lymph
node status.
– 5-year survival rate is 93% for stage I,
– 55% for stage II,
– 30% for stage III disease.
– Involvement of the pelvic lymph nodes is
associated with a 5-year survival rate of less
than 5%.
– Death typically occurs within 2 years if tumors
are left untreated.
Investigations
Investigations
• Laboratory Studies
– Routine
– Special
• Imaging Studies
• Tissue diagnosis
– Cytology
• FNAC of lymph nodes
• Imprint
– Histlogy
Classification
Classification
• Patients are staged
• Tumors are graded
TNM classification
• 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 the corpus spongiosum or
cavernosum
• T3: Tumor invades the urethra or prostate
• T4: Tumor invades other adjacent structures
TNM classification
Regional lymph nodes
• NX: Metastasis to regional lymph nodes is not
assessed or cannot be assessed
• N0: No regional lymph node metastasis
• N1: Metastasis to a single superficial inguinal
lymph node
• N2: Metastasis in multiple or bilateral superficial
inguinal lymph nodes
• N3: Metastasis to deep inguinal and/or pelvic
lymph nodes
TNM classification
Metastasis
• MX: Metastasis cannot be assessed
• M0: No suspicion or detection of metastasis
• M1: Metastasis
•
Grading
Grading
• Broders classification divides tumors into
four histologic grades ranging from well
differentiated to poorly differentiated.
Management
Management
• The primary treatment for penile carcinoma
is surgical
• Radiation, chemotherapy, or both adjunct.
• Chemo- cisplatin and bleomycin
Operative Therapy
Operative Therapy
• Wide excision, partial penectomy, or total
penectomy.
• Lymphadenectomy +- in second step.
• Laser therapy
• Mohs micrographic surgery (for verrucous
carcinoma)
• Photodynamic therapy (for superficial
lesions)
Prevention
Prevention
• Circumcision at early age.
• Personal hygiene
• HPV vaccination
• Avoid smoking
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Ca. penis.pptx

