Carcinoma penis (Genito-Uro oncosurgery).ppt

Penile cancer

1. Carcinoma penis
Dr.SubodhGautam
G.SurgeryResident
First year

3. introduction
•Circumcision soon after birth –complete
immunity.
•Late circumcision does not have same
effect.

8. Anatomical part
•Root of penis
crus penis –from ischiopubic rami.
bulb of penis –attached to the perineal
membrane.
•Body of the penis
2 –corpus cavernosum
1 –corpus spongiosum

9. Cont…..
•Tip of penis
-extended part of corpus spongiosum.

10. Arterial supply
•internal pudendal artery –3-branches.
–bulbar part
-to crus penis (deep artery )
-dorsal artery
•Superficial extr pudendal artery

11. Venous drainage
•Superficial dorsal vein
•Deep dorsal vein

12. Lymphatic drainage
•Superficial inguinal lymph node
•Deep inguinal lymph node
•Iliac lymph node
•Para aortic lymphnode

13. Precancerous condition
1 phimosis
2 leukoplakia
-common in diabetic patient
-white plaque typically involving
meatus.

14. Contd….
3 balanitis xerotica obliterans(lichen
sclerosus)
-white patches originating on prepuce
or glans and usually involve meatus.
-most common in middle aged diabetic
-microscopically –atrophic epidermis
and abnormal collagen deposition

15. Contd…
4 giant condyloma acuminata
-cauliflower like growth from glans or
prepuce.
-HPV
5 Bowen’s disease -velvety red lesion with
ulceration usually in the glans.

16. Contd…
6chronic balanoposthitis
7Long standing genital warts
8Cutaneous horn
9Buschke-lowenstien tumour
10Erythroplasia of Queyrat(paget’s dis of
penis)

17. pathology
•Flat and infiltrating type.
-Flat starts as leukoplakia.
-Infiltrating results from an existing papilloma
•Local growth continues from months to
year.

18. Contd…
•Once growth breaches the fascia of
corpus cavernous –rapid spread –involve
the inguinal lymph node.

19. Clinical presentation
•40 %
•-< 40 yrs age
•-mild discomfort and light discharge
•-large growth with sec. infection causes
foul bloody discharge.
•-mild pain.

20. Contd…
•60 %
-non retractile prepuce.
-enlarged inguinal lymphnode usually due
to sepsis.
•Untreated-fungating offensive
mass,torrential haemorrage due to
involvement of femoral or ext iliac artery.

21. examination
•Prepuce for phimosis.
•Try to retract.
•Discharge through the preputial orifice.
•Proliferative growth in penis / ulcer.
•Extent of growth.
•Involvement of shaft.

22. Contd…
•Inguinal lymphnode involvement.
•If involve –local evaluation.
•Abdomen and para -aortic lymphnode
involvement.

23. Differential diagnosis of ulcer
penis
•Syphilitic ulcer.
•Chancroid
•LGV
•Granuloma inguinale
•Balanoposthitis ulcers
•Herpes progenitalis
•Carcinomatous ulcer

24. Lab. investigation
•Anemia
•Leucocytosis
•Hypercalcemia
•Wedge biopsy-squamous cell carcinoma
•FNAC-inguinal nodes

25. Imaging study
•Chest radiography
•Bone scan
•CT –abdomen / pelvis

26. Pattern of spread
•Local
•Lymphatic
•Blood

27. Tumor staging
1 –confined to glans or prepuce.
2 -involve the penile shaft.
3 -operable inguinal lymphnode.
4 -distant metastasis.

28. TNM -Classification
•The TNM classification of the primary tumor (T) is below.
Note that the following description is devoid of N (node)
and M (metastasis) descriptions. These stages simply
relate the presence or absence of nodal and distant
metastases.
•TX: Primary tumor cannot be assessed.
•T0: Primary tumor is not evident.
•Tis: CIS is present.
•Ta: Noninvasive verrucous carcinoma is present.
•T1: Tumor invades subepithelial connective tissue.
•T2: Tumor invades corpora spongiosum or cavernosum.
•T3: Tumor invades the urethra or prostate.
•T4: Tumor invades other adjacent structures.

29. treatment
•Surgery
•Radiotherapy
•chemotherapy

30. Surgical treatment
Depends upon location and pathology
•Ca in situ –LASER therapy with frequent
follow –up.
•Prepuce –circumcision.
•Glans with distal shaft –partial
penectomy.
•Proximal shaft –total penectomy with
perineal urethrostomy.

31. Lymphnode involvement
•4 –6 weeks antibiotics.
•If persistent B/L lymphnode dissection.
•If improve –sentinel L/N biopsy.

32. inoperable
•Radiotherapy
•chemotherapy

33. Role of radiotherapy
•Ca in situ.
•Small lesion < 3 cm.
•Confined to glans penis.
•Pt. refused surgery.

34. Administration of radiotherapy
1.Implantation of radioactive tantalum wire
deliver a dose of 6000cgy in 5-7 days.
2 .Radium mould applicator applied around
penis which is worn either continuously or
intermittently, deliver a dose of 6000 cgy in
7 days.
3. External beam radiation, deliver 6000 cgy
in 3-5 weeks.

35. chemotherapy
•VBM –vincristine –1 mg
-bleomycin -15 mg
-methotrexate –30 mg
Weekly for 12 weeks.
•PMB –cisplatin –100 mg
-methotrexate –25 mg/ sqm
-bleomycin –10 mg /sqm
6 cycle in every 3 weeks.

36. prognosis
•Node negative -65-90 % -5 yrs survival
•Node positive –30 –50% -5 yrs survival
•Metastasis –no 5 yrs survival.