Materiały źródłowe

• #1 Penile Cancer and Penile Intraepithelial Neoplasia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499930/

  Penile cancer is an uncommon malignancy, but when diagnosed, it is psychologically devastating to the patient and can pose a challenge to clinicians. […] This activity for healthcare professionals reviews the spectrum of penile cancer, primarily focusing on squamous cell carcinoma, the most prevalent penile malignancy. The etiology, epidemiology, histopathology, diagnosis, staging, and follow-up protocols of penile cancer are also reviewed. […] Patients often attempt to self-medicate with lotions, creams, or salves before seeking care. Up to 50% of patients with penile cancers will have delayed seeking medical attention for the lesion for up to 1 year. […] The most common penile malignancy is squamous cell carcinoma, but nonsquamous malignant neoplasms of the penis also exist, including basal cell carcinomas, melanomas, sarcomas, metastatic cancers, and adenosquamous carcinomas.

• #2 The Diagnosis and Treatment of Penile Cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6224543/

  The incidence of penile cancer in Europe lies in the range of 0.9 to 2.1 cases per 100 000 persons per year. […] This review is based on publications (20102017) retrieved by a selective search in PubMed and EMBASE and on the guidelines of the European Association of Urology, the European Society of Medical Oncology, the National Comprehensive Cancer Network, and the National Institute for Health and Care Excellence (NICE). […] 95% of cases of penile cancer are accounted for by squamous cell carcinoma, whose numerous subtypes have different clinical courses. […] Circumcision lowers the risk of penile cancer (hazard ratio: 0.33). […] Maximally organ-preserving surgery with safety margins of no more than a few millimeters is the current therapeutic standard, because a local recurrence, if it arises, can still be treated locally with curative intent.

• #3 Penile Cancer: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/6181-penile-cancer

  Penile cancer happens when healthy cells in your penis change and grow out of control. […] Treatment in the early stages can keep the cancer from growing. […] Like many cancers, penile cancer is most treatable when diagnosed early. In many cases, its curable. If you notice something doesnt seem quite right, tell a healthcare provider right away. Early detection is key. […] A healthcare provider may do the following: […] Exam. A provider will examine you to check for unusual skin changes, like a lump or discoloration on your penis. […] Tissue biopsy. This is the only way to confirm a cancer diagnosis. During the procedure, your healthcare provider removes suspicious-looking cells or tissues. A pathologist views the cells under a microscope to check for signs of cancer. […] Treatment depends on the size of the tumor, whether its spread and how likely it is that the cancer will return (recur).

• #4 Penile Cancer: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/6181-penile-cancer

  For early-stage cancer, your healthcare provider may recommend one or more of the following treatments: […] Your healthcare provider may use radiation, chemotherapy or both before or after surgery. […] Catching cancer early means that its easier to treat and cure. Catching it later means theres a greater chance that its spread beyond your penis. At this point, penile cancer becomes much harder to treat. […] A penile cancer diagnosis is a life-changing event, stirring up a whirlwind of emotions and uncertainties. […] Penile cancer can be curable if caught early.

• #5 Penile Cancer and Penile Intraepithelial Neoplasia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499930/

  Penile cancer is an uncommon malignancy, but when diagnosed, it is psychologically devastating to the patient and can pose a challenge to clinicians. […] This activity for healthcare professionals reviews the spectrum of penile cancer, primarily focusing on squamous cell carcinoma, the most prevalent penile malignancy. The etiology, epidemiology, histopathology, diagnosis, staging, and follow-up protocols of penile cancer are also reviewed. […] Patients often attempt to self-medicate with lotions, creams, or salves before seeking care. Up to 50% of patients with penile cancers will have delayed seeking medical attention for the lesion for up to 1 year. […] The most common penile malignancy is squamous cell carcinoma, but nonsquamous malignant neoplasms of the penis also exist, including basal cell carcinomas, melanomas, sarcomas, metastatic cancers, and adenosquamous carcinomas.

• #6

  https://winshipcancer.emory.edu/cancer-types-and-treatments/penile-cancer/diagnosis.php

  Effective treatment begins with an accurate penile cancer diagnosis. […] When you come to Winship for care, we’ll start by ensuring you have a thorough and accurate penile cancer diagnosis. […] Your penile cancer diagnosis will help us determine which treatment options will work best on your specific cancer. […] Our genitourinary oncology team specializes in penile cancer diagnosis and staging, and we have the technology available to provide the most detailed information about your cancer. […] At Winship, we take a multistage approach to penile cancer diagnosis so we can determine exactly what’s driving your cancer and how best to stop it. […] Having a detailed penile cancer diagnosis is critical, and it won’t take long. […] To confirm a penile cancer diagnosis, your physician will remove a sample of the affected area (biopsy) to be tested for cancer in a lab.

• #7 Diagnosis of penile cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/penile/diagnosis

  Diagnosis is the process of finding out the cause of a health problem. Diagnosing penile cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and may do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for penile cancer or other health problems. […] The following tests are usually used to rule out or diagnose penile cancer. Many of the same tests used to diagnose cancer are used to find out the stage (how far the cancer has spread). Your doctor may also order other tests to check your general health and to help plan your treatment. […] A physical exam allows your doctor to look for any signs of penile cancer. During a physical exam, your doctor may: look at and feel any growths or sores on the penis and genital area.

• #8 Signs and Symptoms of Penile Cancer | Signs Of Penile Cancer | American Cancer Society

  https://www.cancer.org/cancer/types/penile-cancer/detection-diagnosis-staging/signs-symptoms.html

  The signs and symptoms below dont always mean a man has penile cancer. In fact, many are more likely to be caused by other conditions. Still, if you have any of them, see a doctor right away so their cause can be found and treated, if needed. The sooner a diagnosis is made, the sooner you can start treatment and the better it is likely to work. […] The first sign of penile cancer is most often a change in the skin of the penis. This is most likely to be on the glans (tip) of the penis or on the foreskin (in uncircumcised men), but it can also be on the shaft. […] Swelling at the end of the penis, especially when the foreskin is constricted, is another possible sign of penile cancer. It may be harder to draw back the foreskin. […] If the cancer spreads from the penis, it most often travels first to lymph nodes in the groin. This can make those lymph nodes swell. Lymph nodes are collections of immune system cells. Normally, they are bean-sized and can barely be felt at all. If they’re swollen, the lymph nodes may feel like smooth lumps under the skin. […] But swollen lymph nodes dont always mean that cancer has spread there. More commonly, lymph nodes swell in response to an infection. The skin in and around a penile cancer can often become infected, which might cause the nearby lymph nodes to swell, even if the cancer hasnt reached them.

• #9 EAU Guidelines on Penile Cancer – Uroweb

  https://uroweb.org/guidelines/penile-cancer/chapter/diagnostic-evaluation-and-staging

  Primary penile carcinoma are usually clinically evident lesions often presenting as raised or ulcerous lesions which can be locally destructive. It is critically important to note that the appearance of penile tumours can be heterogeneous and can sometimes be hidden under the foreskin in case of phimosis. Physical examination should include inspection and palpation of the entire penis (to identify potential skip lesions). The dimensions, anatomic location, and extent of local invasion should be noted, and assessment of stretched penile length is recommended. […] Physical examination is a reliable method for estimating penile tumour size and clinical T stage. For distinguishing T1 from T2 disease, magnetic resonance imaging (MRI) does not outperform physical examination. However, when there is uncertainty if the tumour invades the cavernosal bodies (cT3), and if organ-sparing treatment options (e.g., glansectomy) are considered, MRI can be helpful. A SR showed a sensitivity and specificity of MRI in predicting corporal invasion of 80% (95% CI: 7087%) and 96% (95% CI: 8599%), respectively. Magnetic resonance imaging can also provide useful information regarding resectability in case of large (T4) tumours with invasion in adjacent structures.

