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</svg> Books</a></div><div class="jr-rhead f1 flexh"><div class="head"></div><div class="body"><div class="t">Penile Cancer Treatment (PDQ®): Health Professional Version</div><div class="j">PDQ Cancer Information Summaries [Internet]</div></div><div class="tail"></div></div><div id="jr-tb2"><a id="jr-bkhelp-sw" class="btn wsprkl hidden" title="Help with NLM PubReader">?</a><a id="jr-help-sw" class="btn wsprkl hidden" title="Settings and typography in NLM PubReader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512" preserveAspectRatio="none"><path d="M462,283.742v-55.485l-29.981-10.662c-11.431-4.065-20.628-12.794-25.274-24.001 c-0.002-0.004-0.004-0.009-0.006-0.013c-4.659-11.235-4.333-23.918,0.889-34.903l13.653-28.724l-39.234-39.234l-28.72,13.652 c-10.979,5.219-23.68,5.546-34.908,0.889c-0.005-0.002-0.01-0.003-0.014-0.005c-11.215-4.65-19.933-13.834-24-25.273L283.741,50 h-55.484l-10.662,29.981c-4.065,11.431-12.794,20.627-24.001,25.274c-0.005,0.002-0.009,0.004-0.014,0.005 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class="title" itemprop="name">Penile Cancer Treatment (PDQ®)</span></h1><div class="subtitle whole_rhythm">Health Professional Version</div><p class="contribs">PDQ Adult Treatment Editorial Board.</p><p class="fm-aai"><a href="#_NBK65943_pubdet_">Publication Details</a></p></div></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000062897__206">This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of penile cancer. It is intended as a resource to inform and assist clinicians in the care of their patients. It does not provide formal guidelines or recommendations for making health care decisions.</p><p id="CDR0000062897__207">This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).</p></div><div id="CDR0000062897__1"><h2 id="_CDR0000062897__1_">General Information About Penile Cancer</h2><div id="CDR0000062897__180"><h3>Incidence and Mortality</h3><p id="CDR0000062897__131">Estimated new cases and deaths from penile (and other male genital) cancer in the United States in 2024:[<a class="bibr" href="#CDR0000062897_rl_1_1" rid="CDR0000062897_rl_1_1">1</a>]</p><ul id="CDR0000062897__132"><li class="half_rhythm"><div>New cases: 2,100.</div></li><li class="half_rhythm"><div>Deaths: 500.</div></li></ul></div><div id="CDR0000062897__196"><h3>Risk Factors</h3><p id="CDR0000062897__197">
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Penile cancer is rare in most developed nations, including the United States, where the rate is less than 1 per 100,000 men per year. Some studies suggest an association between human papillomavirus (HPV) infection and penile cancer.[<a class="bibr" href="#CDR0000062897_rl_1_2" rid="CDR0000062897_rl_1_2">2</a>-<a class="bibr" href="#CDR0000062897_rl_1_5" rid="CDR0000062897_rl_1_5">5</a>] Observational studies have shown a lower prevalence of penile HPV in men who have been circumcised (odds ratio, 0.37; 95% confidence interval, 0.16–0.85).[<a class="bibr" href="#CDR0000062897_rl_1_6" rid="CDR0000062897_rl_1_6">6</a>] Some, but not all, observational studies also suggest that male newborn circumcision is associated with a decreased risk of penile cancer.[<a class="bibr" href="#CDR0000062897_rl_1_7" rid="CDR0000062897_rl_1_7">7</a>,<a class="bibr" href="#CDR0000062897_rl_1_8" rid="CDR0000062897_rl_1_8">8</a>] According to published data, if the relationship is causal, the number needed to treat was about 909 circumcisions to prevent a single case of invasive penile cancer.[<a class="bibr" href="#CDR0000062897_rl_1_9" rid="CDR0000062897_rl_1_9">9</a>]</p></div><div id="CDR0000062897__198"><h3>Treatment Overview</h3><p id="CDR0000062897__199">When diagnosed early (<a href="#CDR0000062897__122">stage 0</a>, <a href="#CDR0000062897__39">stage I</a>, and <a href="#CDR0000062897__51">stage II</a>), penile cancer is highly curable.
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Curability decreases sharply for <a href="#CDR0000062897__58">stage III</a> and <a href="#CDR0000062897__69">stage IV</a> disease. Because of the rarity of
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this cancer in the United States, clinical trials specifically for penile
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cancer are infrequent. Patients with stage III and stage IV cancer are candidates
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for phase I and phase II clinical trials testing new drugs, biological therapy, or surgical
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techniques to improve local control and distant metastases.
