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Penile Malignancy PowerPoint Presentation

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Description : Check out this medical presentation on Penile Cancer, which is titled "Penile Malignancy", to know about the penile cancer, or cancer of the penis.

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Published on : May 25, 2021 | Views : 2724 | Downloads : 24

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PENILE MALIGNACY Department of urology Dr. Matalu Hamis Dr. Mocha George
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Anatomy
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Penile parts Root of the penis(radix)-it is the attached part consisting of the bulb of the penis in the middle and the cruz of penis one on either side of bulb . Lies within the superficial perineal pouch. Body of the penis(corpus)-has two surfaces; dorsal and ventral. The glans –sits as a cap on corpora cavernosa but is a part of corpora spongiosa.
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Gross anatomy
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Vasculature Arterial supply Blood supply to the skin of the penis is from the left and right superficial external pudendal arteries which arise from femoral artery. Supply to deep structures is from continuation of the internal pudendal artery which has three branches bulbourethral artery, carvenosal artery, and the dorsal artery.
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Venous drainage Penis is drained by 3 venous systems, the superficial, intermediate and deep. Superficial veins coalesce to form single superficial dorsal vein which drains to superficial pudendal vein then to great saphenous vein Intermediate veins has circumflex vein which drains to deep dorsal vein. Deep veins is via the crura and carvenosal veins which drains to internal pudendal veins.
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Lymphatic drainage Drains to deep inguinal nodes of the femoral triangle and some to presymphyseal lymph nodes and lateral lymph nodes of the external iliac lymphatics.
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Penile cancer
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Introduction Is a rare type of cancer that most likely to occurs on the glans of penis, or foreskin. Mostly are primary. Among 10 most common is scc. Others include melanoma,adenocarcinoma from Tyson’s gland, bcc. 20 may also occur and are mostly of urological origin.
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Risk factors/Etiologies Uncircumcision. Chronic balanoposthitis, phimosis. Sexually transmitted diseases. Leukoplakia of glans. Long-standing genital warts. Paget’s disease of penis (Erythroplasia of Queyrat is persistent rawness of glans penis).
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Risk factors cont.. Condyloma acuminata (by human papilloma virus),balanitis xerotica obliterans. HIV infection HPV - 16. Age >50yrs. Smoking cigarette and chewing tobacco Penile intraepithelial neoplasia Poor genital hygiene
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Natural history of the disease Penile cancers usually begin as small lesions on the glans or prepuce. Macroscopically may be exophytic or flat, papillary, or ulcerative. The growths rates of papillary and ulcerative are similar but of exophytic tend to metastasize to lymph node earlier and are therefore associated with a lower five year rate. If untreated penile autoamputation can occur.
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Infiltrating type/exophytic occurs in a preexisting leukoplakia. It often presents as indurated area. Papilliferous type eventually attains a large size forming a fungating foul smelling lesion which often gets infected.
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Microscopically tumor ranges from well-differentiated keratinizing tumors to solid anaplastic carcinomas with scant keratinization. Moderated differentiated tumors are highly keratinized, and poorly differentiated carcinomas have variable amounts of spindle cell, giant cell, solid acantholytic, clear cell, small cell, warty, basaloid or glandular components.
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Epidemiology The annual burden of penile cancer has been estimated to be 22000 cases worldwide with incidence rates strongly correlating with those cervical cancer. Incident rate are higher in less developed than in more developed countries, accounting for up to 10% of male cancers in some part of Africa, South America and Asia. Is rare. common affect men aged 50-70 years.
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Staging of penile cancer Jackson’s staging of carcinoma penis-The commonest method. Stage I Tumour involving only glans/prepuce/both. 90% five year survival Stage II Tumour extending into body of penis. 70% five year survival. Stage III Tumour having mobile inguinal nodes. 50% Stage IV Tumour spreading to adjacent structures/fixed nodes. 5%
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TNM
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Spread of the cancer Lymphatics It spreads to the horizontal group of inguinal lymph nodes which become nodular and hard. Lymph nodes on both sides can get involved. Later, external iliac group are involved (above and on medial aspect of the inguinal ligament). Once inguinal lymph nodes are fixed, it causes severe excruciating pain and lymphoedema. Fixed lymphnode status indicates the advancement of the disease. It may erode into the femoral vessels causing torrential haemorrhage and death. Fungation can occur. From glans, it also spreads to Cloquet lymph node which is located in femoral canal. Carcinoma from shaft of penis can spread directly to the external iliac lymph nodes. It spreads proximally to the body of penis causing induration.
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Urethral meatus may get involved causing alteration in urinary stream. It is a locoregional malignant disease. Blood spread is rare.
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Histopathological grading GX level of differentiation can not be assessed. G1 well differentiated. G2 Moderate differentiated. G3 Poorly differentiated/undifferentiated.
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Diagnosis Clinically History & physical exam. Mostly are obvious clinically except those hidden by phimosis. A painless lesion on the glans penis/inner aspect of prepuce skin. Papillary vs ulcerative. Penile discharge Dysuria 50% palpable inguinal lymph nodes at presentation.. Inflammatory vs malignant.
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Investigations Punch or excisional biopsy confirms the diagnosis. Role of imaging in staging… Uss MRI CT scan PET/CT
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TREATMENT The aim is complete removal of the tumor with organ preservation as much as possible. Depends on the stage. Modalities include: Surgery Chemotherapy Radiotherapy
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NOTE; that for the early stages modality of treatment should depend on the; Size, site relative to the meatal opening, histology, stage. No significant differences in terms of long term recurrence rate among the different modalities. Cancer free margin of 10mm is considered oncologically safe.
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Complication and prognosis From treatment. Psychological.
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Prevention Circumcision- neonatal. HPV vaccination. Hygiene. Early management of premalignant conditions. Early refferal
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Summary Its rare. Circumcision main risk factor. Mostly involves the glans penis or the inner aspect of the prepuce. SCC is the most common. Left untreated-auto amputation. Treatment multimodality. Prognosis Prevention
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Refferences Lippincotts and william Atlas of anatomy Baileys and love 25th edition Short practice of surgery SRB’s manual of surgery 3rd edition Smith general urology 17th edition Guidelines on Penile Cancer O.W. Hakenberg (chair), E. Compérat, S. Minhas, A. Necchi, C. Protzel, N. Watkin © European
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Ten-year surgical experiences with penile cancer at a tertiary care hospital in northwestern Tanzania: a retrospective study of 236 patients Phillipo L Chalya1*, Peter F Rambau2, Nestory Masalu3 and Samson Simbila4