• #10 EAU Guidelines on Penile Cancer – Uroweb

  https://uroweb.org/guidelines/penile-cancer/chapter/diagnostic-evaluation-and-staging

  Primary penile carcinoma are usually clinically evident lesions often presenting as raised or ulcerous lesions which can be locally destructive. It is critically important to note that the appearance of penile tumours can be heterogeneous and can sometimes be hidden under the foreskin in case of phimosis. Physical examination should include inspection and palpation of the entire penis (to identify potential skip lesions). The dimensions, anatomic location, and extent of local invasion should be noted, and assessment of stretched penile length is recommended. […] Physical examination is a reliable method for estimating penile tumour size and clinical T stage. For distinguishing T1 from T2 disease, magnetic resonance imaging (MRI) does not outperform physical examination. However, when there is uncertainty if the tumour invades the cavernosal bodies (cT3), and if organ-sparing treatment options (e.g., glansectomy) are considered, MRI can be helpful. A SR showed a sensitivity and specificity of MRI in predicting corporal invasion of 80% (95% CI: 7087%) and 96% (95% CI: 8599%), respectively. Magnetic resonance imaging can also provide useful information regarding resectability in case of large (T4) tumours with invasion in adjacent structures.

• #11 EAU Guidelines on Penile Cancer – Uroweb

  https://uroweb.org/guidelines/penile-cancer/chapter/diagnostic-evaluation-and-staging

  A biopsy of the penile tumour should be obtained when there is doubt about the exact nature of the lesion. However, even in clinically obvious cases, histological information from a biopsy can facilitate treatment decisions (such as indications for surgical staging). Histological confirmation is also necessary to guide management when treatment is planned with topical agents, radiotherapy or laser surgery. […] Penile cancer metastasizes in a stepwise manner through the lymphatic system, initially to the inguinal nodes, the pelvic nodes and finally to distant nodes. Fewer than 5% of patients will present with distant metastases and these are generally accompanied by regional LN involvement. As a result, the most important prognostic factor for survival of penile cancer is the presence and extent of nodal metastases, with a 5-year CSS of approximately 95%, 80%, 65% and 35% for N0, N1, N2 or N3 disease, respectively.

• #12 Signs and Symptoms of Penile Cancer | Signs Of Penile Cancer | American Cancer Society

  https://www.cancer.org/cancer/types/penile-cancer/detection-diagnosis-staging/signs-symptoms.html

  The signs and symptoms below dont always mean a man has penile cancer. In fact, many are more likely to be caused by other conditions. Still, if you have any of them, see a doctor right away so their cause can be found and treated, if needed. The sooner a diagnosis is made, the sooner you can start treatment and the better it is likely to work. […] The first sign of penile cancer is most often a change in the skin of the penis. This is most likely to be on the glans (tip) of the penis or on the foreskin (in uncircumcised men), but it can also be on the shaft. […] Swelling at the end of the penis, especially when the foreskin is constricted, is another possible sign of penile cancer. It may be harder to draw back the foreskin. […] If the cancer spreads from the penis, it most often travels first to lymph nodes in the groin. This can make those lymph nodes swell. Lymph nodes are collections of immune system cells. Normally, they are bean-sized and can barely be felt at all. If they’re swollen, the lymph nodes may feel like smooth lumps under the skin. […] But swollen lymph nodes dont always mean that cancer has spread there. More commonly, lymph nodes swell in response to an infection. The skin in and around a penile cancer can often become infected, which might cause the nearby lymph nodes to swell, even if the cancer hasnt reached them.

• #13 Tests for Penile Cancer | How Is Penile Cancer Diagnosed? | American Cancer Society

  https://www.cancer.org/cancer/types/penile-cancer/detection-diagnosis-staging/how-diagnosed.html

  Medical history and physical exam […] If you have possible symptoms of penile cancer you should go to a doctor. A physical exam will be done and you might also need some tests to find out what’s causing your symptoms. […] If symptoms and/or the exam suggest you might have penile cancer, other tests will be needed. These might include a biopsy and imaging tests. […] A biopsy is the only sure way to know if a change is penile cancer. To do this, a small piece of tissue is taken from the changed area and sent to a lab. There, it’s looked at with a microscope to see if it contains cancer cells. […] If the cancer has spread deep within the penis, nearby lymph nodes usually will need to be checked for cancer spread. This is done to help find the stage (extent) of the cancer after the diagnosis.

• #14 Diagnosis of penile cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/penile/diagnosis

  Diagnosis is the process of finding out the cause of a health problem. Diagnosing penile cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and may do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for penile cancer or other health problems. […] The following tests are usually used to rule out or diagnose penile cancer. Many of the same tests used to diagnose cancer are used to find out the stage (how far the cancer has spread). Your doctor may also order other tests to check your general health and to help plan your treatment. […] A physical exam allows your doctor to look for any signs of penile cancer. During a physical exam, your doctor may: look at and feel any growths or sores on the penis and genital area.

• #15 Penile Cancer: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/6181-penile-cancer

  Penile cancer happens when healthy cells in your penis change and grow out of control. […] Treatment in the early stages can keep the cancer from growing. […] Like many cancers, penile cancer is most treatable when diagnosed early. In many cases, its curable. If you notice something doesnt seem quite right, tell a healthcare provider right away. Early detection is key. […] A healthcare provider may do the following: […] Exam. A provider will examine you to check for unusual skin changes, like a lump or discoloration on your penis. […] Tissue biopsy. This is the only way to confirm a cancer diagnosis. During the procedure, your healthcare provider removes suspicious-looking cells or tissues. A pathologist views the cells under a microscope to check for signs of cancer. […] Treatment depends on the size of the tumor, whether its spread and how likely it is that the cancer will return (recur).

• #16 Penile Cancer and Penile Intraepithelial Neoplasia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499930/

  Confirmation of the diagnosis of penile cancer and assessment of the depth of invasion, the presence of vascular invasion, and histological grade of the lesion by microscopic examination of a biopsy specimen are mandatory before initiation of therapy. […] Squamous cell carcinoma is by far the most common penile malignancy, accounting for over 95% of cases, and is characterized and subclassified by microscopic histologic features. […] Initial evaluation of men with a penile mass or ulcer depends on whether the clinical presentation is consistent with an infectious etiology or malignancy. […] A tissue biopsy is required for a definitive pathologic diagnosis and is necessary before the initiation of any definitive cancer therapy. […] If the biopsy is positive for cancer, an extensive physical examination of the regional lymph nodes is indicated.

• #17 Penile Cancer and Penile Intraepithelial Neoplasia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499930/

  Confirmation of the diagnosis of penile cancer and assessment of the depth of invasion, the presence of vascular invasion, and histological grade of the lesion by microscopic examination of a biopsy specimen are mandatory before initiation of therapy. […] Squamous cell carcinoma is by far the most common penile malignancy, accounting for over 95% of cases, and is characterized and subclassified by microscopic histologic features. […] Initial evaluation of men with a penile mass or ulcer depends on whether the clinical presentation is consistent with an infectious etiology or malignancy. […] A tissue biopsy is required for a definitive pathologic diagnosis and is necessary before the initiation of any definitive cancer therapy. […] If the biopsy is positive for cancer, an extensive physical examination of the regional lymph nodes is indicated.

• #18 Penile Cancer Diagnosis | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/penile-cancer/penile-cancer-diagnosis.html

  MD Andersons experts use the latest technology and techniques, as well as remarkable skill, to accurately diagnose penile cancer. The earlier penile cancer is diagnosed, the higher the chances for successful treatment. This is why it is important to report any changes in your penis to your doctor. […] If you have penile cancer symptoms, your doctor will ask you questions about your health, your lifestyle, including smoking and drinking habits, and your family medical history. The doctor will examine your penis. […] If your doctor suspects you may have penile cancer, one or more of the following tests may be used to diagnose penile cancer and determine if it has spread. These tests also may be used to find out if treatment is working. […] A biopsy usually is the first test performed to find out if you have penile cancer. The type of procedure depends on the type of tissue or lesion.