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</p><p id="CDR0000062897__200">The selection of treatment depends on the following:[<a class="bibr" href="#CDR0000062897_rl_1_10" rid="CDR0000062897_rl_1_10">10</a>,<a class="bibr" href="#CDR0000062897_rl_1_11" rid="CDR0000062897_rl_1_11">11</a>]</p><ul id="CDR0000062897__201"><li class="half_rhythm"><div>Size.</div></li><li class="half_rhythm"><div>Location.</div></li><li class="half_rhythm"><div>Invasiveness.</div></li><li class="half_rhythm"><div>Stage of the tumor.</div></li></ul><div id="CDR0000062897__231"><h4>Fluorouracil dosing</h4><p id="CDR0000062897__sm_CDR0000813769_4"><div class="milestone-start" id="CDR0000062897__sm_CDR0000813769_3"></div>The <i>DPYD</i> gene encodes an enzyme that catabolizes pyrimidines and fluoropyrimidines, like capecitabine and fluorouracil. An estimated 1% to 2% of the population has germline pathogenic variants in <i>DPYD</i>, which lead to reduced DPD protein function and an accumulation of pyrimidines and fluoropyrimidines in the body.[<a class="bibr" href="#CDR0000062897_rl_1_12" rid="CDR0000062897_rl_1_12">12</a>,<a class="bibr" href="#CDR0000062897_rl_1_13" rid="CDR0000062897_rl_1_13">13</a>] Patients with the <i>DPYD*2A</i> variant who receive fluoropyrimidines may experience severe, life-threatening toxicities that are sometimes fatal. Many other <i>DPYD</i> variants have been identified, with a range of clinical effects.[<a class="bibr" href="#CDR0000062897_rl_1_12" rid="CDR0000062897_rl_1_12">12</a>-<a class="bibr" href="#CDR0000062897_rl_1_14" rid="CDR0000062897_rl_1_14">14</a>] Fluoropyrimidine avoidance or a dose reduction of 50% may be recommended based on the patient's <i>DPYD</i> genotype and number of functioning <i>DPYD</i> alleles.[<a class="bibr" href="#CDR0000062897_rl_1_15" rid="CDR0000062897_rl_1_15">15</a>-<a class="bibr" href="#CDR0000062897_rl_1_17" rid="CDR0000062897_rl_1_17">17</a>] <i>DPYD</i> genetic testing costs less than $200, but insurance coverage varies due to a lack of national guidelines.[<a class="bibr" href="#CDR0000062897_rl_1_18" rid="CDR0000062897_rl_1_18">18</a>] In addition, testing may delay therapy by 2 weeks, which would not be advisable in urgent situations. This controversial issue requires further evaluation.<div class="milestone-end"></div>[<a class="bibr" href="#CDR0000062897_rl_1_19" rid="CDR0000062897_rl_1_19">19</a>]</p></div></div><div id="CDR0000062897_rl_1"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062897_rl_1_1">American Cancer Society: Cancer Facts and Figures 2024. American Cancer Society, 2024. <a href="https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2024/2024-cancer-facts-and-figures-acs.pdf" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Available online</a>. Last accessed December 30, 2024.</div></li><li><div class="bk_ref" id="CDR0000062897_rl_1_2">Del Mistro A, Chieco Bianchi L: HPV-related neoplasias in HIV-infected individuals. Eur J Cancer 37 (10): 1227-35, 2001. [<a href="https://pubmed.ncbi.nlm.nih.gov/11423255" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11423255</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_1_3">Griffiths TR, Mellon JK: Human papillomavirus and urological tumours: I. Basic science and role in penile cancer. BJU Int 84 (5): 579-86, 1999. [<a href="https://pubmed.ncbi.nlm.nih.gov/10510097" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10510097</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_1_4">Poblet E, Alfaro L, Fernander-Segoviano P, et al.: Human papillomavirus-associated penile squamous cell carcinoma in HIV-positive patients. Am J Surg Pathol 23 (9): 1119-23, 1999. [<a href="https://pubmed.ncbi.nlm.nih.gov/10478673" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10478673</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_1_5">Frisch M, van den Brule AJ, Jiwa NM, et al.: HPV-16-positive anal and penile carcinomas in a young man--anogenital 'field effect' in the immunosuppressed male? Scand J Infect Dis 28 (6): 629-32, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/9060069" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9060069</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_1_6">Castellsagué X, Bosch FX, Muñoz N, et al.: Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. N Engl J Med 346 (15): 1105-12, 2002. [<a href="https://pubmed.ncbi.nlm.nih.gov/11948269" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11948269</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_1_7">Schoen EJ, Oehrli M, Colby C, et al.: The highly protective effect of newborn circumcision against invasive penile cancer. Pediatrics 105 (3): E36, 2000. [<a href="https://pubmed.ncbi.nlm.nih.gov/10699138" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10699138</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_1_8">Neonatal circumcision revisited. Fetus and Newborn Committee, Canadian Paediatric Society. CMAJ 154 (6): 769-80, 1996. [<a href="/pmc/articles/PMC1487803/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1487803</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/8634956" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8634956</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_1_9">Christakis DA, Harvey E, Zerr DM, et al.: A trade-off analysis of routine newborn circumcision. Pediatrics 105 (1 Pt 3): 246-9, 2000. [<a href="https://pubmed.ncbi.nlm.nih.gov/10617731" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10617731</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_1_10">Mark JR, Hurwitz M, Gomella LG: Cancer of the urethra and penis. In: DeVita VT Jr, Lawrence TS, Rosenberg SA: Cancer: Principles and Practice of Oncology. 11th ed. Wolters Kluwer Health, 2019, pp 1136-44.</div></li><li><div class="bk_ref" id="CDR0000062897_rl_1_11">Chao KS, Perez CA: Penis and male urethra. In: Perez CA, Brady LW, eds.: Principles and Practice of Radiation Oncology. 3rd ed. Lippincott-Raven Publishers, 1998, pp 1717-1732.