Which one of the following does not indicate goodprognosis in Ca penis –
Correct Answer: Size less than 2 cm
Description: Aus. is 'a' i.e., Size less than 2 cm of size 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 cancerStageDescriptionPrimary Tumor (T) TxT0TisT1T2T3T4Cannot be assessedNo evidence of primary tumorCarcinoma in situCorporal invasionSubepithelial invasionUrethral or prostatic invasionOther adjacent structure invasionRegional Lymph Nodes (N)NxN0N1N2N3Cannot be assessedNoneSingle super? cial inguinal lymph nodeMultiple or bilateral superficial inguinal lymph nodesUnilateral or bilateral deep inguinal or pelvic lymph nodesDistant Metastasis (M)MxM0M1Cannot be assessedNoneDistant metastasiso 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 PenisPenile cutaneous hornBalanitis xerotica obliteransLeukoplakiaViral (Human papilloma virus) related Dermatologic lesion# Condyloma acuminata (also k/a genital warts)# Bowenoid papulorio The one etiological factor most commonly associated with penile carcinoma is poor hygiene,o 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)# 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 infrequento Diagnosis is made by biopsy of lesion.Management of Ca PenisSmall nonin vasive lesion can be t/t by# Fluorouracil cream# Nd: YAG Laser# RadiotherapySuch t/t preserves the penis, but close follow up is mandatoryInvasive penile carcinomasThe goal of t/t in invasive penile carcinomas is complete excision with adequate marginsa) 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 urethrostomyInguinal lymph nodesPalpable inguinal nodes should be t/t by antibiotics for 6 weeks following t/t of the primary lesionto 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.
Category:
Surgery
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