• #19 Penile Cancer Workup: Laboratory Studies, Imaging Studies, Diagnostic Procedures

  https://emedicine.medscape.com/article/446554-workup

  No specific laboratory studies or tumor markers are diagnostic for penile cancer. A general evaluation, which includes a complete blood cell count; a chemistry panel with liver function tests; and an assessment of cardiac, pulmonary, and renal status, is helpful as a baseline and in the detection of any unsuspected problems. […] Magnetic resonance imaging (MRI) and ultrasonography are useful for local cancer staging and for assessing the inguinal lymph nodes. These studies may be helpful for detecting tumor invasion into the corpora. MRI produces sharp images of the penile structures, is accurate for demonstrating invasion of the corpora, and can help the physician determine the extent of the cancer along the surface of the penis in patients with tumors larger than 2 cm. […] The most important diagnostic test is a biopsy. This may be an excisional biopsy if the cancer is small or the lesion is confined to the prepuce and a circumcision is acceptable. The biopsy should contain tissue beneath the tumor, if this is feasible, in order to help stage the disease.

• #20 Carcinoma of the penis: Clinical presentation, diagnosis, and staging – UpToDate

  https://www.uptodate.com/contents/carcinoma-of-the-penis-clinical-presentation-diagnosis-and-staging

  Carcinoma of the penis: Clinical presentation, diagnosis, and staging […] The clinical presentation, diagnosis, and staging of penile cancer are reviewed here. […] INTRODUCTION […] Carcinoma of the penis is rare in the United States, Europe, and other industrialized countries. However, the incidence of these malignancies is much higher in parts of South America, Africa, and Asia.

• #21 Penile Cancer Workup: Laboratory Studies, Imaging Studies, Diagnostic Procedures

  https://emedicine.medscape.com/article/446554-workup

  No specific laboratory studies or tumor markers are diagnostic for penile cancer. A general evaluation, which includes a complete blood cell count; a chemistry panel with liver function tests; and an assessment of cardiac, pulmonary, and renal status, is helpful as a baseline and in the detection of any unsuspected problems. […] Magnetic resonance imaging (MRI) and ultrasonography are useful for local cancer staging and for assessing the inguinal lymph nodes. These studies may be helpful for detecting tumor invasion into the corpora. MRI produces sharp images of the penile structures, is accurate for demonstrating invasion of the corpora, and can help the physician determine the extent of the cancer along the surface of the penis in patients with tumors larger than 2 cm. […] The most important diagnostic test is a biopsy. This may be an excisional biopsy if the cancer is small or the lesion is confined to the prepuce and a circumcision is acceptable. The biopsy should contain tissue beneath the tumor, if this is feasible, in order to help stage the disease.

• #22 Penile cancer | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/penile-cancer

  The main test to diagnose penile cancer is a biopsy. For a biopsy, the doctor takes a sample of tissue from any abnormal or sore-looking areas on the penis. […] Before a biopsy is taken, the doctor will inject a local anaesthetic into the penis. This numbs the area to make you more comfortable during the procedure. […] Some people may need to have a biopsy taken under general anaesthetic. You can talk to your doctor about what is right for you. […] Most people go home the same day. If you need to stay in hospital, your doctor or nurse will let you know. […] After the biopsy you may have 1 or 2 stitches. You may have a dressing applied to the area to keep it clean. The stitches usually dissolve on their own. […] When you are diagnosed, you should be referred to a team of healthcare professionals at a hospital or centre that specialises in treating penile cancer. This is called a multidisciplinary team (MDT).

• #23 Tests for Penile Cancer | How Is Penile Cancer Diagnosed? | American Cancer Society

  https://www.cancer.org/cancer/types/penile-cancer/detection-diagnosis-staging/how-diagnosed.html

  Imaging tests use x-rays, magnetic fields, or sound waves to create pictures of the inside of your body. If the doctor thinks the cancer has spread, then one or more of these tests may be used to help find the stage of the cancer. […] A CT scan uses x-rays to make detailed cross-sectional images of your body. It can show how big the tumor is and can also help see if the cancer has spread to lymph nodes or other parts of the body. […] Like CT scans, MRIs show detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays. […] Ultrasound uses sound waves to make pictures of internal organs or masses. It can be useful to find out how deeply the cancer has spread into the penis. It can also help find enlarged lymph nodes in the groin.

• #24 Diagnosis of penile cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/penile/diagnosis

  The most common place for penile cancer to spread is the lymph nodes in the groin that are closest to the penis. A lymph node biopsy removes lymph nodes or cells from lymph nodes during surgery so they can be examined under a microscope to find out if they contain cancer. […] A CT scan of the pelvis is used to see if the cancer has spread to surrounding lymph nodes, especially in men who are obese. It can also be used to see if the cancer has spread to the liver, the lungs or other organs. […] An MRI is used to find out the size of the tumour and where the cancer is in the body. It is also used to see if the cancer has spread to surrounding lymph nodes, nearby organs and tissues or to the brain or spinal cord. […] An ultrasound uses high-frequency sound waves to make images of parts of the body. It is used to find out the extent of the penile cancer. An ultrasound of the pelvis can be used to see if the cancer has spread to nearby lymph nodes, organs or tissues.

• #25 Diagnosis – Penile cancer – Cancer Institute | Northwell Health

  https://cancer.northwell.edu/cancer-care/penile-cancer/diagnosis

  Computerized tomography (CAT) scan: This procedure takes overlapping X-rays from different angles and uses a specialized computer to synthesize them into a high-resolution image with details a normal X-ray can’t capture. Dye is sometimes injected or swallowed for contrast. […] Magnetic resonance imaging (MRI): This sophisticated imaging technology uses a magnetic field, radio waves and a computer to produce highly detailed 3D anatomical images, especially of soft tissues. It’s often used for disease detection, diagnosis and treatment monitoring. […] Further biopsy: Removing one or more lymph nodes in the groin for examination under a microscope.

• #26 EAU Guidelines on Penile Cancer – Uroweb

  https://uroweb.org/guidelines/penile-cancer/chapter/diagnostic-evaluation-and-staging

  Therefore, detecting lymphatic spread as early as possible is a crucial element in penile cancer management. Since penile cancer disseminates to the inguinal LNs first, initial LN staging is focused on identifying (micro)metastatic disease in the inguinal LNs as early as possible, and imaging for distant metastases is only indicated in clinically node-positive patients. […] If no suspicious nodes are present at palpation (cN0), approximately 20-25% of patients may still harbour occult metastases, so additional staging is warranted. […] Unfortunately, there are no validated nomograms or tumour markers that can reliably predict LN involvement. Conventional imaging modalities such as US, computed tomography (CT) or MRI cannot detect micro-metastases, and 18F-fluoro-2-deoxy-D-glucose positron emission tomography (18FDG-PET) does not detect LN metastases 10 mm. Therefore, these imaging modalities are of limited value and are not recommended for routine use in clinically node-negative patients in which the aim is to identify small, sub-clinical, LN metastasis.

• #27 Diagnosis of penile cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/penile/diagnosis

  The most common place for penile cancer to spread is the lymph nodes in the groin that are closest to the penis. A lymph node biopsy removes lymph nodes or cells from lymph nodes during surgery so they can be examined under a microscope to find out if they contain cancer. […] A CT scan of the pelvis is used to see if the cancer has spread to surrounding lymph nodes, especially in men who are obese. It can also be used to see if the cancer has spread to the liver, the lungs or other organs. […] An MRI is used to find out the size of the tumour and where the cancer is in the body. It is also used to see if the cancer has spread to surrounding lymph nodes, nearby organs and tissues or to the brain or spinal cord. […] An ultrasound uses high-frequency sound waves to make images of parts of the body. It is used to find out the extent of the penile cancer. An ultrasound of the pelvis can be used to see if the cancer has spread to nearby lymph nodes, organs or tissues.

