Medical notes (ca penis)

Urology

Carcinoma of penis

It is most commonly a squamous cell ca, can also be melanoma, adenocarcinoma etc..

Premalignant lesions

Genital warts (warts are benign lesions that are caused after an infection) eg Buschke- Lowensteine lesion, a cauliflower like tumor.
Paget's disease of penis: a reddish raw lesion (erythroplasia)
Leukoplakia (white lesion)
Bowen's disease: a small eczematous plaque

Etiology: Phymosis- common in uncircumcised.

Clinical features
Common after 60 yrs
Foul smelling discharge
Hematuria
Phymosis
Ulceroproliferative growth with induration.
A fungating lesion which may make the external meatus (opening) disappear.

Spread:
Direct- prepuce (skin over the glans penis)- glans penis (the terminal part of penis)- shaft- corpora cavernosa.
Lymphatic- Inguinal ligament.

Investigation:
Wedge biopsy of growth
FNAC of nodes
CT, MRI
CT guided FNAC

Staging
1- tumor only in glans penis
2- tumor in shaft
3- lymphatic spread
4- metastatic, fixed nodes.

Treatment
Stage 1-
Only in prepuce- circumcision
In glans- partial amputation

Stage 2- partial amputation (at least 2.5 cms after lesion)
Or total penectomy and perineal urithrostomy (making a permanent urithral opening in perineum)
Or Radiotherapy

Stage 3
Total penectomy, or partial penectomy depending on the extent of lesion.

Lymph enlargement
Give antibiotics- enlargement persists- nodal dissection.
Or Radiotherapy

Stage four
Radiotherapy (external radiotherapy, intestesial radiotherapy)
+ chemotherapy (cisplatin, methotrexate, bleomycin)