Penile cancer
Penile Cancer. General Epidemiology.

This tumor is very rare in Europe and in developed countries, but recently there has been a clear increase in the number of cases, including a rather high incidence rate in developing countries.

Increased incidence in France: 1 case per 100,000 men or 300 new cases per year. Diagnosis average age: 60 years.

Localized stage is diagnosed in most cases. There is an obvious association with oncogenic HPV serotypes type 16 and 18.

The involvement of lymph nodes is difficult to evaluate clinically because of the many false-positive and false-negative results.

Risk factors:
  • Phimosis
  • Poor hygiene
  • Sexually transmitted infections: HPV and HIV
  • Photochemotherapy using UVA
  • Smoking
  • No circumcision

Prognostic factors.
General factors of poor prognosis:
  • damage to the lymph nodes (especially if at least 2 lymph nodes are affected)
  • T2 or higher
  • involvement of the perineural vessels and lympho-vascular system
  • high stage of the tumor: G3
  • incomplete tumor surgery

Prognostic factors for metastases of occult lymph nodes:
  • degree of tumor differentiation
  • lymphatic vascular invasion


The histological type. and main characteristics.
Precancerous lesions / in situ carcinoma.
  • Squamous cell carcinoma without an invasive component in> 95% of cases.
  • Bowen's disease, lymphomatoid papulosis, and Kairat erythroplasia are among the precancerous lesions. High level of local relapse after treatment.
  • Invasive squamous cell carcinoma (Low degree: G1-G2: 80%) (High degree: G3: 20%) - The papillary form is quite exophytic with a good prognosis. Small, local and distant evolutionary character.
  • An ulcerative infiltrative form with a poor prognosis. More lymphophilic tumors, damage to the lymph nodes is common.
  • Various histological subtypes: typical (50-60%), warty, papillary, basaloid. Other basal cell carcinomas, adenosquamous, sebaceous, lymphomas, melanomas, sarcomas or metastases from other places.

Clinical signs.

- Edema of the penis or ulcerative process usually located on the head of the penis or foreskin.
- Pain.
- Urinary symptoms in case of urethral invasion [CC1].

Penile cancer. Treatment and diagnostic evaluation.

Physiological examination.
Examination of the penis, examination for the presence of:
  • ulcerative,
  • size,
  • anatomical location.
A full clinical examination with a thorough examination of the bilateral sections of the inguinal lymph node.

Biological and pathological assessment:
  • Lab: Standard biologic assessment before chemotherapy: NFS platelets, blood ionograms, and liver tests.
  • Diagnosis of sexually transmitted infections: HIV, HBV and syphilis.
  • Partner screening (to check especially for cervical cancer).
  • Biopsy to diagnose the underlying tumor. Search for the presence of oncogenic HPV types 16 and 18.
Suspicious lymph nodes should also be biopsied.

Screening and prognostic factors:
  • Sonography can help detect cavernous infiltration if the tumor is on the head (this analysis is difficult to interpret).
  • MRI of the penis: assessment of the spread of the tumor in various structures of the penis infiltration of the cavernous bodies or ureter.
  • CT scan of the abdominal cavity: search for local-regional lymphadenopathy. In case of damage to the lymph nodes, it will be supplemented with a thoracic scanner.
  • PET is performed on clinically palpable lymph nodes. Very high specificity of this examination for this pathology.
Poor prognosis factors include lymph node invasion, severity, vascular and lymphatic embolism, and deep infiltration.

Therapeutic strategies.

The standard treatment is surgery. Small tumors are usually treated with organ-sparing surgery or local treatment. Highly advanced cancer or poor prognosis of tumors often requires full or partial amputation of the penis.

However, given the potentially strong impact of these operations on the patient’s mental health and subsequent quality of life, strategies for preserving the penis should be discussed in advance for advanced tumors. Conservative maximalist treatment using radio-chemotherapy is carried out by analogy with the treatment of squamous cell carcinoma of the anal canal.
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