EAU & ASCO: Penile Cancer 2023: Difference between revisions

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See [https://pubmed.ncbi.nlm.nih.gov/36906413/ Original Guidelines]

'''See [https://pubmed.ncbi.nlm.nih.gov/36906413/ Original Guidelines]'''

'''See [[Penile Cancer: Squamous Penile Cancer]] Chapter Notes'''

== Background ==

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** Localized disease: 81%

** Distant metastasis: 18%

*'''Prognostic ~~factors'''~~

*#'''Presence and extent of nodal metastases (most important)'''

=== Prognostic Factors ===

*#*'''Extra-capsular extension in even one single LN carries a poor prognosis and is denoted as pN3'''

#'''Presence and extent of nodal metastases (most important)'''

*#'''Depth of invasion'''

#*'''Extra-capsular extension in even one single LN carries a poor prognosis and is denoted as pN3'''

*#'''Grade in the primary tumour'''

#'''Depth of invasion'''

*#'''Pathological subtype'''

#'''Grade in the primary tumour'''

*#'''Peri-neural invasion'''

#'''Pathological subtype'''

*#'''Lymphovascular invasion'''

#'''Peri-neural invasion'''

#'''Lymphovascular invasion'''

== Follow-up ==

* Local or regional nodal recurrences usually occur within ~~two to three~~ years of primary treatment

=== Recurrence ===

* ~~After local treatment with negative inguinal nodes, follow-up should include~~ physical examination of the ~~penis and groins for local and/~~or ~~regional~~ recurrence. ~~Additional imaging has no proven benefit~~

* Follow-up also depends on the primary treatment modality. Histology from the glans should be obtained to confirm disease-free status following laser ablation or topical chemotherapy

* Local or regional nodal recurrences usually occur within 2-3 years of primary treatment

* ~~Local recurrence is easily detected by~~ physical examination~~, by~~ the ~~patient himself~~ or ~~his physician~~.

** Local recurrence is easily detected by physical examination, by the patient himself or his physician.

* Regional recurrence requires timely treatment by rILND with (neo)adjuvant chemotherapy/chemoradiotherapy.

** Regional recurrence requires timely treatment by rILND with (neo)adjuvant chemotherapy/chemoradiotherapy.

* Men should be assessed for genital and lower limb lymphoedema at each outpatient clinic appointment, advised about good skin care, compression, exercise, massage, and elevation when resting as the mainstay of treatment. Following nodal surgery, ideally, ~~they would be referred~~ to specialist lymphoedema services for assessment and management before any significant lymphoedema occurs.

* Follow-up also depends on the primary treatment modality

** Histology from the glans should be obtained to confirm disease-free status following laser ablation or topical chemotherapy

* After local treatment with negative inguinal nodes

** Follow-up should include physical examination of the penis and groins for local and/or regional recurrence. Additional imaging has no proven benefit

=== Lymphedema ===

* Following nodal surgery, ideally, refer to specialist lymphoedema services for assessment and management before any significant lymphoedema occurs.

** Specialist lymphoedema services offer a range of made-to-measure compression garments or multi-layer lymphoedema bandaging for lower limb and genital lymphoedema

*** For lower limb compression adjustable Velcro garments also exist.

* Assess for genital and lower limb lymphoedema at each outpatient clinic appointment

*** Good skin care is critical to prevent infection that can damage remaining lymphatic channels.

* Advise good skin care, compression, exercise, massage, and elevation when resting as the mainstay of treatment.

*** Prophylactic antibiotics should be used following any episode of cellulitis~~, with penicillin~~ V, erythromycin or clindamycin recommended, except in genital lymphoedema where prophylactic trimethoprim can be used

** For lower limb compression adjustable Velcro garments also exist.

** Good skin care is critical to prevent infection that can damage remaining lymphatic channels.

** Prophylactic antibiotics should be used following any episode of cellulitis

*** Penicillin V, erythromycin or clindamycin recommended, except in genital lymphoedema where prophylactic trimethoprim can be used

== References ==

Brouwer, Oscar R., et al. "European Association of Urology-American Society of Clinical Oncology collaborative guideline on penile cancer: 2023 update." ''European urology'' 83.6 (2023): 548-560.

