Penile cancer is a rare neoplasm.
The vast majority are histologically squamous cell carcinoma.
Late diagnosis may force more aggressive treatments, whereas early lesions may allow organ-preserving strategies.
Relevant factors include:
HPV is involved in a proportion of penile carcinomas, but it does not explain all cases.
It may present as:
Alert
A persistent, ulcerated, infiltrative or exophytic lesion of the penis must be evaluated.
It should not be repeatedly treated as an infection without establishing the diagnosis.
We must assess:
Primary lesionBut there is another essential exam: palpation of both inguinal regions.
Lymph node status is central to the evaluation and prognosis of penile cancer.
Unlike a testicular mass, in a suspicious penile lesion biopsy does play a fundamental role.
It allows us to establish:
Treatment depends fundamentally on:
In early disease, whenever it is oncologically safe, the aim is to preserve the penis.
There are different local and surgical strategies for early disease, with the goal of controlling the tumor while preserving as much tissue and function as possible.
When there is greater local invasion, more extensive surgery may be necessary: partial penectomy or total penectomy in selected patients.
In advanced cases, systemic treatments, lymph node surgery and/or radiotherapy may be added depending on the clinical scenario.
Penile cancer follows a lymphatic spread pattern in which the inguinal lymph nodes are of enormous importance.
That is why looking only at the penis is not enough.
Key concept
The presence of lymphadenopathy requires specific evaluation, although not every palpable lymph node necessarily implies metastasis.
Penile cancer and testicular cancer are evaluated differently from the start:
| Suspicious testicular mass | Suspicious penile lesion | |
|---|---|---|
| Initial study | Ultrasound | Exam + biopsy |
| Routine local biopsy | NOT transscrotal | YES |
| Classic diagnostic surgery | Inguinal orchiectomy | Depends on lesion/stage |
| Relevant first-echelon lymph nodes | Retroperitoneal | Inguinal |
| Organ preservation | Selected situations | A priority when oncologically safe |
Final pearl
Suspicious lesion of the penis: examine the penis and groins and obtain a histologic diagnosis.
Key takeaways from this lesson
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