• #28 EAU Guidelines on Penile Cancer – Uroweb

  https://uroweb.org/guidelines/penile-cancer/chapter/diagnostic-evaluation-and-staging

  Primary penile carcinoma are usually clinically evident lesions often presenting as raised or ulcerous lesions which can be locally destructive. It is critically important to note that the appearance of penile tumours can be heterogeneous and can sometimes be hidden under the foreskin in case of phimosis. Physical examination should include inspection and palpation of the entire penis (to identify potential skip lesions). The dimensions, anatomic location, and extent of local invasion should be noted, and assessment of stretched penile length is recommended. […] Physical examination is a reliable method for estimating penile tumour size and clinical T stage. For distinguishing T1 from T2 disease, magnetic resonance imaging (MRI) does not outperform physical examination. However, when there is uncertainty if the tumour invades the cavernosal bodies (cT3), and if organ-sparing treatment options (e.g., glansectomy) are considered, MRI can be helpful. A SR showed a sensitivity and specificity of MRI in predicting corporal invasion of 80% (95% CI: 7087%) and 96% (95% CI: 8599%), respectively. Magnetic resonance imaging can also provide useful information regarding resectability in case of large (T4) tumours with invasion in adjacent structures.

• #29 EAU Guidelines on Penile Cancer – Uroweb

  https://uroweb.org/guidelines/penile-cancer/chapter/diagnostic-evaluation-and-staging

  Primary penile carcinoma are usually clinically evident lesions often presenting as raised or ulcerous lesions which can be locally destructive. It is critically important to note that the appearance of penile tumours can be heterogeneous and can sometimes be hidden under the foreskin in case of phimosis. Physical examination should include inspection and palpation of the entire penis (to identify potential skip lesions). The dimensions, anatomic location, and extent of local invasion should be noted, and assessment of stretched penile length is recommended. […] Physical examination is a reliable method for estimating penile tumour size and clinical T stage. For distinguishing T1 from T2 disease, magnetic resonance imaging (MRI) does not outperform physical examination. However, when there is uncertainty if the tumour invades the cavernosal bodies (cT3), and if organ-sparing treatment options (e.g., glansectomy) are considered, MRI can be helpful. A SR showed a sensitivity and specificity of MRI in predicting corporal invasion of 80% (95% CI: 7087%) and 96% (95% CI: 8599%), respectively. Magnetic resonance imaging can also provide useful information regarding resectability in case of large (T4) tumours with invasion in adjacent structures.

• #30 EAU Guidelines on Penile Cancer – Uroweb

  https://uroweb.org/guidelines/penile-cancer/chapter/diagnostic-evaluation-and-staging

  Primary penile carcinoma are usually clinically evident lesions often presenting as raised or ulcerous lesions which can be locally destructive. It is critically important to note that the appearance of penile tumours can be heterogeneous and can sometimes be hidden under the foreskin in case of phimosis. Physical examination should include inspection and palpation of the entire penis (to identify potential skip lesions). The dimensions, anatomic location, and extent of local invasion should be noted, and assessment of stretched penile length is recommended. […] Physical examination is a reliable method for estimating penile tumour size and clinical T stage. For distinguishing T1 from T2 disease, magnetic resonance imaging (MRI) does not outperform physical examination. However, when there is uncertainty if the tumour invades the cavernosal bodies (cT3), and if organ-sparing treatment options (e.g., glansectomy) are considered, MRI can be helpful. A SR showed a sensitivity and specificity of MRI in predicting corporal invasion of 80% (95% CI: 7087%) and 96% (95% CI: 8599%), respectively. Magnetic resonance imaging can also provide useful information regarding resectability in case of large (T4) tumours with invasion in adjacent structures.

• #31 Tests for Penile Cancer | How Is Penile Cancer Diagnosed? | American Cancer Society

  https://www.cancer.org/cancer/types/penile-cancer/detection-diagnosis-staging/how-diagnosed.html

  Imaging tests use x-rays, magnetic fields, or sound waves to create pictures of the inside of your body. If the doctor thinks the cancer has spread, then one or more of these tests may be used to help find the stage of the cancer. […] A CT scan uses x-rays to make detailed cross-sectional images of your body. It can show how big the tumor is and can also help see if the cancer has spread to lymph nodes or other parts of the body. […] Like CT scans, MRIs show detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays. […] Ultrasound uses sound waves to make pictures of internal organs or masses. It can be useful to find out how deeply the cancer has spread into the penis. It can also help find enlarged lymph nodes in the groin.

• #32 Diagnosis of penile cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/penile/diagnosis

  The most common place for penile cancer to spread is the lymph nodes in the groin that are closest to the penis. A lymph node biopsy removes lymph nodes or cells from lymph nodes during surgery so they can be examined under a microscope to find out if they contain cancer. […] A CT scan of the pelvis is used to see if the cancer has spread to surrounding lymph nodes, especially in men who are obese. It can also be used to see if the cancer has spread to the liver, the lungs or other organs. […] An MRI is used to find out the size of the tumour and where the cancer is in the body. It is also used to see if the cancer has spread to surrounding lymph nodes, nearby organs and tissues or to the brain or spinal cord. […] An ultrasound uses high-frequency sound waves to make images of parts of the body. It is used to find out the extent of the penile cancer. An ultrasound of the pelvis can be used to see if the cancer has spread to nearby lymph nodes, organs or tissues.

• #33 Penile cancer | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/penile-cancer

  Ultrasound scan […] An ultrasound scan uses soundwaves to build up a picture of the inside of the body. A gel is spread onto the groin and a small device that produces soundwaves is passed over it. This test is painless and only takes a few minutes. […] Fine needle aspiration (FNA) […] When a lymph node is bigger than normal, the doctor may use a needle to take some fluid from it into a syringe. This is called a fine needle aspiration. The fluid is checked under a microscope for cancer cells. […] Removing a sample of lymph nodes […] Sometimes your doctor may recommend removing 1 or more lymph nodes. This operation is usually done under a general anaesthetic. The surgeon removes a sample of lymph nodes from 1 or both sides of the groin. They remove the nodes through a small cut in each side of the groin. This may be done at the same time as surgery to remove the cancer.

• #34 Diagnosis of penile cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/penile/diagnosis

  A bone scan uses bone-seeking radioactive materials called radiopharmaceuticals and a computer to create a picture of the bones. It is used to see if penile cancer has spread (metastasized) to the bones. […] A PET scan is used to see if cancer has spread to nearby lymph nodes. It may be combined with a CT scan (called a PET-CT scan).

• #35 EAU Guidelines on Penile Cancer – Uroweb

  https://uroweb.org/guidelines/penile-cancer/chapter/diagnostic-evaluation-and-staging

  Imaging with 18FDG-PET/CT is likely to be more accurate than CT alone in the pre-operative staging of pelvic LNs, as shown in other malignancies. In penile cancer, 18FDG-PET/CT showed a sensitivity and specificity of 91% and specificity of 100%, respectively, for the detection of pelvic metastases in patients with an US + FNAC-confirmed positive inguinal LN.

• #36 EAU Guidelines on Penile Cancer – Uroweb

  https://uroweb.org/guidelines/penile-cancer/chapter/diagnostic-evaluation-and-staging

  Imaging with 18FDG-PET/CT is likely to be more accurate than CT alone in the pre-operative staging of pelvic LNs, as shown in other malignancies. In penile cancer, 18FDG-PET/CT showed a sensitivity and specificity of 91% and specificity of 100%, respectively, for the detection of pelvic metastases in patients with an US + FNAC-confirmed positive inguinal LN.

