Carcinoma Of Penis

Carcinoma Penis

Q. 1 Carcinoma penis is rarest among –

 A

Americans

 B

Indians

 C

Swedes

 D

Jews

Q. 1

Carcinoma penis is rarest among –

 A

Americans

 B

Indians

 C

Swedes

 D

Jews

Ans. D

Explanation:

Ans. is `d’ i.e., Jews

Carcinoma of penis

  • Penile cancer is a malignant growth found on the skin or in the tissue of penis.
  • Circumcision confers protection hence, this cancer is extremely rare among jews and moslems and is correspondingly more common in populations in which circumcision is not routinely practiced. Predisposing factors : – 

 Smoking    

  • Infection with HPV16 and HPV- 18
  • Presence of pre-cancerous lesion —> Bowen disease.

Q. 2 Not true about carcinoma penis is –

 A

Erythroplasia of Queret is a precancerous condition

 B

40% of pts are under 40 year of age

 C

Circumcision if done any time before puberty provides 100% protection against carcinoma penis

 D

More than 50% pt. have inguinal 1.n enlargement when they present

Q. 2

Not true about carcinoma penis is –

 A

Erythroplasia of Queret is a precancerous condition

 B

40% of pts are under 40 year of age

 C

Circumcision if done any time before puberty provides 100% protection against carcinoma penis

 D

More than 50% pt. have inguinal 1.n enlargement when they present

Ans. C

Explanation:

Ans. ie ‘c’ ie Circumcision if done any time before puberty provides 100% protection 

  • The circumcision that is done soon after birth in infancy gives almost complete immunity against Ca penis; but that done later in life does not have the same effect, so Muslims circumcised between the ages of 4 and 9 years are still liable to the disease.
  • About Ca Penis

Most common histological type is –> sq. cell Ca (98%)

Erythroplasia of Queret is precancerous condition. It’s the in-situ form of Ca Penis.

[Carcinoma in situ of the penis is called Erythroplasia of Queyrat if it involves the glans penis, prepuce or penile shaft, and is called Bowen’s disease if it involves the remainder of the genitalia or perinea! region” – Cambell’s Urology 8/e, p 2950]

  • Premalignant lesions of Ca Penis

a.          Penile cutaneous horn
b.          Balanitis xerotica obliterans
c.          Leukoplakia
d.          Viral (Human papilloma virus) related Dermatologic lesion

– Condyloma acuminata (also k/a genital warts)

– Bowenoid papulori

  • The one etiological factor most commonly associated with penile carcinoma is poor hygine.
  • Clinical features
  • Age – Penile Ca occurs most commonly in the sixth decade of life, but its presentation in younger age group is not uncommon (“40% of pts are under 40 years of age” – Bailey)
  • Most common complaint at presentation is the lesion itself. Pain is rare.
  • Most common site of involvement (% from Cambell’s Urology 8/e, p 2953)

Glans

—>

-48%

Prepuce

—>

-21%

Both Glans & Prepuce

-4

9%

Coronal sulcus

 

-6%

Shaft

—>

-2%

  • Lymph node involvement

More than 50% of patients present with enlarged inguinal lymph nodes (but half of these are reactive enlargement d/t sepsis).

–  The presence and the extent of metastasis to the inguinal region is the most important prognostic factor for survival in patients with Ca Penis.

  • Distant metastasis is infrequent
  • Diagnosis is made by biopsy of lesion.
  • Treatment is discussed ahead.

Q. 3

Cause of death in Carcinoma penis is usually –

 A Metastasis to lung

 B

Metastasis to liver

 C

Erosion of Femoral blood vessels

 D

Urinary obstruction

Q. 3

Cause of death in Carcinoma penis is usually –

 A

Metastasis to lung

 B

Metastasis to liver

 C

Erosion of Femoral blood vessels

 D

Urinary obstruction

Ans. C

Explanation:

Ans. is ‘c’ i.e., Erosion of femoral blood vessels 

Inguinal lymph nodes erode the skin of the groin and the death of the patient may be due to involvement of the femoral or external iliac artery with torrential haemorrhage.

