Editing Penis (section)

== Carcinoma of the penis ==

* Risk factors
** HPV 16 and 18
** BXO
** Smoking
** Phimosis
** Chronic balanoposthitis
* Protective - circumcision soon after birth confers immunity
* Pathophysiology
** Typically SCC arising in the skin of the glans penis or the prepuce
** Can be either flat and infiltrating (starts as PeIN or leucoplakia) or warty (starts as papilloma)
* Penile intraepithelial neoplasia - red cutaneous patch on penis
** Known as erythroplasia of Queyrat when it occurs on the glans
** Known as Bowe's disease on the shaft
** There are several benign causes of red patches, so biopsy is indicated
** Treatment - topical 5-FU cream, CO2 laser ablation, or surgical excision
* Staging
** T1 - confined to skin
** T2 - corpus cavernosum/spongiosum
** T3 - urethra
** T4 - adjacent structures
** N1 - inguinal nodes (50% have nodes at presentation, which can be infective rather than malignant)
** N3 - iliac nodes
** Only rarely metastasises
* Management:
** Treatment of tumour
*** Surgical excision - often penile preserving surgery. If it affects the glans, glansectomy will be required. More advanced tumours require partial penectomy.
** Treatment of inguinal lymphadenopathy
*** Delay until 3/52 after treatment of primary tumour - if enlargement is caused by infection, then it will show signs of improvement by then
*** USS FNA will confirm diagnosis
*** Requires block dissection of both groins if positive
*** If no clinical nodes, needs SLNB
* Prognosis
** 5 year survival >80% if confined to penis
** 40% if node positive

[[Category:Urology]]