@@ Line 1: / Line 1: @@
-See [https://pubmed.ncbi.nlm.nih.gov/36906413/ Original Guidelines]
+'''See [https://pubmed.ncbi.nlm.nih.gov/36906413/ Original Guidelines]'''
+'''See [[Penile Cancer: Squamous Penile Cancer]] Chapter Notes'''
 == Background ==
@@ Line 593: / Line 595: @@
 ** Localized disease: 81%
 ** Distant metastasis: 18%
-*'''Prognostic factors'''
-*#'''Presence and extent of nodal metastases (most important)'''
+=== Prognostic Factors ===
-*#*'''Extra-capsular extension in even one single LN carries a poor prognosis and is denoted as pN3'''
+#'''<span style="color:#ff0000">Presence and extent of nodal metastases (most important)'''
-*#'''Depth of invasion'''
+#*'''<span style="color:#ff0000">Extra-capsular extension in even one single LN carries a poor prognosis and is denoted as pN3'''
-*#'''Grade in the primary tumour'''
+#'''<span style="color:#ff0000">Depth of invasion'''
-*#'''Pathological subtype'''
+#'''<span style="color:#ff0000">Grade in the primary tumour'''
-*#'''Peri-neural invasion'''
+#'''<span style="color:#ff0000">Pathological subtype'''
-*#'''Lymphovascular invasion'''
+#'''<span style="color:#ff0000">Peri-neural invasion'''
+#'''<span style="color:#ff0000">Lymphovascular invasion'''
 == Follow-up ==
-* Local or regional nodal recurrences usually occur within two to three years of primary treatment
+=== Recurrence ===
-* After local treatment with negative inguinal nodes, follow-up should include physical examination of the penis and groins for local and/or regional recurrence. Additional imaging has no proven benefit
-* Follow-up also depends on the primary treatment modality. Histology from the glans should be obtained to confirm disease-free status following laser ablation or topical chemotherapy
+* Local or regional nodal recurrences usually occur within 2-3 years of primary treatment
-* Local recurrence is easily detected by physical examination, by the patient himself or his physician.
+** Local recurrence is easily detected by physical examination, by the patient himself or his physician.
-* Regional recurrence requires timely treatment by rILND with (neo)adjuvant chemotherapy/chemoradiotherapy.
+** Regional recurrence requires timely treatment by rILND with (neo)adjuvant chemotherapy/chemoradiotherapy.
-* Men should be assessed for genital and lower limb lymphoedema at each outpatient clinic appointment, advised about good skin care, compression, exercise, massage, and elevation when resting as the mainstay of treatment. Following nodal surgery, ideally, they would be referred to specialist lymphoedema services for assessment and management before any significant lymphoedema occurs.
+* Follow-up also depends on the primary treatment modality
+** Histology from the glans should be obtained to confirm disease-free status following laser ablation or topical chemotherapy
+* After local treatment with negative inguinal nodes
+** Follow-up should include physical examination of the penis and groins for local and/or regional recurrence. Additional imaging has no proven benefit
+=== Lymphedema ===
+* Following nodal surgery, ideally, refer to specialist lymphoedema services for assessment and management before any significant lymphoedema occurs.
 ** Specialist lymphoedema services offer a range of made-to-measure compression garments or multi-layer lymphoedema bandaging for lower limb and genital lymphoedema
-*** For lower limb compression adjustable Velcro garments also exist.
+* Assess for genital and lower limb lymphoedema at each outpatient clinic appointment
-*** Good skin care is critical to prevent infection that can damage remaining lymphatic channels.
+* Advise good skin care, compression, exercise, massage, and elevation when resting as the mainstay of treatment.
-*** Prophylactic antibiotics should be used following any episode of cellulitis, with penicillin V, erythromycin or clindamycin recommended, except in genital lymphoedema where prophylactic trimethoprim can be used
+** For lower limb compression adjustable Velcro garments also exist.
+** Good skin care is critical to prevent infection that can damage remaining lymphatic channels.
+** Prophylactic antibiotics should be used following any episode of cellulitis
+*** Penicillin V, erythromycin or clindamycin recommended, except in genital lymphoedema where prophylactic trimethoprim can be used
 == References ==
 Brouwer, Oscar R., et al. "European Association of Urology-American Society of Clinical Oncology collaborative guideline on penile cancer: 2023 update." ''European urology'' 83.6 (2023): 548-560.