• #37 EAU Guidelines on Penile Cancer – Uroweb

  https://uroweb.org/guidelines/penile-cancer/chapter/diagnostic-evaluation-and-staging

  Therefore, detecting lymphatic spread as early as possible is a crucial element in penile cancer management. Since penile cancer disseminates to the inguinal LNs first, initial LN staging is focused on identifying (micro)metastatic disease in the inguinal LNs as early as possible, and imaging for distant metastases is only indicated in clinically node-positive patients. […] If no suspicious nodes are present at palpation (cN0), approximately 20-25% of patients may still harbour occult metastases, so additional staging is warranted. […] Unfortunately, there are no validated nomograms or tumour markers that can reliably predict LN involvement. Conventional imaging modalities such as US, computed tomography (CT) or MRI cannot detect micro-metastases, and 18F-fluoro-2-deoxy-D-glucose positron emission tomography (18FDG-PET) does not detect LN metastases 10 mm. Therefore, these imaging modalities are of limited value and are not recommended for routine use in clinically node-negative patients in which the aim is to identify small, sub-clinical, LN metastasis.

• #38 Diagnosis of penile cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/penile/diagnosis

  A bone scan uses bone-seeking radioactive materials called radiopharmaceuticals and a computer to create a picture of the bones. It is used to see if penile cancer has spread (metastasized) to the bones. […] A PET scan is used to see if cancer has spread to nearby lymph nodes. It may be combined with a CT scan (called a PET-CT scan).

• #39 Penile Cancer and Penile Intraepithelial Neoplasia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499930/

  Managing regional lymph nodes in penile cancer is quite important, as the presence and extent of regional inguinal lymph node metastases is the single most important prognostic indicator in determining the long-term survival of men with squamous cell carcinoma of the penis. […] The presence and extent of regional inguinal lymph nodal metastases, as well as the tumor grade, have been identified as the most important prognostic indicators in determining long-term survival in men with invasive penile squamous cell carcinoma.

• #40 Diagnosis and Staging in Penile Cancer | SpringerLink

  https://link.springer.com/10.1007/978-3-319-42603-7_34-1

  Penile cancer is usually an obvious visual diagnosis but may be hidden under a phimosis and always requires histological confirmation. […] A high degree of diagnostic suspicion and early biopsy are required in such cases. […] Since metastatic lymphatic spread occurs early in penile cancer and can quickly lead to disseminated disease, examination of the regional inguinal lymph nodes is essential. […] Groin palpation remains the most useful examination to detect suspicious lymph nodes. […] But no imaging modality can reliably exclude micrometastatic disease in clinically normal inguinal lymph nodes which occurs in up to 25% of cases. […] This can only reliably be done by invasive lymph node staging of inguinal nodes removed by sentinel lymph node biopsy or limited modified lymphadenectomy.

• #41 EAU Guidelines on Penile Cancer – Uroweb

  https://uroweb.org/guidelines/penile-cancer/chapter/diagnostic-evaluation-and-staging

  Since delayed treatment of occult LN metastasis results in a lower CSS rate and current non-invasive staging options (nomograms, imaging) are not reliable enough to detect micrometastatic disease, invasive/surgical staging remains indispensable to identify micro-metastasis before nodal metastases become palpable/visible. […] Based on these predictors, surgical staging is recommended in all high-risk tumours (T1 with presence of lympho-vascular invasion, peri-neural invasion or poorly differentiated, and T2T4 with any grade). In intermediate-risk tumours (pT1a G2), the risk of LN metastasis should be balanced against the morbidity of surgical staging on a case-by-case basis. […] In patients with palpable nodes, nodal metastases are present in approximately 4580% of cases. Lymph node metastasis should preferably be histopathologically confirmed by image-guided biopsy (e.g., US or CT).

• #42 EAU Guidelines on Penile Cancer – Uroweb

  https://uroweb.org/guidelines/penile-cancer/chapter/diagnostic-evaluation-and-staging

  Since delayed treatment of occult LN metastasis results in a lower CSS rate and current non-invasive staging options (nomograms, imaging) are not reliable enough to detect micrometastatic disease, invasive/surgical staging remains indispensable to identify micro-metastasis before nodal metastases become palpable/visible. […] Based on these predictors, surgical staging is recommended in all high-risk tumours (T1 with presence of lympho-vascular invasion, peri-neural invasion or poorly differentiated, and T2T4 with any grade). In intermediate-risk tumours (pT1a G2), the risk of LN metastasis should be balanced against the morbidity of surgical staging on a case-by-case basis. […] In patients with palpable nodes, nodal metastases are present in approximately 4580% of cases. Lymph node metastasis should preferably be histopathologically confirmed by image-guided biopsy (e.g., US or CT).

• #43 EAU Guidelines on Penile Cancer – Uroweb

  https://uroweb.org/guidelines/penile-cancer/chapter/diagnostic-evaluation-and-staging

  Therefore, detecting lymphatic spread as early as possible is a crucial element in penile cancer management. Since penile cancer disseminates to the inguinal LNs first, initial LN staging is focused on identifying (micro)metastatic disease in the inguinal LNs as early as possible, and imaging for distant metastases is only indicated in clinically node-positive patients. […] If no suspicious nodes are present at palpation (cN0), approximately 20-25% of patients may still harbour occult metastases, so additional staging is warranted. […] Unfortunately, there are no validated nomograms or tumour markers that can reliably predict LN involvement. Conventional imaging modalities such as US, computed tomography (CT) or MRI cannot detect micro-metastases, and 18F-fluoro-2-deoxy-D-glucose positron emission tomography (18FDG-PET) does not detect LN metastases 10 mm. Therefore, these imaging modalities are of limited value and are not recommended for routine use in clinically node-negative patients in which the aim is to identify small, sub-clinical, LN metastasis.

• #44 EAU Guidelines on Penile Cancer – Uroweb

  https://uroweb.org/guidelines/penile-cancer/chapter/diagnostic-evaluation-and-staging

  Therefore, detecting lymphatic spread as early as possible is a crucial element in penile cancer management. Since penile cancer disseminates to the inguinal LNs first, initial LN staging is focused on identifying (micro)metastatic disease in the inguinal LNs as early as possible, and imaging for distant metastases is only indicated in clinically node-positive patients. […] If no suspicious nodes are present at palpation (cN0), approximately 20-25% of patients may still harbour occult metastases, so additional staging is warranted. […] Unfortunately, there are no validated nomograms or tumour markers that can reliably predict LN involvement. Conventional imaging modalities such as US, computed tomography (CT) or MRI cannot detect micro-metastases, and 18F-fluoro-2-deoxy-D-glucose positron emission tomography (18FDG-PET) does not detect LN metastases 10 mm. Therefore, these imaging modalities are of limited value and are not recommended for routine use in clinically node-negative patients in which the aim is to identify small, sub-clinical, LN metastasis.

• #45 EAU Guidelines on Penile Cancer – Uroweb

  https://uroweb.org/guidelines/penile-cancer/chapter/diagnostic-evaluation-and-staging

  Since delayed treatment of occult LN metastasis results in a lower CSS rate and current non-invasive staging options (nomograms, imaging) are not reliable enough to detect micrometastatic disease, invasive/surgical staging remains indispensable to identify micro-metastasis before nodal metastases become palpable/visible. […] Based on these predictors, surgical staging is recommended in all high-risk tumours (T1 with presence of lympho-vascular invasion, peri-neural invasion or poorly differentiated, and T2T4 with any grade). In intermediate-risk tumours (pT1a G2), the risk of LN metastasis should be balanced against the morbidity of surgical staging on a case-by-case basis. […] In patients with palpable nodes, nodal metastases are present in approximately 4580% of cases. Lymph node metastasis should preferably be histopathologically confirmed by image-guided biopsy (e.g., US or CT).