</div></li><li><div class="bk_ref" id="CDR0000062897_rl_1_12">Sharma BB, Rai K, Blunt H, et al.: Pathogenic DPYD Variants and Treatment-Related Mortality in Patients Receiving Fluoropyrimidine Chemotherapy: A Systematic Review and Meta-Analysis. Oncologist 26 (12): 1008-1016, 2021. [<a href="/pmc/articles/PMC8649021/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8649021</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34506675" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34506675</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_1_13">Lam SW, Guchelaar HJ, Boven E: The role of pharmacogenetics in capecitabine efficacy and toxicity. Cancer Treat Rev 50: 9-22, 2016. [<a href="https://pubmed.ncbi.nlm.nih.gov/27569869" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27569869</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_1_14">Shakeel F, Fang F, Kwon JW, et al.: Patients carrying DPYD variant alleles have increased risk of severe toxicity and related treatment modifications during fluoropyrimidine chemotherapy. Pharmacogenomics 22 (3): 145-155, 2021. [<a href="https://pubmed.ncbi.nlm.nih.gov/33410339" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33410339</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_1_15">Amstutz U, Henricks LM, Offer SM, et al.: Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for Dihydropyrimidine Dehydrogenase Genotype and Fluoropyrimidine Dosing: 2017 Update. Clin Pharmacol Ther 103 (2): 210-216, 2018. [<a href="/pmc/articles/PMC5760397/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5760397</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29152729" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29152729</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_1_16">Henricks LM, Lunenburg CATC, de Man FM, et al.: DPYD genotype-guided dose individualisation of fluoropyrimidine therapy in patients with cancer: a prospective safety analysis. Lancet Oncol 19 (11): 1459-1467, 2018. [<a href="https://pubmed.ncbi.nlm.nih.gov/30348537" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30348537</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_1_17">Lau-Min KS, Varughese LA, Nelson MN, et al.: Preemptive pharmacogenetic testing to guide chemotherapy dosing in patients with gastrointestinal malignancies: a qualitative study of barriers to implementation. BMC Cancer 22 (1): 47, 2022. [<a href="/pmc/articles/PMC8742388/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8742388</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34996412" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34996412</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_1_18">Brooks GA, Tapp S, Daly AT, et al.: Cost-effectiveness of DPYD Genotyping Prior to Fluoropyrimidine-based Adjuvant Chemotherapy for Colon Cancer. Clin Colorectal Cancer 21 (3): e189-e195, 2022. [<a href="/pmc/articles/PMC10496767/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC10496767</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/35668003" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35668003</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_1_19">Baker SD, Bates SE, Brooks GA, et al.: DPYD Testing: Time to Put Patient Safety First. J Clin Oncol 41 (15): 2701-2705, 2023. [<a href="/pmc/articles/PMC10414691/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC10414691</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/36821823" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 36821823</span></a>]</div></li></ol></div></div><div id="CDR0000062897__4"><h2 id="_CDR0000062897__4_">Cellular Classification of Penile Cancer</h2><p id="CDR0000062897__5">Virtually all penile carcinomas are of squamous cell origin and include the following subtypes:
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</p><ul id="CDR0000062897__105"><li class="half_rhythm"><div>Verrucous carcinoma.[<a class="bibr" href="#CDR0000062897_rl_4_1" rid="CDR0000062897_rl_4_1">1</a>]</div></li><li class="half_rhythm"><div> Warty carcinoma (verruciform).[<a class="bibr" href="#CDR0000062897_rl_4_2" rid="CDR0000062897_rl_4_2">2</a>]</div></li><li class="half_rhythm"><div>Basaloid carcinoma.[<a class="bibr" href="#CDR0000062897_rl_4_3" rid="CDR0000062897_rl_4_3">3</a>] </div></li></ul><p id="CDR0000062897__130">Although they are less common subtypes, warty carcinoma and basaloid carcinoma appear to be more highly associated with human papillomaviruses (HPV), particularly HPV 16, than typical squamous cell carcinoma or verrucous carcinoma of the penis.[<a class="bibr" href="#CDR0000062897_rl_4_3" rid="CDR0000062897_rl_4_3">3</a>-<a class="bibr" href="#CDR0000062897_rl_4_5" rid="CDR0000062897_rl_4_5">5</a>] </p><p id="CDR0000062897__106">Neuroendocrine carcinomas can also be seen.[<a class="bibr" href="#CDR0000062897_rl_4_6" rid="CDR0000062897_rl_4_6">6</a>]</p><div id="CDR0000062897_rl_4"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062897_rl_4_1">Schwartz RA: Verrucous carcinoma of the skin and mucosa. J Am Acad Dermatol 32 (1): 1-21; quiz 22-4, 1995. [<a href="https://pubmed.ncbi.nlm.nih.gov/7822496" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7822496</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_4_2">Bezerra AL, Lopes A, Landman G, et al.: Clinicopathologic features and human papillomavirus dna prevalence of warty and squamous cell carcinoma of the penis. Am J Surg Pathol 25 (5): 673-8, 2001. [<a href="https://pubmed.ncbi.nlm.nih.gov/11342782" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11342782</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_4_3">Cubilla AL, Reuter VE, Gregoire L, et al.: Basaloid squamous cell carcinoma: a distinctive human papilloma virus-related penile neoplasm: a report of 20 cases. Am J Surg Pathol 22 (6): 755-61, 1998. [<a href="https://pubmed.ncbi.nlm.nih.gov/9630184" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9630184</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_4_4">Gregoire L, Cubilla AL, Reuter VE, et al.: Preferential association of human papillomavirus with high-grade histologic variants of penile-invasive squamous cell carcinoma. J Natl Cancer Inst 87 (22): 1705-9, 1995. [<a href="https://pubmed.ncbi.nlm.nih.gov/7473819" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7473819</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_4_5">Rubin MA, Kleter B, Zhou M, et al.: Detection and typing of human papillomavirus DNA in penile carcinoma: evidence for multiple independent pathways of penile carcinogenesis. Am J Pathol 159 (4): 1211-8, 2001. [<a href="/pmc/articles/PMC1850485/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1850485</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/11583947" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11583947</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_4_6">Vadmal MS, Steckel J, Teichberg S, et al.: Primary neuroendocrine carcinoma of the penile urethra. J Urol 157 (3): 956-7, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9072615" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9072615</span></a>]</div></li></ol></div></div><div id="CDR0000062897__6"><h2 id="_CDR0000062897__6_">Stage Information for Penile Cancer</h2><div id="CDR0000062897__163"><h3>American Joint Committee on Cancer (AJCC) Stage Groupings and Definitions of TNM</h3><p id="CDR0000062897__179">The AJCC has designated staging by TNM
