Download - Penile cancer
PENILE CANCER
Jyothis PSImaging technologistAmrita institute of medical science
penis is a reproductive organ of menit situated in the pelvic regionit 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.
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
Artery Dorsal artery of the penis, deep artery of the penis, artery of the urethral bulb
Vein Dorsal veins of the penis
Nerve Dorsal nerve of the penis
Lymph Superficial inguinal lymph nodes
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)
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)
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 lesionpain or itching ,bleeding , groin mass,urinary symptoms.
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
• 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
PATTERN OF SPREAD
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
staging system proposed by jJACKSON
I Tumor confined to glans and/or prepuce
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
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
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
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