Quiz In Between


Q. 4 What is true about carcinoma penis – 

 A

Metastasis is rare

 B

Occurs more commonly in circumcised male

 C

Arises from corona of glans

 D

Pain is frequent

Q. 4

What is true about carcinoma penis – 

 A

Metastasis is rare

 B

Occurs more commonly in circumcised male

 C

Arises from corona of glans

 D

Pain is frequent

Ans. C

Explanation:

Ans. is ‘c’ i.e., Arises from corona of glans 

  • As already mentioned persons circumcised at birth or soon after are immune to Ca Penis.
  • Metastasis to lymph nodes is quite common. Distant metastasis occurs in less than 10% of pts.
  • MC site is glans penis
  • Pain is infrequent
  • Bailey writes – “There is little or no pain”

Q. 5

Features of carcinoma penis are all EXCEPT:

March 2013

 A

Circumcision soon after birth provides total immunity

 B

Pagets disease is not a premalignant disease

 C

Metastasis to inguinal nodes

 D

Surgery is treatment of choice

Q. 5

Features of carcinoma penis are all EXCEPT:
March 2013

 A

Circumcision soon after birth provides total immunity

 B

Pagets disease is not a premalignant disease

 C

Metastasis to inguinal nodes

 D

Surgery is treatment of choice

Ans. B

Explanation:

Ans. B i.e. Pagets disease is not a premalignant disease

Quiz In Between


Q. 6

Features of carcinoma penis include all except:
March 2007

 A

Metastasize to inguinal lymph nodes

 B

Surgery is the treatment of choice

 C

Hypospadias is a premalignant lesion

 D

Circumcision provides protection

Q. 6

Features of carcinoma penis include all except:
March 2007

 A

Metastasize to inguinal lymph nodes

 B

Surgery is the treatment of choice

 C

Hypospadias is a premalignant lesion

 D

Circumcision provides protection

Ans. C

Explanation:

Ans. C: Hypospadias is a premalignant lesion

Following as risk factors for penile cancer:

Human papillomavirus (HPV) infection, smoking, smegma, phimosis, treatment of psoriasis, age, and AIDS. The other etiologic factor most commonly associated with penile carcinoma is poor hygiene. Lichen sclerosus (also known as balanitis xerotica obliterans) may also be a risk factor.

Symptoms

Redness, irritation and a sore or a lump on the penis.

Pathology

  • Precancerous Dermatologic Lesions
  • Carcinoma in Situ (Bowen Disease, Erythroplasia of Queyrat)
  • Invasive Carcinoma of the Penis

A Squamous cell carcinoma usually originating in the glans or foreskin is by far the most common type, occurring in 9 out of 10 cases.

Staging

The stages are assessed as follows:

  • Stage I – Cancer has only affected the glans and/or foreskin.
  • Stage II – Cancer has spread to the shaft of the penis.
  • Stage III – Cancer has affected the penis and surrounding lymph nodes.
  • Stage IV – Cancer has moved beyond the groin area to other parts of the body.
  • Recurrent – Cancer that has returned after treatment.

The most common treatment is one of five types of surgery:

  • Wide local excision – The tumor and some surrounding healthy tissue are removed
  • Microsurgery – Surgery performed with a microscope is used to remove the tumor and as little healthy tissue as possible
  • Laser surgery – laser light is used to burn or cut away cancerous cells
  • Circumcision – cancerous foreskin is removed
  • Amputation (penectomy) – a partial or total removal of the penis, and possibly the associated lymph nodes. This is the most common and effective treatment.

Radiation therapy is usually used adjuvantly with surgery to reduce the risk of recurrence.

With earlier stages of penile cancer, a combination of topical chemotherapy and less invasive surgery may be used. More advanced stages of penile cancer usually require a combination of surgery, radiation and chemotherapy.


Q. 7 All of the following are features of carcinoma penis Except:        
March 2005

 A

Surgery is the treatment of choice

 B

Balanoposthitis may be a predisposing factor

 C

Metastaizes to inguinal nodes

 D

Histologically a transitional cell carcinoma

Q. 7

All of the following are features of carcinoma penis Except:        
March 2005

 A

Surgery is the treatment of choice

 B

Balanoposthitis may be a predisposing factor

 C

Metastaizes to inguinal nodes

 D

Histologically a transitional cell carcinoma

Ans. D

Explanation:

Ans. D: Histologically a transitional cell carcinoma

Penile squamous cell carcinoma, the most common penile malignancy, behaves similarly to squamous cell carcinoma in other parts of the skin.

Chronic balanoposthitis is known to be a contributory factor for penile carcinoma.

Metastasis, which is possible with this type of carcinoma, is often lethal.

Quiz In Between



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