CARCINOMA OF PENIS

• MC type – SCC

1. Premalignant lesions-

• Genital warts- Bushke- Lowenstein tumour is a giant penile condyloma (verrucous carcinoma of penis)
• Erythroplasia of Queyrat or Paget’s disease of penis- precancerous lesion
• Leukoplakia of glans
• Bowen’s disease- small eczematous plaque
• Chronic balanoposthitis, phimosis (50%), Balanitis xerotica obliterans
• Condyloma auminata (HPV)
• Most important carcinogens- HPV (16, 18, 31, 33)
• Poor hygiene

PATHOLOGY-

1. Infiltrating type- pre-existing leukoplakia
2. Papilliferous type
3. Ulcerative type- glans penis MC site. 80% are low grade tumours

SPREAD-

1. Lymphatics-

• Spreads to horizontal group of inguinal lymph nodes and are nodular, hard, fixed which suggests metstasis.
• Carcinoma from shaft of penis spreads to external iliac LN
• Initernal and paraaortic LN get enlarged

2. Blood spread is rare

3. Death may occur due to erosions of femoral vessels by iguinal LN.

CLINICAL FEATURES-

• Occurs in 6^th decade
• Neonatal circumcision helps in immunity against carcinoma penis, HIV or STD.
• MC orginates from glans > sulcus > prepuce > shaft
• Foul smelling discharge is common
• In adults, recent onset of phimosis
• Haematuria, pain while passing urine- advanced tumours
• On examination, fungation and induration, everted edge
• Pain, oedema, tenderness, redness present on infection
• Urethra is rarely involved as it is protected by tough Buck’s fascia

 

INVESTIGATIONS-

• Incisional biopsy for grade and depth of invasion and wedge biopsy for SCC
• Senitel LN biopsy (Cabana sentinel LN)
• USG- assessment of depth
• MRI- IOC for staging in CA penis

STAGING-

1. Stage 1- Confined to glans or prepuce
2. Stage 2- involving penile shaft or copora cavernosa
3. Stage 3- Operable inguinal LN metastasis
4. Stage 4- inoperable inguinal LN metastasis Or advanced spread

TNM STAGING 

TREATMENT-

• Surgery is the TOC
• Ca in situ- topical 5- FU cream, Nd- YAG laser, radiotherapy + follow up
• Ca in situ
• Young’s operation- for glans involvement without extending into proximal part of shaft
• Total amputation with perineal urethrostomy- if shaft is involved
• Piersey Gold operation- total amputation + total scrotectomy + total orchidectomy
• Laser ablation- stage T1 tumour
• Enlarged inguinal node- block dissection

Don’t Forget to Solve all the previous Year Question asked on CARCINOMA OF PENIS