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Penile Cancer: Squamous Penile Cancer: Difference between revisions

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* '''<span style="color:#ff0000">≈20% of patients with clinically nonpalpable inguinal nodes harbor occult metastases</span>'''
* '''<span style="color:#ff0000">≈20% of patients with clinically nonpalpable inguinal nodes harbor occult metastases</span>'''
**Cross-sectional imaging studies such as CT and magnetic resonance imaging (MRI) are unable to accurately detect these cases and are only largely used to assess for the presence of pelvic lymph node involvement
**Cross-sectional imaging studies such as CT and magnetic resonance imaging (MRI) are unable to accurately detect these cases and are only largely used to assess for the presence of pelvic lymph node involvement
* '''<span style="color:#ff0000">Stage and grade of the primary penile tumor have been known to dictate the management of penile SCC with nonpalpable inguinal lymph nodes.</span>'''
**'''Immediate resection of clinically occult lymph node metastases is associated with improved survival when compared with delayed resection of involved nodes at the time of clinical detection'''
**'''Patients with stage ≥pT2 have high risk of metastasis, patients with pTis, pTa, pT1, grade 1 tumours have low risk of metastasis'''
* '''<span style="color:#ff0000">Surgical staging</span>'''
*** '''Immediate resection of clinically occult lymph node metastases is associated with improved survival when compared with delayed resection of involved nodes at the time of clinical detection'''
**'''<span style="color:#ff0000">Indications</span>'''
**'''<span style="color:#ff0000">Patients with high-risk disease (high-grade or ≥pT2) should undergo lymph node staging with (2):</span>'''
***'''<span style="color:#ff0000">Recommended (1):</span>'''
**#'''<span style="color:#ff0000">Bilateral modified inguinal lymphadenectomy</span>'''
****'''<span style="color:#ff0000">High-risk tumor (≥pT1b)</span>'''
**#*'''Lymphatic spread of penile carcinoma can be unilateral or bilateral to the inguinal lymph nodes'''
***'''<span style="color:#ff0000">Optional (1):</span>'''
**#'''<span style="color:#ff0000">Dynamic sentinel node biopsy</span>'''
****'''<span style="color:#ff0000">T1a G2 disease</span>'''
*****'''<span style="color:#ff0000">Surveillance is an alternative to surgical staging with patients willing to comply with strict follow-up</span>'''
**'''<span style="color:#ff0000">Options (2)</span>'''
**#'''<span style="color:#ff0000">Dynamic sentinel node biopsy (DNSB) (preferred)[https://pubmed.ncbi.nlm.nih.gov/36906413/]</span>'''
**#* Sentinel lymph node biopsy is the technique to remove nodes that are first affected by the spread of metastatic disease.
**#* Sentinel lymph node biopsy is the technique to remove nodes that are first affected by the spread of metastatic disease.
**#**Based on the assumption that penile cancer cells will initially spread unilaterally or bilaterally to a single inguinal lymph node before disseminating to adjoining lymph nodes and that this sentinel lymph node can have a variable position among individuals
**#**Based on the assumption that penile cancer cells will initially spread unilaterally or bilaterally to a single inguinal lymph node before disseminating to adjoining lymph nodes and that this sentinel lymph node can have a variable position among individuals
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**#*** '''Those with a positive DSNB should proceed to a full therapeutic lymphadenectomy. It is not appropriate for palpable lymphadenopathy and applies only to clinically negative nodes'''.
**#*** '''Those with a positive DSNB should proceed to a full therapeutic lymphadenectomy. It is not appropriate for palpable lymphadenopathy and applies only to clinically negative nodes'''.
**#*** '''In patients with palpable lymphadenopathy'''
**#*** '''In patients with palpable lymphadenopathy'''
**#Alternatives
**#'''<span style="color:#ff0000">Bilateral modified inguinal lymphadenectomy</span>'''
**#*Inguinal staging procedure
**#*'''Lymphatic spread of penile carcinoma can be unilateral or bilateral to the inguinal lymph nodes'''
**#** Begins with a superficial node dissection which involves removal of nodes superficial to fascia lata.
**#*** In patients with no evidence of palpable adenopathy who are selected to undergo inguinal procedures by virtue of adverse prognostic factors within the primary tumor, the goal is to define whether metastases exist with minimal morbidity. The gold-standard for detecting microscopic metastases is the superficial inguinal node dissection
**#** Complete ilionguinal lymph node dissection (removal of those nodes deep to the fascia lata contained within the femoral triangle as well as the pelvic nodes) is then performed if the superficial nodes are positive at surgery by frozen-section analysis.
**#*** Series have shown that in patients with negative superficial nodes, nodes deep to the fascia were always negative
**#*** Given morbidity of pelvic lymph node dissection, this can be spared in select patients with limited inguinal metastases
**#** The superficial lymph node dissection should be bilateral
**#***
**#***Lymph node dissection does not need to be bilateral if adenopathy is unilateral at recurrence (after treating primary tumour)


===== <span style="color:#ff0000">Palpable adenopathy</span> =====
===== <span style="color:#ff0000">Palpable adenopathy</span> =====
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