• #46 Tests for penile cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/penile-cancer/getting-diagnosed/tests-for-penile-cancer

  An MRI scan can show your doctor where the cancer is, how big it is and whether it has spread to the lymph nodes. […] You might have a CT to find out whether the cancer has spread. […] You might have a PET-CT scan to see where cancer is in the penis. […] If any of the lymph nodes look abnormal you have a FNA. Your doctor sends the sample of cells to the laboratory to check for cancer cells. […] A dynamic sentinel lymph node biopsy is a test to find the first lymph node or nodes that penile cancer may spread to. […] The tests you have help your doctor find out if you have penile cancer and how far it has grown. This is the stage of the cancer. […] This is important because doctors recommend your treatment according to the stage of the cancer.

• #47 Penile cancer | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/penile-cancer

  Sentinel lymph node biopsy (SLNB) […] A sentinel lymph node biopsy (SNLB) is a way of checking the smallest possible number of lymph nodes in the groin to see if they contain cancer cells. The sentinel nodes are the first nodes that lymph fluid from the penis drains to. This means they are the nodes most likely to contain any cancer cells. […] You have an SLNB done under a general anaesthetic. The surgeon injects a blue dye and a tiny amount of harmless, radioactive liquid into the area of the cancer. The dye drains into the sentinel lymph nodes and turns them blue. The surgeon uses a small, hand-held instrument to find the lymph nodes that have picked up the radioactive liquid. They remove any blue or radioactive nodes through a small cut in the groin. […] If these sentinel nodes do not contain cancer, it is very unlikely that any other lymph nodes will. This means you will not need to have any more lymph nodes removed. If there are cancer cells in any sentinel nodes, you will need more surgery. This will remove all the lymph nodes in the affected area.

• #48 The Diagnosis and Treatment of Penile Cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6224543/

  If left untreated, a regional lymph node recurrence will occur within a period of 1 to 2 years which has a detrimental effect on prognosis (long-term survival 40%). […] In patients with clinically unremarkable inguinal lymph node status, diagnostic imaging does not improve the detection of lymph node metastases measuring less than 1 cm in diameter. […] For DSNB, high micrometastasis detection rates (sensitivity approximately 9095%) along with rates of false-negative results of 5 to 10% as well as low morbidity have been described. […] In patients with inguinal lymph nodes suspicious on palpation, surgical removal, histologic confirmation by means of intraoperative frozen-section analysis, and, in case of positive findings, radical inguinal lymphadenectomy are indicated. […] After radical lymphadenectomy, adjuvant chemotherapy improves tumor-specific survival. […] In principle, several chemotherapeutic agents are effective in penile cancer. […] The prognosis for patients with systemic metastasis remains extremely poor.

• #49 Penile cancer | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/penile-cancer

  Sentinel lymph node biopsy (SLNB) […] A sentinel lymph node biopsy (SNLB) is a way of checking the smallest possible number of lymph nodes in the groin to see if they contain cancer cells. The sentinel nodes are the first nodes that lymph fluid from the penis drains to. This means they are the nodes most likely to contain any cancer cells. […] You have an SLNB done under a general anaesthetic. The surgeon injects a blue dye and a tiny amount of harmless, radioactive liquid into the area of the cancer. The dye drains into the sentinel lymph nodes and turns them blue. The surgeon uses a small, hand-held instrument to find the lymph nodes that have picked up the radioactive liquid. They remove any blue or radioactive nodes through a small cut in the groin. […] If these sentinel nodes do not contain cancer, it is very unlikely that any other lymph nodes will. This means you will not need to have any more lymph nodes removed. If there are cancer cells in any sentinel nodes, you will need more surgery. This will remove all the lymph nodes in the affected area.

• #50 Diagnosis and Staging in Penile Cancer | SpringerLink

  https://link.springer.com/10.1007/978-3-319-42603-7_34-1

  In case of enlarged and suspicious inguinal lymph nodes, imaging to detect pelvic nodes and distant metastasis by CT, MRI, or PET/CT scanning can be required in addition to pathological staging by radical inguinal lymphadenectomy followed by ipsilateral pelvic lymphadenectomy if more than one inguinal node is affected. […] Thus, diagnosis and staging in penile cancer remains mostly clinical and surgical.

• #51 The Diagnosis and Treatment of Penile Cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6224543/

  The aim of this paper is to highlight the complexity of this cancer and to show that delayed or incorrect treatment can be life-threatening. […] Confirmation of the diagnosis by biopsy and tumor staging are both required for treatment planning. […] Invasive penile cancer typically shows exophytic growth. […] Histologic subtype and tumor grade are key determinants of prognosis. […] The UICC classification categorizes the grades I to III and the sarcomatoid, dedifferentiated type. […] Lymph node evaluation is of great prognostic significance because extracapsular spread of lymph node metastases which is classified as pN3 even with only 1 lymph node ultimately requires adjuvant chemotherapy. […] The management of patients with unremarkable inguinal lymph nodes on physical examination is particularly challenging because in up to 20 to 25% of cases depending on local stage and degree of differentiation of the tumor inguinal lymphatic micrometastases (0.2 to 2 mm in diameter) are present.

• #52 Stages of penile cancer: What they mean, treatment, and outlook

  https://www.medicalnewstoday.com/articles/penile-cancer-staging

  Penile cancer is the growth of harmful cells in the skin and tissues of the penis. Treatment options and outlook for a person with penile cancer depend on the stage of cancer at the time of diagnosis. […] A doctor can determine the stage of penile cancer to help inform which treatment is the most appropriate. […] The process of staging is when a doctor determines the extent of cancer growth. […] According to the American Cancer Society, medical professionals most often use the TNM staging system. This system uses three key pieces of information to determine the stage of cancer: Extent of the tumor (T): This describes how far the cancer has spread into the penis. Spread to nearby lymph nodes (N): This examines whether cancer has affected nearby lymph nodes, such as in the groin. Metastasis (M) to distant sites: This describes whether the cancer has spread to distant parts of the body.

• #53 The Diagnosis and Treatment of Penile Cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6224543/

  The aim of this paper is to highlight the complexity of this cancer and to show that delayed or incorrect treatment can be life-threatening. […] Confirmation of the diagnosis by biopsy and tumor staging are both required for treatment planning. […] Invasive penile cancer typically shows exophytic growth. […] Histologic subtype and tumor grade are key determinants of prognosis. […] The UICC classification categorizes the grades I to III and the sarcomatoid, dedifferentiated type. […] Lymph node evaluation is of great prognostic significance because extracapsular spread of lymph node metastases which is classified as pN3 even with only 1 lymph node ultimately requires adjuvant chemotherapy. […] The management of patients with unremarkable inguinal lymph nodes on physical examination is particularly challenging because in up to 20 to 25% of cases depending on local stage and degree of differentiation of the tumor inguinal lymphatic micrometastases (0.2 to 2 mm in diameter) are present.

• #54 The Diagnosis and Treatment of Penile Cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6224543/

  The aim of this paper is to highlight the complexity of this cancer and to show that delayed or incorrect treatment can be life-threatening. […] Confirmation of the diagnosis by biopsy and tumor staging are both required for treatment planning. […] Invasive penile cancer typically shows exophytic growth. […] Histologic subtype and tumor grade are key determinants of prognosis. […] The UICC classification categorizes the grades I to III and the sarcomatoid, dedifferentiated type. […] Lymph node evaluation is of great prognostic significance because extracapsular spread of lymph node metastases which is classified as pN3 even with only 1 lymph node ultimately requires adjuvant chemotherapy. […] The management of patients with unremarkable inguinal lymph nodes on physical examination is particularly challenging because in up to 20 to 25% of cases depending on local stage and degree of differentiation of the tumor inguinal lymphatic micrometastases (0.2 to 2 mm in diameter) are present.