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(tumor, node, metastasis) classification to define penile cancer.[<a class="bibr" href="#CDR0000062897_rl_6_1" rid="CDR0000062897_rl_6_1">1</a>]</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figCDR0000062897214"><a href="/books/NBK65943/table/CDR0000062897__214/?report=objectonly" target="object" title="Table" class="img_link icnblk_img" rid-ob="figobCDR0000062897214"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="CDR0000062897__214"><a href="/books/NBK65943/table/CDR0000062897__214/?report=objectonly" target="object" rid-ob="figobCDR0000062897214">Table</a></h4><p class="float-caption no_bottom_margin">Definitions of TNM Stages 0is and 0a<sup>a</sup>. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figCDR0000062897215"><a href="/books/NBK65943/table/CDR0000062897__215/?report=objectonly" target="object" title="Table" class="img_link icnblk_img" rid-ob="figobCDR0000062897215"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="CDR0000062897__215"><a href="/books/NBK65943/table/CDR0000062897__215/?report=objectonly" target="object" rid-ob="figobCDR0000062897215">Table</a></h4><p class="float-caption no_bottom_margin">Definitions of TNM Stage I<sup>a</sup>. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figCDR0000062897216"><a href="/books/NBK65943/table/CDR0000062897__216/?report=objectonly" target="object" title="Table" class="img_link icnblk_img" rid-ob="figobCDR0000062897216"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="CDR0000062897__216"><a href="/books/NBK65943/table/CDR0000062897__216/?report=objectonly" target="object" rid-ob="figobCDR0000062897216">Table</a></h4><p class="float-caption no_bottom_margin">Definitions of TNM Stages IIA and IIB<sup>a</sup>. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figCDR0000062897217"><a href="/books/NBK65943/table/CDR0000062897__217/?report=objectonly" target="object" title="Table" class="img_link icnblk_img" rid-ob="figobCDR0000062897217"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="CDR0000062897__217"><a href="/books/NBK65943/table/CDR0000062897__217/?report=objectonly" target="object" rid-ob="figobCDR0000062897217">Table</a></h4><p class="float-caption no_bottom_margin">Definitions of TNM Stages IIIA and IIIB<sup>a</sup>. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figCDR0000062897218"><a href="/books/NBK65943/table/CDR0000062897__218/?report=objectonly" target="object" title="Table" class="img_link icnblk_img" rid-ob="figobCDR0000062897218"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="CDR0000062897__218"><a href="/books/NBK65943/table/CDR0000062897__218/?report=objectonly" target="object" rid-ob="figobCDR0000062897218">Table</a></h4><p class="float-caption no_bottom_margin">Definitions of TNM Stage IV<sup>a</sup>. </p></div></div></div><div id="CDR0000062897_rl_6"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062897_rl_6_1">Penis. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. Springer; 2017, pp 701–14.</div></li></ol></div></div><div id="CDR0000062897__122"><h2 id="_CDR0000062897__122_">Treatment of Stage 0 Penile Cancer</h2><p id="CDR0000062897__184">
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<b>Stage 0 penile cancer is defined by the following TNM classifications:[<a class="bibr" href="#CDR0000062897_rl_122_1" rid="CDR0000062897_rl_122_1">1</a>]</b>
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</p><ul id="CDR0000062897__124"><li class="half_rhythm"><div>Tis, N0, M0</div></li><li class="half_rhythm"><div>Ta, N0, M0</div></li></ul><p id="CDR0000062897__125">Carcinoma <i>in situ</i> of the penis is referred to as erythroplasia of Queyrat when it occurs on the glans, and Bowen disease when it occurs on the penile shaft. These precursor lesions progress to invasive squamous cell carcinoma in 5% to 15% of cases. In case series studies, human papillomavirus DNA has been detected in most of these lesions.[<a class="bibr" href="#CDR0000062897_rl_122_2" rid="CDR0000062897_rl_122_2">2</a>,<a class="bibr" href="#CDR0000062897_rl_122_3" rid="CDR0000062897_rl_122_3">3</a>] With no data from clinical trials in this disease stage, treatment recommendations are largely based on case reports and case series involving limited numbers of patients.</p><p id="CDR0000062897__126">
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<b>Treatment options:
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</b>
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</p><ol id="CDR0000062897__127"><li class="half_rhythm"><div>Surgical excision can result in scarring, deformity, and impaired function. To minimize these effects, Mohs micrographic surgery, which involves the excision of successive horizontal layers of tissue with microscopic examination of each layer in frozen section, has been used in patients with <i>in situ</i> and invasive penile cancers.[<a class="bibr" href="#CDR0000062897_rl_122_4" rid="CDR0000062897_rl_122_4">4</a>,<a class="bibr" href="#CDR0000062897_rl_122_5" rid="CDR0000062897_rl_122_5">5</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000810039/" class="def">Level of evidence C3</a>]</div></li><li class="half_rhythm"><div>Topical application of fluorouracil cream has been effective in cases of erythroplasia of Queyrat [<a class="bibr" href="#CDR0000062897_rl_122_6" rid="CDR0000062897_rl_122_6">6</a>] and Bowen disease.[<a class="bibr" href="#CDR0000062897_rl_122_7" rid="CDR0000062897_rl_122_7">7</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000810039/" class="def">Level of evidence C3</a>]</div></li><li class="half_rhythm"><div> Imiquimod 5% cream is a topical immune response modifier that has been effective with good cosmetic and functional results.