  • 1. Tips on using my ppt. 1. You can freely download, edit, modify and put your name etc. 2. Don’t be concerned about number of slides. Half the slides are blanks except for the title. 3. First show the blank slides (eg. Aetiology ) > Ask students what they already know about ethology of today's topic. > Then show next slide which enumerates aetiologies. 4. At the end rerun the show – show blank> ask questions > show next slide. 5. This will be an ACTIVE LEARNING SESSION x three revisions. 6. Good for self study also. Good for self study also. Display blank slide> Think what you already know about this > Read next slide.
  • 3. Introduction & History. Uncommon disease of older uncircumcised men.
  • 5. Etiology • Idiopathic • Congenital • Traumatic • Infections /Infestation HPV • Autoimmune • Neoplastic (Benign/Malignant) • Degenerative
  • 6. Etiology: Infections causing malignancy Viruses – HPV Ca Cx, Penis , anus , vagina, vulva – Hepatitis B-Liver – Epstein-Barr virus (EBV)-nasopharyngeal cancer, Burkitt lymphoma, Hodgkin lymphoma, Ca. Stomach – HIV- Kaposi sarcoma cervical cancer,non-Hodgkin lymphoma, Anal cancer,Hodgkin disease,Lung cancer,Cancers of the mouth and throat,skin cancer,Liver cancer • Human herpes virus 8 (HHV-8) – Kaposi’s Sarcoma • Human T-lymphotrophic virus-1 (HTLV-1) – T-cell leukemia/lymphoma (ATL). • Merkel cell polyomavirus (MCV) Merkel cell carcinoma
  • 7. Etiology: Infections causing malignancy • Bacteria – Helicobacter pylori- Ca. Stomach, Lymphoma of stomach • Parasites- – Liver Fluke (Opisthorchis viverrini and Clonorchis sinensis) - Cholangiocarcinoma – Schistosoma haematobium -Bladder cancer
  • 8. Etiology: premalignant lesions AKA Penile intraepithelial neoplasia (PIN), • Erythroplasia of Queyrat • Bowen disease • Bowenoid papulosis.
  • 9. Erythroplasia of Queyrat • Bright red, well-demarcated, velvety plaque or plaques that involve the glans, coronal sulcus, or prepuce. • Risk for progression to invasive carcinoma- up to 10%. • Predisposing factors- – lack of circumcision, – poor hygiene – chronic infection. • Several HPV serotypes have been isolated from this disease, including HPV 8, 16, 18, 39, and 51.
  • 11. Bowen disease • A sharply marginated, erythematous, scaly patch or plaque on the shaft of the penis. • A pigmented variant exists • Risk for progression to invasive carcinoma- up to 10%. • Ulceration may signal an invasive lesion • Predisposing factors- – Exposure to ultraviolet light, – chemical carcinogens, – arsenic. – HPV types 16, 18, and 57b
  • 12. Bowenoid Papulosis • Seen predominantly in young, sexually active males. • solitary or multiple, rapidly growing, red-brown to violaceous, flat-topped papules that may coalesce into larger plaques on the penile shaft or the perineum. • The papules are nonpruritic, range in size from 2- 10 mm, and usually lack scale. • Progression to squamous cell carcinoma, the rate (2.6%) .
  • 13. All three PINs • Diagnosis-Biopsy . • Treatment-removal or destruction of the lesion- – topical therapy, cryotherapy, laser ablation, radiotherapy, diathermy, surgical excision (including partial penectomy), and Mohs micrographic surgery – opical therapy with either 5-fluorouracil(5-FU) or imiquimod – photodynamic therapy
  • 14. Other etiological factors • Phimosis • HPV infection • associated with spousal cervical cancerassociated with spousal cervical cancer • poor hygiene. • Smegma retention • Chronic balanitis • Ultraviolet light exposure • Chemical carcinogen exposure • Cigarette smoking • HIV infection • Immunosuppression.
  • 16. Pathophysiology • Invasive squamous cell carcinomas -well- differentiated neoplasm – Exophytic – Verrucous – Flat
  • 18. Clinical Features • Demography • Symptoms • Signs • Prognosis • Complications
  • 20. Demography • In US 1% of all cancers in males. • Higher incidence inUganda, Brazil, Jamaica, Mexico, India, and Haiti.
  • 22. Symptoms & Signs • An ulcerated mass on glans . • Followed by the prepuce, coronal sulcus, and shaft. • penile pain, malignant priapism, discharge, and difficulty voiding. • Lymphadenopathy Lymphadenopathy
  • 24. Differential diagnoses • HPV infection • Atypical herpes simplex infection • Malignant cutaneous adnexal tumors • Sarcomas • Amelanotic melanoma
  • 26. Prognosis • Locally advanced, aggressive disease. • Survival is most closely related to lymph node status. – 5-year survival rate is 93% for stage I, – 55% for stage II, – 30% for stage III disease. – Involvement of the pelvic lymph nodes is associated with a 5-year survival rate of less than 5%. – Death typically occurs within 2 years if tumors are left untreated.
  • 28. Investigations • Laboratory Studies – Routine – Special • Imaging Studies • Tissue diagnosis – Cytology • FNAC of lymph nodes • Imprint – Histlogy
  • 30. Classification • Patients are staged • Tumors are graded
  • 31. TNM classification • 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 the corpus spongiosum or cavernosum • T3: Tumor invades the urethra or prostate • T4: Tumor invades other adjacent structures
  • 32. TNM classification Regional lymph nodes • NX: Metastasis to regional lymph nodes is not assessed or cannot be assessed • N0: No regional lymph node metastasis • N1: Metastasis to a single superficial inguinal lymph node • N2: Metastasis in multiple or bilateral superficial inguinal lymph nodes • N3: Metastasis to deep inguinal and/or pelvic lymph nodes
  • 33. TNM classification Metastasis • MX: Metastasis cannot be assessed • M0: No suspicion or detection of metastasis • M1: Metastasis •
  • 35. Grading • Broders classification divides tumors into four histologic grades ranging from well differentiated to poorly differentiated.
  • 37. Management • The primary treatment for penile carcinoma is surgical • Radiation, chemotherapy, or both adjunct. • Chemo- cisplatin and bleomycin
  • 39. Operative Therapy • Wide excision, partial penectomy, or total penectomy. • Lymphadenectomy +- in second step. • Laser therapy • Mohs micrographic surgery (for verrucous carcinoma) • Photodynamic therapy (for superficial lesions)
  • 41. Prevention • Circumcision at early age. • Personal hygiene • HPV vaccination • Avoid smoking
  • 42. Get this ppt in mobile 1. Download Microsoft PowerPoint from play store. 2. Open Google assistant 3. Open Google lens. 4. Scan qr code from next slide.
  • 43.
  • 44.
  • 45. Get my ppt collection • https://www.slideshare.net/drpradeeppande/ edit_my_uploads • https://www.dropbox.com/sh/x600md3cvj8 5woy/AACVMHuQtvHvl_K8ehc3ltkEa?dl =0 • https://www.facebook.com/doctorpradeeppa nde/?ref=pages_you_manage

Editor's Notes

  1. drpradeeppande@gmail.com 7697305442
  2. drpradeeppande@gmail.com 7697305442