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Seminar on carcinoma penis
moderator
• Dr A I Mazumder
Asstt. Professor
Deptt of surgery
SMCH
Presenter
• Dr Biswajit Deka
2nd yr PGT
Deptt of surgery
SMCH
Anatomy
Arterial supply
Introduction
• Penile cancer is uncommon, but, when it is diagnosed, it is
psychologically devastating to the patient
• . Benign, premalignant, and malignant conditions must be
differentiated.
• Metastasis, which occurs when the diagnosis or treatment is
delayed, is usually lethal.
• This is a slow-growing cancer in its early stages, and because it
seldom interferes with voiding or erectile function, patients do not
complain until pain or a discharge from the cancer occurs. By this
time, the cancer has usually progressed from being superficial to
invasive.
Epidemiology
• 0.5% of all malignancies in western world (decreasing)
• Higher incidence- south America , east Africa & south east asia
• In urban India- 0.7-2.3 cases per 100,000 men.
• In rural India, 3 cases per 100,000 men, accounting for more than
6% of all malignancies in this population
• Overall incidence is decreasing
Natural history
• Begins as small lesion: papillary & exophytic or flat & ulcerative
• Flat & ulcerative lesions >5cm & extending >75% of the shaft–
higher incidence of metastasis & poor survival
• Lymphatic spread
• Metastatic nodes cause erosion into vessels , skin necrosis &
chronic infection
• Distant mets uncommon : 1-10%
• Most untreated cases : death within 2 yrs
Presentation
•Delayed presentation – embarrassment , anxiety , fear (
5.8months )
•Lump 47%
•Ulcer 35%
•Erythematous lesion 17%
•Bleeding & discharge from lesion
•Usually sharply demarcated lesion
Location
• Glans 48%
• Prepuce 21%
• Glans & prepuce 9%
• Coronal sulcus 6 %
• Shaft <2%
TNM classification : Primary tumour
• Tx – primary tumour cannot be assessed
• To- no evidence of primary tumour
• Tis – ca in situ
• Ta – non invasive verrucous ca
• T1a – tumour invades subepithelial connective tissue without
lymphovascular invasion & is not poorly differentiated
• T1b - tumour invades subepithelial connective tissue without
lymphovascular invasion & is poorly differentiated
• T2- tumour invades corpus cavernosum or spongiosum
• T3- tumour invades urethra
• T4- tumour invades other adjacent structures
Lymph nodes
• Nx - regional nodes cannot be assessed
• No- no palpable or visibly enlarged inguinal LN
• pNo- no regional LN metastasis
• N1 – palpable, mobile , unilateral inguinal LN
• pN1- metastasis in a single inguinal LN
• N2-- palpable mobile multiple or B/L inguinal LN
• pN2– metastasis in multiple or B/L inguinal LN
• N3- palpable fixed inguinal nodal mass or pelvic LN U/L or B/L
• pN3- extranodal extension of LN metastasis or pelvic LN U/L or B/L
Metastasis
• Mo – no distant mets
• M1 – distant mets
Broder’s grading
• Very well differentiated (75% epithelial pearls)
• Well differentiated (50-75%)
• Moderately differentiated (25-50%)
• Undifferentiated (<25%)
Grading of penile SSC
Features Grade 1 Grade 2 Grade 3 Sarcomatoid
( grade 4 )
Cytological atypia Mild Moderate Anaplasia Sarcomatoid
keratinisation Usually abundant Less prominent May be absent Absent
Inter cellular bridges Prominent Occasional Few or more Absent
Mitotic activity Rare Increased Abundant Abundant
Tumour margin Pushing/ well defined Increased Infiltrative/ ill defined Abundant
Investigation
• Routine inv
• Edge biopsy
• FNAC
• USG abdomen – look for external iliac nodes
• SLNB- CABANA node
Radiotherapy
• Indication : early lesion , palliation , LN involvement
• EBRT : widely available , delivers homogenous dose , less expertise
• Brachytherapy : RADIUM-226 , IRIDIUM-192, CESIUM-137
• Dose: 60 cGy for 3 weeks (high dose)
• Prophylactic – not recommended
Follow up
• Most relapses in first 2 yrs
• 0-7% chances of relapse after partial / total penectomy
Thank you
Seminar on carcinoma penis

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Seminar on carcinoma penis

  • 1. Seminar on carcinoma penis moderator • Dr A I Mazumder Asstt. Professor Deptt of surgery SMCH Presenter • Dr Biswajit Deka 2nd yr PGT Deptt of surgery SMCH
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  • 7. Introduction • Penile cancer is uncommon, but, when it is diagnosed, it is psychologically devastating to the patient • . Benign, premalignant, and malignant conditions must be differentiated. • Metastasis, which occurs when the diagnosis or treatment is delayed, is usually lethal. • This is a slow-growing cancer in its early stages, and because it seldom interferes with voiding or erectile function, patients do not complain until pain or a discharge from the cancer occurs. By this time, the cancer has usually progressed from being superficial to invasive.
