Carcinoma Of Penis

CARCINOMA OF PENIS


CARCINOMA OF PENIS

  • MC type – SCC

ETIOLOGY-

  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 6th 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

Exam Important

  • MC type – SCC

ETIOLOGY-

  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

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 6th 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

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

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