[<a class="bibr" href="#CDR0000062897_rl_122_8" rid="CDR0000062897_rl_122_8">8</a>-<a class="bibr" href="#CDR0000062897_rl_122_10" rid="CDR0000062897_rl_122_10">10</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000810039/" class="def">Level of evidence C3</a>]</div></li><li class="half_rhythm"><div>Laser therapy with Nd:YAG or CO<sub>2</sub> lasers has also resulted in excellent cosmetic results.[<a class="bibr" href="#CDR0000062897_rl_122_11" rid="CDR0000062897_rl_122_11">11</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000810039/" class="def">Level of evidence C3</a>]</div></li><li class="half_rhythm"><div>Cryosurgery has resulted in good cosmetic results in patients with erythroplasia of Queyrat and verrucous penile carcinoma.[<a class="bibr" href="#CDR0000062897_rl_122_12" rid="CDR0000062897_rl_122_12">12</a>,<a class="bibr" href="#CDR0000062897_rl_122_13" rid="CDR0000062897_rl_122_13">13</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000810039/" class="def">Level of evidence C3</a>]</div></li></ol><div id="CDR0000062897__TrialSearch_122_sid_4"><h3>Current Clinical Trials</h3><p id="CDR0000062897__TrialSearch_122_22">Use our <a href="https://www.cancer.gov/research/participate/clinical-trials-search/advanced" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">advanced clinical trial search</a> to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062897_rl_122"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062897_rl_122_1">Penis. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. Springer; 2017, pp 701–14.</div></li><li><div class="bk_ref" id="CDR0000062897_rl_122_2">Cupp MR, Malek RS, Goellner JR, et al.: The detection of human papillomavirus deoxyribonucleic acid in intraepithelial, in situ, verrucous and invasive carcinoma of the penis. J Urol 154 (3): 1024-9, 1995. [<a href="https://pubmed.ncbi.nlm.nih.gov/7637047" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7637047</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_122_3">Rubin MA, Kleter B, Zhou M, et al.: Detection and typing of human papillomavirus DNA in penile carcinoma: evidence for multiple independent pathways of penile carcinogenesis. Am J Pathol 159 (4): 1211-8, 2001. [<a href="/pmc/articles/PMC1850485/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1850485</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/11583947" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11583947</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_122_4">Mohs FE, Snow SN, Messing EM, et al.: Microscopically controlled surgery in the treatment of carcinoma of the penis. J Urol 133 (6): 961-6, 1985. [<a href="https://pubmed.ncbi.nlm.nih.gov/3999220" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3999220</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_122_5">Moritz DL, Lynch WS: Extensive Bowen's disease of the penile shaft treated with fresh tissue Mohs micrographic surgery in two separate operations. J Dermatol Surg Oncol 17 (4): 374-8, 1991. [<a href="https://pubmed.ncbi.nlm.nih.gov/2040751" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2040751</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_122_6">Goette DK, Carson TE: Erythroplasia of Queyrat: treatment with topical 5-fluorouracil. Cancer 38 (4): 1498-502, 1976. [<a href="https://pubmed.ncbi.nlm.nih.gov/991073" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 991073</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_122_7">Tolia BM, Castro VL, Mouded IM, et al.: Bowen's disease of shaft of penis. Successful treatment with 5-fluorouracil. Urology 7 (6): 617-9, 1976. [<a href="https://pubmed.ncbi.nlm.nih.gov/936382" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 936382</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_122_8">Danielsen AG, Sand C, Weismann K: Treatment of Bowen's disease of the penis with imiquimod 5% cream. Clin Exp Dermatol 28 (Suppl 1): 7-9, 2003. [<a href="https://pubmed.ncbi.nlm.nih.gov/14616803" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14616803</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_122_9">Micali G, Nasca MR, Tedeschi A: Topical treatment of intraepithelial penile carcinoma with imiquimod. Clin Exp Dermatol 28 (Suppl 1): 4-6, 2003. [<a href="https://pubmed.ncbi.nlm.nih.gov/14616802" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14616802</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_122_10">Schroeder TL, Sengelmann RD: Squamous cell carcinoma in situ of the penis successfully treated with imiquimod 5% cream. J Am Acad Dermatol 46 (4): 545-8, 2002. [<a href="https://pubmed.ncbi.nlm.nih.gov/11907505" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11907505</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_122_11">van Bezooijen BP, Horenblas S, Meinhardt W, et al.: Laser therapy for carcinoma in situ of the penis. J Urol 166 (5): 1670-1, 2001. [<a href="https://pubmed.ncbi.nlm.nih.gov/11586199" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11586199</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_122_12">Michelman FA, Filho AC, Moraes AM: Verrucous carcinoma of the penis treated with cryosurgery. J Urol 168 (3): 1096-7, 2002. [<a href="https://pubmed.ncbi.nlm.nih.gov/12187233" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12187233</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_122_13">Sonnex TS, Ralfs IG, Plaza de Lanza M, et al.: Treatment of erythroplasia of Queyrat with liquid nitrogen cryosurgery. Br J Dermatol 106 (5): 581-4, 1982. [<a href="https://pubmed.ncbi.nlm.nih.gov/7073983" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7073983</span></a>]</div></li></ol></div></div><div id="CDR0000062897__39"><h2 id="_CDR0000062897__39_">Treatment of Stage I Penile Cancer</h2><p id="CDR0000062897__185">
|
|
<b>Stage I penile cancer is defined by the following TNM classification:[<a class="bibr" href="#CDR0000062897_rl_39_1" rid="CDR0000062897_rl_39_1">1</a>]</b>
|
|
</p><ul id="CDR0000062897__87"><li class="half_rhythm"><div>T1a, N0, M0</div></li></ul><p id="CDR0000062897__41">Stage I penile cancer is curable.[<a class="bibr" href="#CDR0000062897_rl_39_2" rid="CDR0000062897_rl_39_2">2</a>]
|
|
</p><p id="CDR0000062897__42">
|
|
<b>Treatment options:
|
|
</b>
|
|
</p><ol id="CDR0000062897__79"><li class="half_rhythm"><div>For lesions limited to the foreskin, wide local excision with circumcision may
|
|
be adequate therapy for control.