  • 8. Epidemiology • 0.5% of all malignancies in western world (decreasing) • Higher incidence- south America , east Africa & south east asia • In urban India- 0.7-2.3 cases per 100,000 men. • In rural India, 3 cases per 100,000 men, accounting for more than 6% of all malignancies in this population • Overall incidence is decreasing
  • 9. Natural history • Begins as small lesion: papillary & exophytic or flat & ulcerative • Flat & ulcerative lesions >5cm & extending >75% of the shaft– higher incidence of metastasis & poor survival • Lymphatic spread • Metastatic nodes cause erosion into vessels , skin necrosis & chronic infection • Distant mets uncommon : 1-10% • Most untreated cases : death within 2 yrs
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  • 11. Presentation •Delayed presentation – embarrassment , anxiety , fear ( 5.8months ) •Lump 47% •Ulcer 35% •Erythematous lesion 17% •Bleeding & discharge from lesion •Usually sharply demarcated lesion
  • 12. Location • Glans 48% • Prepuce 21% • Glans & prepuce 9% • Coronal sulcus 6 % • Shaft <2%
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  • 17. TNM classification : Primary tumour • Tx – primary tumour cannot be assessed • To- no evidence of primary tumour • Tis – ca in situ • Ta – non invasive verrucous ca • T1a – tumour invades subepithelial connective tissue without lymphovascular invasion & is not poorly differentiated • T1b - tumour invades subepithelial connective tissue without lymphovascular invasion & is poorly differentiated • T2- tumour invades corpus cavernosum or spongiosum • T3- tumour invades urethra • T4- tumour invades other adjacent structures
  • 18. Lymph nodes • Nx - regional nodes cannot be assessed • No- no palpable or visibly enlarged inguinal LN • pNo- no regional LN metastasis • N1 – palpable, mobile , unilateral inguinal LN • pN1- metastasis in a single inguinal LN • N2-- palpable mobile multiple or B/L inguinal LN • pN2– metastasis in multiple or B/L inguinal LN • N3- palpable fixed inguinal nodal mass or pelvic LN U/L or B/L • pN3- extranodal extension of LN metastasis or pelvic LN U/L or B/L
  • 19. Metastasis • Mo – no distant mets • M1 – distant mets
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  • 23. Broder’s grading • Very well differentiated (75% epithelial pearls) • Well differentiated (50-75%) • Moderately differentiated (25-50%) • Undifferentiated (<25%)
  • 24. Grading of penile SSC Features Grade 1 Grade 2 Grade 3 Sarcomatoid ( grade 4 ) Cytological atypia Mild Moderate Anaplasia Sarcomatoid keratinisation Usually abundant Less prominent May be absent Absent Inter cellular bridges Prominent Occasional Few or more Absent Mitotic activity Rare Increased Abundant Abundant Tumour margin Pushing/ well defined Increased Infiltrative/ ill defined Abundant
  • 25. Investigation • Routine inv • Edge biopsy • FNAC • USG abdomen – look for external iliac nodes • SLNB- CABANA node
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  • 46. Radiotherapy • Indication : early lesion , palliation , LN involvement • EBRT : widely available , delivers homogenous dose , less expertise • Brachytherapy : RADIUM-226 , IRIDIUM-192, CESIUM-137 • Dose: 60 cGy for 3 weeks (high dose) • Prophylactic – not recommended
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  • 50. Follow up • Most relapses in first 2 yrs • 0-7% chances of relapse after partial / total penectomy
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