Editing Penile Cancer: Squamous Penile Cancer (section)

== Diagnosis and Evaluation ==

=== UrologySchool.com Summary ===

* '''<span style="color:#ff0000">History and Physical exam (including exam of inguinal nodes)</span>'''
* '''<span style="color:#ff0000">Laboratory (1): serum calcium, HPV status</span>'''
* '''<span style="color:#ff0000">Imaging (2):</span>'''
** '''<span style="color:#ff0000">Primary tumour</span>'''
*** '''For small-volume glanular lesions, imaging studies are not needed'''
*** '''For larger lesions/lesions suspicious for invasion, US can provide information about infiltration of the corpora'''
** '''<span style="color:#ff0000">Metastasis: if indicated (see below)</span>'''
* '''<span style="color:#ff0000">Other (1): biopsy</span>'''

=== History and Physical Exam ===

* '''History'''
** Delay in seeking medical attention is common
** '''Signs and Symptoms'''
***'''Pain is uncommon'''
* '''<span style="color:#ff0000">Physical exam</span>'''
** '''Penile lesion'''
***'''Size, location, fixation, and involvement of corporeal bodies'''
**** '''Lesions are most commonly on the glans (48%) and foreskin (21%)'''
**** '''Physical exam incorrectly establishes pathologic tumour stage in 26% of cases'''
** '''<span style="color:#ff0000">Inguinal area</span>'''
***'''<span style="color:#ff0000">Careful palpation of the inguinal area for adenopathy is important</span>'''
**** '''EAU Guidelines: Palpably enlarged lymph nodes are highly indicative of lymph node metastases. Physical examination should note the number of palpable nodes on each side and whether these are fixed or mobile. Additional imaging does not alter management and is not required'''

=== Laboratory ===

* '''<span style="color:#ff0000">Serum calcium'''
** '''<span style="color:#ff0000">Hypercalcemia may occur without detectable osseous metastases from elevated PTH''' and related substances produced by tumour
*'''<span style="color:#ff0000">HPV status'''
**'''Mandatory to determine HPV status when a patient is diagnosed with penile cancer[https://pubmed.ncbi.nlm.nih.gov/36906413/]'''

=== Imaging ===

==== Primary tumour ====
* '''<span style="color:#ff0000">For small-volume glanular lesions, imaging studies are not needed'''
* '''<span style="color:#ff0000">For larger lesions/lesions suspicious for invasion, US can provide information about infiltration of the corpora'''
** '''Penile Doppler US has been reported to have a higher staging accuracy than an MRI in detecting corporal infiltration'''
*** MRI with an artificially induced erection can be used to detect corporal invasion but is very unpleasant for the patient
*** '''CT has poor soft-tissue resolution and is not useful for imaging the extent of the primary tumour'''

==== Metastases ====
* '''<span style="color:#ff0000">Regional'''
** '''<span style="color:#ff0000">Physical exam of the inguinal region remains the clinical gold standard for evaluating the presence of metastasis in the non-obese patients'''
*** '''EAU Guidelines: Imaging studies are not helpful in staging clinically normal inguinal regions; however, CT or MRI should also be performed in obese patients and those who have had prior inguinal surgery, whose physical examination findings may be unreliable'''
*** '''EAU Guidelines: A pelvic CT/PET scan can be used to assess the pelvic lymph nodes'''
*** '''Campbell's: some patients may have a challenging inguinal nodal examination because of body habitus or lymphedema from prior procedures. In these patients ultrasound can be used'''. The role of computed tomography (CT), positron emission tomography (PET)-CT, or magnetic resonance imaging (MRI) is not well defined
* '''Distant'''
** '''CT scan of the chest, abdomen, pelvis'''
**'''Bone scan'''
**'''CT/PET scan'''

=== Other ===

* '''<span style="color:#ff0000">Biopsy</span>'''
** '''<span style="color:#ff0000">Before initiation of therapy, biopsy is necessary to (4):</span>'''
**# '''<span style="color:#ff0000">Confirm the diagnosis of penile carcinoma</span>'''
**# '''<span style="color:#ff0000">Evaluate the depth of invasion</span>'''
**# '''<span style="color:#ff0000">Evaluate presence of vascular invasion</span>'''
**# '''<span style="color:#ff0000">Evaluate histologic grade</span>'''
**#* '''<span style="color:#ff0000">Squamous cell carcinomas are graded (1 to 4) using Broder classification</span>'''
**#** '''Low-grade lesions (grade 1 and 2) represent majority (70-80%) of cases at diagnosis'''
** '''<span style="color:#ff0000">Risk factors for nodal metastases (5):</span>'''
**# '''<span style="color:#ff0000">High-grade disease</span>'''
**# '''<span style="color:#ff0000">Depth of invasion [pT stage]</span>'''
**# '''<span style="color:#ff0000">Sarcomatoid tumors</span>'''
**#'''<span style="color:#ff0000">Perineural invasion</span>'''
**# '''<span style="color:#ff0000">Vascular invasion</span>'''

=== Differential diagnosis ===

# Condyloma acuminatum (HPV warts)
# Verrucous carcinoma (Buschke-Lowenstein tumour)
# Lichen sclerosis
# STI lesion: Chancre, chancroid, herpes, lymphogranuloma venereum, granuloma inguinale
# Tuberculosis