penile%20cancer
PENILE CANCER

Penile cancer is a rare type of malignant growth that occurs on the skin or tissues of the penis.

It often presents as a palpable visible penile lesion w/ signs that may include pain, bleeding, discharge or a foul odor.

The lesion may be fungating, nodular or ulcerative and may be concealed by phimosis.


Radiotherapy

  • Eg external-beam radiation therapy (EBRT) or brachytherapy
    • EBRT course typically consists of 2 Gy daily fraction, 5 fractions per week for 6-7 weeks to total 60-70 Gy
      • External-beam radiation with chemotherapy may be given for tumors ≥4 cm
      • May be considered for patients with T1-2, N0 tumors <4 cm with or without chemotherapy with total dose of 65-70 Gy with conventional fractionation using appropriate bolus to lesion with 2-cm margins
      • May be given concurrently with chemotherapy after circumcision at 45-50.4 Gy to the whole penile shaft, penile lymph nodes, & bilateral inguinal lymph nodes, with additional external-beam radiation therapy (EBRT) to primary lesion with 2 cm margins & gross lymph nodes (total dose of 60-70 Gy)
    • Brachytherapy typical schedule consists of 55-60 Gy administered in 4-6 days, & with an interstitial implant is preferred for tumors <4 cm
      • Recommended by the ABS-GEC-ESTRO consensus statement for the primary treatment of invasive T1, T2 & selected T3 penile cancers due to its good tumor control rates, acceptable morbidity, & preservation of functional organ
      • May be considered for patients with T1-2, N0 tumors ≥4 cm
  • Circumcision may be done before radiation therapy to ensure complete exposure of the penile cancer, avoid maceration & preputial edema, & allow healing of any superficial infection
  • May be given to patients with stage I penile cancer
  • Together with surgical salvage, it is an alternative option for stage II penile cancer
  • An alternative to lymph node dissection in stage III patients who are not surgical candidates
    • May be given postoperatively to decrease incidence of inguinal recurrence
  • May be palliative in the treatment of primary tumor, regional adenopathy & bone metastases in patients with stage IV penile cancer
  • Local recurrences occurring after radiation therapy may be treated surgically if diagnosed early
  • Adjuvant radiation therapy to the inguinal region may be beneficial in patients with pN2 to N3 penile cancer or as palliative treatment in patients with disease not amenable to surgery
    • If primary site margin is positive, bilateral inguinal & pelvic lymph nodes are treated if there had been no or inadequate lymph node dissection
    • Consider also adjuvant radiation therapy or chemoradiation therapy in patients with the following high-risk features: extranodal extension, metastases to pelvic lymph nodes, involvement of bilateral inguinal lymph nodes, or a 4-cm tumor in the lymph nodes
  • Adverse effects of radiation therapy include edema, secondary infection, or urethral mucositis while late complications can also occur with fibrosis, skin atrophy & depigmentation, telangiectasia, urethral stenosis, necrosis & ulcerations
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