• #55 Penile Cancer Diagnosis | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/penile-cancer/penile-cancer-diagnosis.html

  Imaging tests, which may include: CT or CAT (computed axial tomography) scans, MRI (magnetic resonance imaging) scans, PET (positron emission tomography) scans, X-Rays, Ultrasound. […] If you are diagnosed with penile cancer, your doctor will determine the stage of the disease. Staging is a way of classifying cancer by how much disease is in the body and where it has spread when it is diagnosed. This helps the doctor plan the best way to treat the cancer. […] Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads. […] Recurrent penile cancer is cancer that went away with treatment but later came back. Recurrent penile cancer may return in the penis or any other part of the body.

• #56 Penile Cancer Diagnosis | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/penile-cancer/penile-cancer-diagnosis.html

  Imaging tests, which may include: CT or CAT (computed axial tomography) scans, MRI (magnetic resonance imaging) scans, PET (positron emission tomography) scans, X-Rays, Ultrasound. […] If you are diagnosed with penile cancer, your doctor will determine the stage of the disease. Staging is a way of classifying cancer by how much disease is in the body and where it has spread when it is diagnosed. This helps the doctor plan the best way to treat the cancer. […] Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads. […] Recurrent penile cancer is cancer that went away with treatment but later came back. Recurrent penile cancer may return in the penis or any other part of the body.

• #57 Penile Cancer | Department of Urology | UPMC | Pittsburgh, PA

  https://www.upmc.com/services/urology/conditions/penile-cancer

  Diagnosing penile cancer includes: […] A number of benign conditions, including genital warts and infections, may give similar symptoms to penile cancer. For this reason, it is very important to get a correct diagnosis as early as possible. […] Your doctor will ask you questions regarding your symptoms and discuss your medical history. […] Your doctor will look at your genital area for signs of penile cancer or other health concerns. Your doctor might also look at the lymph nodes in your groin to see if they are swollen. […] Penile cancer is initially diagnosed with a biopsy. Other tests might be performed if needed. […] If your medical history or physical exam suggests you might have penile cancer, your doctor will perform other tests. […] Common tests include: […] A small sample of tissue is removed from the penis and is looked at under a microscope.

• #58 Penile Cancer | Department of Urology | UPMC | Pittsburgh, PA

  https://www.upmc.com/services/urology/conditions/penile-cancer

  Diagnosing penile cancer includes: […] A number of benign conditions, including genital warts and infections, may give similar symptoms to penile cancer. For this reason, it is very important to get a correct diagnosis as early as possible. […] Your doctor will ask you questions regarding your symptoms and discuss your medical history. […] Your doctor will look at your genital area for signs of penile cancer or other health concerns. Your doctor might also look at the lymph nodes in your groin to see if they are swollen. […] Penile cancer is initially diagnosed with a biopsy. Other tests might be performed if needed. […] If your medical history or physical exam suggests you might have penile cancer, your doctor will perform other tests. […] Common tests include: […] A small sample of tissue is removed from the penis and is looked at under a microscope.

• #59 Penile Cancer: What Every Man Should Know – Broward Urology Center

  https://www.browardurologycenter.com/patient-education/penile-cancer-what-every-man-should-know/

  Following the biopsy and imaging tests, a pathology report will detail the type of cancer, its aggressiveness (grade), and its extent (stage). This report will guide the treatment plan. […] The prognosis of penile cancer depends on several factors, including the cancer’s stage at diagnosis, the type of cells involved, and the patient’s overall health. […] Early-stage cancers (I and II) have a higher success rate of treatment, often with options that preserve the function and appearance of the penis. […] Cancer in the lymph nodes can affect the treatment choice and prognosis. Early lymph node detection and treatment are key to improving outcomes. […] Certain types of penile cancer may be more aggressive and require more intensive treatment.

• #60 Penile Cancer and Penile Intraepithelial Neoplasia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499930/

  Penile cancer is an uncommon malignancy, but when diagnosed, it is psychologically devastating to the patient and can pose a challenge to clinicians. […] This activity for healthcare professionals reviews the spectrum of penile cancer, primarily focusing on squamous cell carcinoma, the most prevalent penile malignancy. The etiology, epidemiology, histopathology, diagnosis, staging, and follow-up protocols of penile cancer are also reviewed. […] Patients often attempt to self-medicate with lotions, creams, or salves before seeking care. Up to 50% of patients with penile cancers will have delayed seeking medical attention for the lesion for up to 1 year. […] The most common penile malignancy is squamous cell carcinoma, but nonsquamous malignant neoplasms of the penis also exist, including basal cell carcinomas, melanomas, sarcomas, metastatic cancers, and adenosquamous carcinomas.

• #61 The Diagnosis and Treatment of Penile Cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6224543/

  Local radiotherapy can be performed in early stages. […] Lymphogenic metastasis must be treated with radical lymphadenectomy and adjuvant chemotherapy. […] Patients with clinically unremarkable inguinal lymph nodes nonetheless need invasive lymph node staging because of the high rate of lymphogenic micrometastasis. […] Penile cancer is curable in all early stages with the appropriate treatment, but its prognosis depends crucially on the proper management of the regional (i.e., inguinal) lymph nodes. […] Early metastatic spread to regional lymph nodes can be life-threatening. […] It is not uncommon that factors, both from the patient and the treating physician, are causing delays in diagnosis and start of treatment. […] Thus, several countries have centralized the treatment of this rare tumor.

• #62 What Is Penile Cancer? | UC Health | Symptoms and Causes

  https://www.uchealth.com/en/conditions/penile-cancer

  Routinely check for any skin changes on your penis. These changes might be warts, sores, ulcers, white patches, or blisters. If you notice any of these changes on the skin of your foreskin, glans, or shaft of your penis, tell your healthcare provider right away. Don’t let embarrassment keep you from seeing your provider about these issues.

• #63 Penile cancer | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/penile-cancer

  The MDT team for penile cancer will usually include the following professionals: […] Urologist a doctor who specialises in treating urinary and genital problems. […] Clinical oncologist a doctor who uses radiotherapy, chemotherapy and other anti-cancer drugs to treat people with cancer. […] Clinical nurse specialist (CNS) a nurse who gives information about cancer, and support during treatment. […] Radiologist a doctor who looks at scans and x-rays to diagnose problems. […] Pathologist a doctor who looks at cells or body tissue under a microscope to diagnose cancer. […] The MDT may also include: […] a dietitian […] a physiotherapist […] a psychologist […] a counsellor. […] After the meeting your specialist doctor and nurse will talk to you about your treatment options. They will explain different treatments and their advantages and disadvantages.

• #64 Penile cancer | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/penile-cancer

  The MDT team for penile cancer will usually include the following professionals: […] Urologist a doctor who specialises in treating urinary and genital problems. […] Clinical oncologist a doctor who uses radiotherapy, chemotherapy and other anti-cancer drugs to treat people with cancer. […] Clinical nurse specialist (CNS) a nurse who gives information about cancer, and support during treatment. […] Radiologist a doctor who looks at scans and x-rays to diagnose problems. […] Pathologist a doctor who looks at cells or body tissue under a microscope to diagnose cancer. […] The MDT may also include: […] a dietitian […] a physiotherapist […] a psychologist […] a counsellor. […] After the meeting your specialist doctor and nurse will talk to you about your treatment options. They will explain different treatments and their advantages and disadvantages.