|
|
</div></li><li class="half_rhythm"><div>For infiltrating tumors of the glans with or without involvement of the
|
|
adjacent skin, the choice of therapy is dictated by tumor size, extent of
|
|
infiltration, and degree of tumor destruction of normal tissue. Equivalent
|
|
therapeutic options include:
|
|
<ul id="CDR0000062897__47"><li class="half_rhythm"><div>Penile amputation.[<a class="bibr" href="#CDR0000062897_rl_39_3" rid="CDR0000062897_rl_39_3">3</a>]
|
|
</div></li><li class="half_rhythm"><div>Radiation therapy (i.e., external-beam radiation therapy and brachytherapy).[<a class="bibr" href="#CDR0000062897_rl_39_4" rid="CDR0000062897_rl_39_4">4</a>,<a class="bibr" href="#CDR0000062897_rl_39_5" rid="CDR0000062897_rl_39_5">5</a>]
|
|
</div></li><li class="half_rhythm"><div>Microscopically controlled surgery.[<a class="bibr" href="#CDR0000062897_rl_39_6" rid="CDR0000062897_rl_39_6">6</a>]
|
|
</div></li></ul></div></li><li class="half_rhythm"><div>Nd:YAG laser therapy has offered excellent control/cure with preservation of
|
|
cosmetic appearance and sexual function (under clinical evaluation).[<a class="bibr" href="#CDR0000062897_rl_39_7" rid="CDR0000062897_rl_39_7">7</a>,<a class="bibr" href="#CDR0000062897_rl_39_8" rid="CDR0000062897_rl_39_8">8</a>]
|
|
</div></li></ol><p id="CDR0000062897__50">Because of the high incidence of microscopic node metastases, elective
|
|
adjunctive inguinal dissection of clinically uninvolved (negative) lymph nodes
|
|
in conjunction with amputation is often used for patients with poorly
|
|
differentiated tumors. Lymphadenectomy can carry substantial
|
|
morbidity, such as infection, skin necrosis, wound breakdown, chronic edema,
|
|
and even a low, but finite, mortality rate. The impact of prophylactic
|
|
lymphadenectomy on survival is not known. For these reasons, opinions vary on its use.[<a class="bibr" href="#CDR0000062897_rl_39_9" rid="CDR0000062897_rl_39_9">9</a>-<a class="bibr" href="#CDR0000062897_rl_39_12" rid="CDR0000062897_rl_39_12">12</a>]
|
|
</p><div id="CDR0000062897__TrialSearch_39_sid_5"><h3>Current Clinical Trials</h3><p id="CDR0000062897__TrialSearch_39_22">Use our <a href="https://www.cancer.gov/research/participate/clinical-trials-search/advanced" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">advanced clinical trial search</a> to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062897_rl_39"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062897_rl_39_1">Penis. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. Springer; 2017, pp 701–14.</div></li><li><div class="bk_ref" id="CDR0000062897_rl_39_2">Harty JI, Catalona WJ: Carcinoma of the penis. In: Javadpour N, ed.: Principles and Management of Urologic Cancer. 2nd ed. Williams and Wilkins, 1983, pp 581-597.</div></li><li><div class="bk_ref" id="CDR0000062897_rl_39_3">Lynch DF, Pettaway CA: Tumors of the penis. In: Walsh PC, Retik AB, Vaughan ED, et al., eds.: Campbell's Urology. 8th ed. Saunders, 2002, pp 2945-2947.</div></li><li><div class="bk_ref" id="CDR0000062897_rl_39_4">Chao KS, Perez CA: Penis and male urethra. In: Perez CA, Brady LW, eds.: Principles and Practice of Radiation Oncology. 3rd ed. Lippincott-Raven Publishers, 1998, pp 1717-1732.</div></li><li><div class="bk_ref" id="CDR0000062897_rl_39_5">McLean M, Akl AM, Warde P, et al.: The results of primary radiation therapy in the management of squamous cell carcinoma of the penis. Int J Radiat Oncol Biol Phys 25 (4): 623-8, 1993. [<a href="https://pubmed.ncbi.nlm.nih.gov/8454480" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8454480</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_39_6">Mohs FE, Snow SN, Messing EM, et al.: Microscopically controlled surgery in the treatment of carcinoma of the penis. J Urol 133 (6): 961-6, 1985. [<a href="https://pubmed.ncbi.nlm.nih.gov/3999220" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3999220</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_39_7">Smith JA Jr.: Lasers in clinical urologic surgery. In: Dixon JA, ed.: Surgical Application of Lasers. 2nd ed. Year Book Medical Publishers, Inc., 1987, pp 218-237.</div></li><li><div class="bk_ref" id="CDR0000062897_rl_39_8">Horenblas S, van Tinteren H, Delemarre JF, et al.: Squamous cell carcinoma of the penis. II. Treatment of the primary tumor. J Urol 147 (6): 1533-8, 1992. [<a href="https://pubmed.ncbi.nlm.nih.gov/1593683" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1593683</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_39_9">Theodorescu D, Russo P, Zhang ZF, et al.: Outcomes of initial surveillance of invasive squamous cell carcinoma of the penis and negative nodes. J Urol 155 (5): 1626-31, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/8627839" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8627839</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_39_10">Lindegaard JC, Nielsen OS, Lundbeck FA, et al.: A retrospective analysis of 82 cases of cancer of the penis. Br J Urol 77 (6): 883-90, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/8705227" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8705227</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_39_11">Ornellas AA, Seixas AL, Marota A, et al.: Surgical treatment of invasive squamous cell carcinoma of the penis: retrospective analysis of 350 cases. J Urol 151 (5): 1244-9, 1994. [<a href="https://pubmed.ncbi.nlm.nih.gov/7512656" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7512656</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_39_12">Young MJ, Reda DJ, Waters WB: Penile carcinoma: a twenty-five-year experience. Urology 38 (6): 529-32, 1991. [<a href="https://pubmed.ncbi.nlm.nih.gov/1746081" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1746081</span></a>]</div></li></ol></div></div><div id="CDR0000062897__51"><h2 id="_CDR0000062897__51_">Treatment of Stage II Penile Cancer</h2><p id="CDR0000062897__186">
|
|
<b>Stage II penile cancer is defined by the following TNM classifications:[<a class="bibr" href="#CDR0000062897_rl_51_1" rid="CDR0000062897_rl_51_1">1</a>]</b>
|
|
</p><ul id="CDR0000062897__88"><li class="half_rhythm"><div>T1b, N0, M0</div></li><li class="half_rhythm"><div>T2, N0, M0</div></li><li class="half_rhythm"><div>T3, N0, M0</div></li></ul><p id="CDR0000062897__53">
|
|
<b>Treatment options:
|
|
</b>
|
|
</p><ol id="CDR0000062897__230"><li class="half_rhythm"><div>Stage II penile cancer is most frequently managed by penile amputation for
|
|
local control. Whether the amputation is partial, total, or radical will
|
|
depend on the extent and location of the neoplasm. External-beam radiation therapy and brachytherapy with
|
|
surgical salvage are alternative approaches.[<a class="bibr" href="#CDR0000062897_rl_51_2" rid="CDR0000062897_rl_51_2">2</a>-<a class="bibr" href="#CDR0000062897_rl_51_6" rid="CDR0000062897_rl_51_6">6</a>]</div></li><li class="half_rhythm"><div>Nd:YAG laser therapy has been used to preserve the penis in selected patients
