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

THANK YOU…