• #65 Penile cancer | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/penile-cancer

  This is a rare type of cancer. So your specialist team may be based some distance from your home and local hospital. […] The specialist team will arrange further tests. These are to find out whether the cancer is only in the penis or if it has spread. The results help your specialist team plan your treatment. […] These tests may include: […] CT scan […] A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of your body. […] MRI scan […] An MRI scan uses magnetism to build up a detailed picture of areas of your body. […] One of the first places penile cancer can spread to is the lymph nodes in the groin. Lymph nodes are part of the lymphatic system. The lymphatic system helps protect us against infection and disease. […] If the cancer has spread, the lymph nodes in the groin may be bigger than normal. But this can also happen because of infection. Your doctor may arrange for you to have tests to check for signs of cancer in the lymph nodes.

• #66 Diagnosis of penile cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/penile/diagnosis

  Diagnosis is the process of finding out the cause of a health problem. Diagnosing penile cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and may do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for penile cancer or other health problems. […] The following tests are usually used to rule out or diagnose penile cancer. Many of the same tests used to diagnose cancer are used to find out the stage (how far the cancer has spread). Your doctor may also order other tests to check your general health and to help plan your treatment. […] A physical exam allows your doctor to look for any signs of penile cancer. During a physical exam, your doctor may: look at and feel any growths or sores on the penis and genital area.

• #67 Penile cancer | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/penile-cancer

  The MDT team for penile cancer will usually include the following professionals: […] Urologist a doctor who specialises in treating urinary and genital problems. […] Clinical oncologist a doctor who uses radiotherapy, chemotherapy and other anti-cancer drugs to treat people with cancer. […] Clinical nurse specialist (CNS) a nurse who gives information about cancer, and support during treatment. […] Radiologist a doctor who looks at scans and x-rays to diagnose problems. […] Pathologist a doctor who looks at cells or body tissue under a microscope to diagnose cancer. […] The MDT may also include: […] a dietitian […] a physiotherapist […] a psychologist […] a counsellor. […] After the meeting your specialist doctor and nurse will talk to you about your treatment options. They will explain different treatments and their advantages and disadvantages.

• #68 Penile cancer | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/penile-cancer

  This is a rare type of cancer. So your specialist team may be based some distance from your home and local hospital. […] The specialist team will arrange further tests. These are to find out whether the cancer is only in the penis or if it has spread. The results help your specialist team plan your treatment. […] These tests may include: […] CT scan […] A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of your body. […] MRI scan […] An MRI scan uses magnetism to build up a detailed picture of areas of your body. […] One of the first places penile cancer can spread to is the lymph nodes in the groin. Lymph nodes are part of the lymphatic system. The lymphatic system helps protect us against infection and disease. […] If the cancer has spread, the lymph nodes in the groin may be bigger than normal. But this can also happen because of infection. Your doctor may arrange for you to have tests to check for signs of cancer in the lymph nodes.

• #69 Penile Cancer: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/6181-penile-cancer

  For early-stage cancer, your healthcare provider may recommend one or more of the following treatments: […] Your healthcare provider may use radiation, chemotherapy or both before or after surgery. […] Catching cancer early means that its easier to treat and cure. Catching it later means theres a greater chance that its spread beyond your penis. At this point, penile cancer becomes much harder to treat. […] A penile cancer diagnosis is a life-changing event, stirring up a whirlwind of emotions and uncertainties. […] Penile cancer can be curable if caught early.

• #70 Tests for Penile Cancer | How Is Penile Cancer Diagnosed? | American Cancer Society

  https://www.cancer.org/cancer/types/penile-cancer/detection-diagnosis-staging/how-diagnosed.html

  Medical history and physical exam […] If you have possible symptoms of penile cancer you should go to a doctor. A physical exam will be done and you might also need some tests to find out what’s causing your symptoms. […] If symptoms and/or the exam suggest you might have penile cancer, other tests will be needed. These might include a biopsy and imaging tests. […] A biopsy is the only sure way to know if a change is penile cancer. To do this, a small piece of tissue is taken from the changed area and sent to a lab. There, it’s looked at with a microscope to see if it contains cancer cells. […] If the cancer has spread deep within the penis, nearby lymph nodes usually will need to be checked for cancer spread. This is done to help find the stage (extent) of the cancer after the diagnosis.

• #71 Tests for Penile Cancer | How Is Penile Cancer Diagnosed? | American Cancer Society

  https://www.cancer.org/cancer/types/penile-cancer/detection-diagnosis-staging/how-diagnosed.html

  Imaging tests use x-rays, magnetic fields, or sound waves to create pictures of the inside of your body. If the doctor thinks the cancer has spread, then one or more of these tests may be used to help find the stage of the cancer. […] A CT scan uses x-rays to make detailed cross-sectional images of your body. It can show how big the tumor is and can also help see if the cancer has spread to lymph nodes or other parts of the body. […] Like CT scans, MRIs show detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays. […] Ultrasound uses sound waves to make pictures of internal organs or masses. It can be useful to find out how deeply the cancer has spread into the penis. It can also help find enlarged lymph nodes in the groin.

• #72 Penile Cancer and Penile Intraepithelial Neoplasia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499930/

  Managing regional lymph nodes in penile cancer is quite important, as the presence and extent of regional inguinal lymph node metastases is the single most important prognostic indicator in determining the long-term survival of men with squamous cell carcinoma of the penis. […] The presence and extent of regional inguinal lymph nodal metastases, as well as the tumor grade, have been identified as the most important prognostic indicators in determining long-term survival in men with invasive penile squamous cell carcinoma.

• #73 EAU Guidelines on Penile Cancer – Uroweb

  https://uroweb.org/guidelines/penile-cancer/chapter/diagnostic-evaluation-and-staging

  Since delayed treatment of occult LN metastasis results in a lower CSS rate and current non-invasive staging options (nomograms, imaging) are not reliable enough to detect micrometastatic disease, invasive/surgical staging remains indispensable to identify micro-metastasis before nodal metastases become palpable/visible. […] Based on these predictors, surgical staging is recommended in all high-risk tumours (T1 with presence of lympho-vascular invasion, peri-neural invasion or poorly differentiated, and T2T4 with any grade). In intermediate-risk tumours (pT1a G2), the risk of LN metastasis should be balanced against the morbidity of surgical staging on a case-by-case basis. […] In patients with palpable nodes, nodal metastases are present in approximately 4580% of cases. Lymph node metastasis should preferably be histopathologically confirmed by image-guided biopsy (e.g., US or CT).

• #74 Penile cancer | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/penile-cancer

  The MDT team for penile cancer will usually include the following professionals: […] Urologist a doctor who specialises in treating urinary and genital problems. […] Clinical oncologist a doctor who uses radiotherapy, chemotherapy and other anti-cancer drugs to treat people with cancer. […] Clinical nurse specialist (CNS) a nurse who gives information about cancer, and support during treatment. […] Radiologist a doctor who looks at scans and x-rays to diagnose problems. […] Pathologist a doctor who looks at cells or body tissue under a microscope to diagnose cancer. […] The MDT may also include: […] a dietitian […] a physiotherapist […] a psychologist […] a counsellor. […] After the meeting your specialist doctor and nurse will talk to you about your treatment options. They will explain different treatments and their advantages and disadvantages.

• #75 Penile cancer | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/penile-cancer

  This is a rare type of cancer. So your specialist team may be based some distance from your home and local hospital. […] The specialist team will arrange further tests. These are to find out whether the cancer is only in the penis or if it has spread. The results help your specialist team plan your treatment. […] These tests may include: […] CT scan […] A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of your body. […] MRI scan […] An MRI scan uses magnetism to build up a detailed picture of areas of your body. […] One of the first places penile cancer can spread to is the lymph nodes in the groin. Lymph nodes are part of the lymphatic system. The lymphatic system helps protect us against infection and disease. […] If the cancer has spread, the lymph nodes in the groin may be bigger than normal. But this can also happen because of infection. Your doctor may arrange for you to have tests to check for signs of cancer in the lymph nodes.

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