|
|
with small lesions (under clinical evaluation).[<a class="bibr" href="#CDR0000062897_rl_51_7" rid="CDR0000062897_rl_51_7">7</a>]</div></li></ol><p id="CDR0000062897__57">Because of the high incidence of microscopic node metastases, elective
|
|
adjunctive dissection of clinically uninvolved (negative) lymph nodes in
|
|
conjunction with amputation is often used for patients with poorly
|
|
differentiated tumors. Lymphadenectomy can carry substantial
|
|
morbidity, such as infection, skin necrosis, wound breakdown, chronic edema,
|
|
and even a low, but finite, mortality rate. The impact of prophylactic
|
|
lymphadenectomy on survival is not known.[<a class="bibr" href="#CDR0000062897_rl_51_8" rid="CDR0000062897_rl_51_8">8</a>-<a class="bibr" href="#CDR0000062897_rl_51_11" rid="CDR0000062897_rl_51_11">11</a>]
|
|
</p><p id="CDR0000062897__142">To reduce the morbidity associated with prophylactic lymphadenectomy, dynamic sentinel node biopsy is used in patients with stage T2 clinically node-negative penile cancer. One retrospective single-institution study of 22 patients reported a false-negative rate of 11%.[<a class="bibr" href="#CDR0000062897_rl_51_12" rid="CDR0000062897_rl_51_12">12</a>]</p><div id="CDR0000062897__TrialSearch_51_sid_6"><h3>Current Clinical Trials</h3><p id="CDR0000062897__TrialSearch_51_22">Use our <a href="https://www.cancer.gov/research/participate/clinical-trials-search/advanced" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">advanced clinical trial search</a> to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062897_rl_51"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062897_rl_51_1">Penis. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. Springer; 2017, pp 701–14.</div></li><li><div class="bk_ref" id="CDR0000062897_rl_51_2">Harty JI, Catalona WJ: Carcinoma of the penis. In: Javadpour N, ed.: Principles and Management of Urologic Cancer. 2nd ed. Williams and Wilkins, 1983, pp 581-597.</div></li><li><div class="bk_ref" id="CDR0000062897_rl_51_3">Schellhammer PF, Spaulding JT: Carcinoma of the penis. In: Paulson DF, ed.: Genitourinary Surgery. Vol. 2. Churchill Livingston, 1984, pp 629-654.</div></li><li><div class="bk_ref" id="CDR0000062897_rl_51_4">Johnson DE, Lo RK: Tumors of the penis, urethra, and scrotum. In: deKernion JB, Paulson DF, eds.: Genitourinary Cancer Management. Lea and Febiger, 1987, pp 219-258.</div></li><li><div class="bk_ref" id="CDR0000062897_rl_51_5">McLean M, Akl AM, Warde P, et al.: The results of primary radiation therapy in the management of squamous cell carcinoma of the penis. Int J Radiat Oncol Biol Phys 25 (4): 623-8, 1993. [<a href="https://pubmed.ncbi.nlm.nih.gov/8454480" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8454480</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_51_6">Crook JM, Jezioranski J, Grimard L, et al.: Penile brachytherapy: results for 49 patients. Int J Radiat Oncol Biol Phys 62 (2): 460-7, 2005. [<a href="https://pubmed.ncbi.nlm.nih.gov/15890588" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15890588</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_51_7">Horenblas S, van Tinteren H, Delemarre JF, et al.: Squamous cell carcinoma of the penis. II. Treatment of the primary tumor. J Urol 147 (6): 1533-8, 1992. [<a href="https://pubmed.ncbi.nlm.nih.gov/1593683" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1593683</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_51_8">Theodorescu D, Russo P, Zhang ZF, et al.: Outcomes of initial surveillance of invasive squamous cell carcinoma of the penis and negative nodes. J Urol 155 (5): 1626-31, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/8627839" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8627839</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_51_9">Lindegaard JC, Nielsen OS, Lundbeck FA, et al.: A retrospective analysis of 82 cases of cancer of the penis. Br J Urol 77 (6): 883-90, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/8705227" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8705227</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_51_10">Ornellas AA, Seixas AL, Marota A, et al.: Surgical treatment of invasive squamous cell carcinoma of the penis: retrospective analysis of 350 cases. J Urol 151 (5): 1244-9, 1994. [<a href="https://pubmed.ncbi.nlm.nih.gov/7512656" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7512656</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_51_11">Young MJ, Reda DJ, Waters WB: Penile carcinoma: a twenty-five-year experience. Urology 38 (6): 529-32, 1991. [<a href="https://pubmed.ncbi.nlm.nih.gov/1746081" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1746081</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_51_12">Perdonà S, Autorino R, De Sio M, et al.: Dynamic sentinel node biopsy in clinically node-negative penile cancer versus radical inguinal lymphadenectomy: a comparative study. Urology 66 (6): 1282-6, 2005. [<a href="https://pubmed.ncbi.nlm.nih.gov/16360457" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16360457</span></a>]</div></li></ol></div></div><div id="CDR0000062897__58"><h2 id="_CDR0000062897__58_">Treatment of Stage III Penile Cancer</h2><p id="CDR0000062897__187">
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<b>Stage III penile cancer is defined by the following TNM classifications:[<a class="bibr" href="#CDR0000062897_rl_58_1" rid="CDR0000062897_rl_58_1">1</a>]</b>
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|
</p><ul id="CDR0000062897__89"><li class="half_rhythm"><div>T1–3, N1, M0</div></li><li class="half_rhythm"><div>T1–3, N2, M0</div></li></ul><p id="CDR0000062897__60">Inguinal adenopathy in patients with penile cancer is common but may be the
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result of infection rather than neoplasm. If palpable enlarged lymph nodes
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|
exist 3 or more weeks after removal of the infected primary lesion and completion of a
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course of antibiotic therapy, bilateral inguinal lymph node dissection should
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|
be performed.
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|
</p><p id="CDR0000062897__61">In cases of proven regional inguinal lymph node metastasis without evidence of
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distant spread, bilateral ilioinguinal dissection is the treatment of
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choice.[<a class="bibr" href="#CDR0000062897_rl_58_2" rid="CDR0000062897_rl_58_2">2</a>-<a class="bibr" href="#CDR0000062897_rl_58_5" rid="CDR0000062897_rl_58_5">5</a>] Because many patients with positive lymph nodes are not
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cured, clinical trials may be appropriate.
