The most important prognostic factor in a case of Penile carcinoma is-
Correct Answer: LN metastasis
Description: Ans. is A LN metastasis o The most important prognostic and treatment-related factor in penile ca is the presence and degree of nodal disease. Smith s Urology writes - "Survival in penile carcinoma correlates with the presence or absence of nodal disease. Five-year survival rates for patients with node-negative disease range from 65% to 90%. For patients with positive inguinal nodes, this rate decreases to 30-50% and with positive iliac nodes decreases to less than 20%. In the presence of soft-tissue or bony metastases, no 5-year survivors have been reported". o The most adverse prognostic factors appear to be hymphovascular invasion and high histological grade. o It is not the size of the tumor but the invasion of the lesion into the corpora or overlying fascial layers, which are prognostic indicator. o Lymph node status is the most important prognostic marker of the disease. Here's the TNM staging of penile cancer Stage Description Primary Tumor (T) Tx Cannot be assessed T0 No evidence of primary tumor Tis Carcinoma in situ T1 Corporal invasion T2 Subepithelial invasion T3 Urethral or prostatic invasion T4 Other adjacent structure invasion Regional Lymph Nodes (N) Nx Cannot be assessed N0 None N1 Single super? cial inguinal lymph node N2 Multiple or bilateral superficial inguinal lymph nodes N3 Unilateral or bilateral deep inguinal or pelvic lymph nodes Distant Metastasis (M) Mx Cannot be assessed M0 None Ml Distant metastasis o 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. Premalignant lesions of Ca Penis Penile cutaneous horn Balanitis xerotica obliterans Leukoplakia Viral (Human papillpapillomavirusted Dermatologic lesion Condyloma Acuminata (also k/a genital warts) # Bowenoid papulori o The one etiological factor most commonly associated with penile carcinoma is poor hvgine. o Clinical features Age - Penile Ca occurs most commonly in the sixth decade of life, but its presentation in the 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 Campbell's 8/e, p 2953) * Gians - ~48% * Prepuce - ~21% * Both Gians & Prepuce - 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 o Diagnosis is made by biopsy of lesion. Management of Ca Penis Small noninvasive lesion can be t/t by * Fluorouracil cream * Nd: YAG Laser * Radiotherapy- Such t/t preserves the penis, but close follow up is mandatory Invasive penile carcinomas The goal of t/t in invasive penile carcinomas is complete excision with adequate margins a) For lesion involving the prepuce * Simple circumcision is effective. b) For lesion of glans or distal shaft * Partial penectomy with a 2 cm margin (less aggressive surgical resections such as Mohs micrographic surgery and local excisions directed at penile preservation can be done.) c) For lesion involving the proximal shaft or when partial penectomy results in a penile stump of insufficient length for sexual function or directing the urinary stream * Total penectomy with perineal urethrostomy Inguinal lymph nodes Palpable inguinal nodes should be t/t by antibiotics for 6 weeks following t/t of the primary lesion to eliminate infection (this is to cure reactive lymphadenopathy d/t sepsis). Persistent adenopathy following antibiotic t/t is considered to be metastatic disease and bilateral ilioinguinal node dissection is performed.
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