Surgical Challenges and Opportunities in Treating Penile Cancer

Kevin R. Loughlin, MD, MBA
Published: Friday, Aug 03, 2018
Kevin R. Loughlin, MD, MBA,from Harvard

Kevin R. Loughlin, MD, MBA

Penile cancer occurs rarely in the United States and Western Europe. In the United States, the incidence is 1 to 2 cases for every 100,000 individuals a year. In Western Europe, it is less than 1% of all male cancers. Risk factors include being uncircumcised, poor hygiene, history of human papillomavirus (HPV) infection, and smoking tobacco. HPV strains 16 and 18, in particular, put men at risk for penile cancer.

Clinicians should have a low threshold to biopsy penile lesions. This can usually be done under local anesthesia. No treatment should be undertaken without a confirmation of an unequivocal permanent section pathology diagnosis. Urologists should not depend on a frozen section diagnosis done at the same time as a partial or total penectomy.

Challenges in Penile Tumor Staging

It is important to stage the primary tumor (T), the regional lymph nodes (N), and the presence of distant metastases (M). Several staging systems have been used through the years, but currently, the TNM system is the most widely used.1 The grade of the primary lesion is also considered in determining prognosis (Table 1).

Table 1. Stages and Grades of Penile Cancer1

Table 1. Stages and Grades of Penile Cancer1
Magnetic resonance imaging (MRI) has emerged as the imaging modality of choice for the primary lesion.2 MRI is superior to computed tomography (CT) scans in the evaluation of the primary lesion because MRI has excellent soft tissue and spatial resolution. T2-weighted and gadolinium-enhanced T1-weighted images are the most useful in determining the local extent of the penile cancer.2
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