EAU & ASCO: Penile Cancer 2023: Difference between revisions
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* '''Human papilloma virus (HPV)''' | * '''Human papilloma virus (HPV)''' | ||
** '''Most important risk factor''' | ** '''Most important risk factor''' | ||
** Most frequent HPV genotypes: HPV16 followed by HPV6 | |||
** Risk of penile cancer is increased in patients with condyloma acuminata | |||
** Female sexual partners of patients with penile cancer have not been found to have an increased incidence of cervical cancer | |||
** No general recommendation (except in a few countries) for HPV vaccination in males because of the different HPV-associated risk patterns in penile- and cervical cancer | |||
*** Since up to 50% of invasive penile carcinomas and 80% of preneoplastic lesions are HPV-associated, HPV vaccination is encouraged | |||
* '''Phimosis''' | * '''Phimosis''' | ||
* '''Chronic penile | ** Strongly associated with invasive penile cancer, due to associated chronic infections | ||
** Smegma is not a carcinogen | |||
** Neonatal circumcision reduces the incidence of penile cancer, but does not reduce the risk of Penile Intraepithelial Neoplasia | |||
* '''Chronic penile inflammation''' | |||
* '''Lichen sclerosus''' | * '''Lichen sclerosus''' | ||
* '''Ultraviolet A phototherapy''' | * '''Ultraviolet A phototherapy''' | ||
* '''Cigarette smoking''' | |||
* '''Low level of education''' | |||
* '''Low socio-economic status''' | * '''Low socio-economic status''' | ||
== Pathology == | == Pathology == | ||
* >95% of penile cancers are squamous cell carcinomas (SCCs) | * >95% of penile cancers are squamous cell carcinomas (SCCs) | ||
* Other malignant lesions of the penis | |||
** Melanoma | |||
** Mesenchymal tumors | |||
** Lymphomas | |||
** Metastases | |||
*** Penile metastases are frequently of prostatic, urinary bladder or colorectal origin | |||
**Sarcoma | |||
=== Penile Squamous Cell Carcinoma === | === Penile Squamous Cell Carcinoma === | ||
| Line 38: | Line 55: | ||
* Subtypes | * Subtypes | ||
** HPV-independent | ** HPV-independent | ||
*** Usual | *** Usual | ||
*** Pseudohyperplastic | *** Pseudohyperplastic | ||
*** Pseudoglandular | *** Pseudoglandular | ||
| Line 47: | Line 64: | ||
*** Mixed | *** Mixed | ||
** HPV-associated | ** HPV-associated | ||
*** Basaloid | *** Basaloid (most common among HPV-associated penile carcinomas) | ||
*** Warty | *** Warty | ||
*** Clear cell | *** Clear cell | ||
*** Lymphoepithelioma-like | *** Lymphoepithelioma-like | ||
*** Mixed | *** Mixed | ||
*'''Penile intraepithelial neoplasia is considered the precursor lesion of penile SCC''' | |||
**'''Clinical terms such as ‘Erythroplasia of Queyrat, Bowenoid papulosis and Bowen’s disease’ are discouraged''' | |||
**Penile intraepithelial neoplasia is also classified as HPV-independent and HPV-associated | |||
== Diagnosis and Evaluation == | == Diagnosis and Evaluation == | ||
| Line 61: | Line 81: | ||
* Overall 5-year survival: 67% | * Overall 5-year survival: 67% | ||
** Localized disease: 81% | ** Localized disease: 81% | ||
** Distant | ** Distant metastasis: 18% | ||
== References == | == References == | ||
Revision as of 14:52, 5 September 2024
See Original Guidelines
Background
- Penile cancer negatively impacts quality of life through
- Physical and emotional changes
- Feelings of mutilation
- Loss of masculinity
- Voiding and sexual dysfunction, which in turn can result in relationship breakdowns and withdrawal from society
- Lymphedema
Epidemiology
- Uncommon in industrialized countries
- More common in South America, Southeast Asia, and parts of Africa
- Race
- Highest incidence in white Hispanics, followed by Alaskans and Native American Indians, African Americans, white non-Hispanics.
- Increasing incidence in Western/developed countries most likely due to higher infection rates of HPV
Pathophysiology
Risk factors
- Human papilloma virus (HPV)
- Most important risk factor
- Most frequent HPV genotypes: HPV16 followed by HPV6
- Risk of penile cancer is increased in patients with condyloma acuminata
- Female sexual partners of patients with penile cancer have not been found to have an increased incidence of cervical cancer
- No general recommendation (except in a few countries) for HPV vaccination in males because of the different HPV-associated risk patterns in penile- and cervical cancer
- Since up to 50% of invasive penile carcinomas and 80% of preneoplastic lesions are HPV-associated, HPV vaccination is encouraged
- Phimosis
- Strongly associated with invasive penile cancer, due to associated chronic infections
- Smegma is not a carcinogen
- Neonatal circumcision reduces the incidence of penile cancer, but does not reduce the risk of Penile Intraepithelial Neoplasia
- Chronic penile inflammation
- Lichen sclerosus
- Ultraviolet A phototherapy
- Cigarette smoking
- Low level of education
- Low socio-economic status
Pathology
- >95% of penile cancers are squamous cell carcinomas (SCCs)
- Other malignant lesions of the penis
- Melanoma
- Mesenchymal tumors
- Lymphomas
- Metastases
- Penile metastases are frequently of prostatic, urinary bladder or colorectal origin
- Sarcoma
Penile Squamous Cell Carcinoma
- Usually arises from the epithelium of the inner prepuce or the glans
- Subtypes
- HPV-independent
- Usual
- Pseudohyperplastic
- Pseudoglandular
- Verrucous
- Caniculatum
- Papillary
- Sarcomatoid (Most aggressive and worse prognosis)
- Mixed
- HPV-associated
- Basaloid (most common among HPV-associated penile carcinomas)
- Warty
- Clear cell
- Lymphoepithelioma-like
- Mixed
- HPV-independent
- Penile intraepithelial neoplasia is considered the precursor lesion of penile SCC
- Clinical terms such as ‘Erythroplasia of Queyrat, Bowenoid papulosis and Bowen’s disease’ are discouraged
- Penile intraepithelial neoplasia is also classified as HPV-independent and HPV-associated
Diagnosis and Evaluation
Management
Prognosis
- Overall 5-year survival: 67%
- Localized disease: 81%
- Distant metastasis: 18%