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</p><p id="CDR0000062897__62"><b>Treatment options:</b>
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</p><ol id="CDR0000062897__83"><li class="half_rhythm"><div>Clinically evident regional lymph node metastasis without evidence of
|
|
distant spread is an indication for bilateral ilioinguinal lymph node
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|
dissection after penile amputation.[<a class="bibr" href="#CDR0000062897_rl_58_6" rid="CDR0000062897_rl_58_6">6</a>]</div></li><li class="half_rhythm"><div>Radiation therapy may be considered as an alternative to lymph node
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|
dissection in patients who are not surgical candidates.</div></li><li class="half_rhythm"><div>Postoperative radiation therapy may decrease incidence of inguinal recurrences.</div></li><li class="half_rhythm"><div>Clinical trials using radiosensitizers or cytotoxic drugs are appropriate. A
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|
combination of vincristine, bleomycin, and methotrexate has been effective as
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both neoadjuvant and adjuvant therapy.[<a class="bibr" href="#CDR0000062897_rl_58_7" rid="CDR0000062897_rl_58_7">7</a>] Cisplatin (100 mg/m²) as neoadjuvant therapy plus continuous-infusion fluorouracil has also
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been effective.[<a class="bibr" href="#CDR0000062897_rl_58_6" rid="CDR0000062897_rl_58_6">6</a>] Single-agent cisplatin (50 mg/m<sup>2</sup>) was tested in a large trial and was ineffective.[<a class="bibr" href="#CDR0000062897_rl_58_8" rid="CDR0000062897_rl_58_8">8</a>]</div></li></ol><p id="CDR0000062897__68">Because of the high incidence of microscopic node metastases, adjunctive
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inguinal dissection of clinically uninvolved (negative) lymph nodes in
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conjunction with amputation is often used for patients with poorly
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|
differentiated tumors. Lymphadenectomy can carry substantial
|
|
morbidity, such as infection, skin necrosis, wound breakdown, chronic edema,
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|
and even a low, but finite, mortality rate. The impact of prophylactic
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lymphadenectomy on survival is not known. [<a class="bibr" href="#CDR0000062897_rl_58_3" rid="CDR0000062897_rl_58_3">3</a>,<a class="bibr" href="#CDR0000062897_rl_58_4" rid="CDR0000062897_rl_58_4">4</a>,<a class="bibr" href="#CDR0000062897_rl_58_9" rid="CDR0000062897_rl_58_9">9</a>,<a class="bibr" href="#CDR0000062897_rl_58_10" rid="CDR0000062897_rl_58_10">10</a>]
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|
</p><p id="CDR0000062897__146">To reduce the morbidity associated with prophylactic lymphadenectomy, dynamic sentinel node biopsy is used in patients with stage T2 and stage T3 clinically node-negative penile cancer. One retrospective single-institution study of 22 patients reported a false-negative rate of 11%.[<a class="bibr" href="#CDR0000062897_rl_58_11" rid="CDR0000062897_rl_58_11">11</a>]</p><div id="CDR0000062897__TrialSearch_58_sid_7"><h3>Current Clinical Trials</h3><p id="CDR0000062897__TrialSearch_58_22">Use our <a href="https://www.cancer.gov/research/participate/clinical-trials-search/advanced" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">advanced clinical trial search</a> to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062897_rl_58"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062897_rl_58_1">Penis. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. Springer; 2017, pp 701–14.</div></li><li><div class="bk_ref" id="CDR0000062897_rl_58_2">Harty JI, Catalona WJ: Carcinoma of the penis. In: Javadpour N, ed.: Principles and Management of Urologic Cancer. 2nd ed. Williams and Wilkins, 1983, pp 581-597.</div></li><li><div class="bk_ref" id="CDR0000062897_rl_58_3">Theodorescu D, Russo P, Zhang ZF, et al.: Outcomes of initial surveillance of invasive squamous cell carcinoma of the penis and negative nodes. J Urol 155 (5): 1626-31, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/8627839" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8627839</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_58_4">Lindegaard JC, Nielsen OS, Lundbeck FA, et al.: A retrospective analysis of 82 cases of cancer of the penis. Br J Urol 77 (6): 883-90, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/8705227" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8705227</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_58_5">Lynch DF, Pettaway CA: Tumors of the penis. In: Walsh PC, Retik AB, Vaughan ED, et al., eds.: Campbell's Urology. 8th ed. Saunders, 2002, pp 2945-2947.</div></li><li><div class="bk_ref" id="CDR0000062897_rl_58_6">Fisher HA, Barada JH, Horton J, et al.: Neoadjuvant therapy with cisplatin and 5-fluorouracil for stage III squamous cell carcinoma of the penis. [Abstract] J Urol 143(4 Suppl): A-653, 352A, 1990.</div></li><li><div class="bk_ref" id="CDR0000062897_rl_58_7">Pizzocaro G, Piva L: Adjuvant and neoadjuvant vincristine, bleomycin, and methotrexate for inguinal metastases from squamous cell carcinoma of the penis. Acta Oncol 27 (6b): 823-4, 1988. [<a href="https://pubmed.ncbi.nlm.nih.gov/2466471" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2466471</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_58_8">Gagliano RG, Blumenstein BA, Crawford ED, et al.: cis-Diamminedichloroplatinum in the treatment of advanced epidermoid carcinoma of the penis: a Southwest Oncology Group Study. J Urol 141 (1): 66-7, 1989. [<a href="https://pubmed.ncbi.nlm.nih.gov/2642312" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2642312</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_58_9">Ornellas AA, Seixas AL, Marota A, et al.: Surgical treatment of invasive squamous cell carcinoma of the penis: retrospective analysis of 350 cases. J Urol 151 (5): 1244-9, 1994. [<a href="https://pubmed.ncbi.nlm.nih.gov/7512656" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7512656</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_58_10">Young MJ, Reda DJ, Waters WB: Penile carcinoma: a twenty-five-year experience. Urology 38 (6): 529-32, 1991. [<a href="https://pubmed.ncbi.nlm.nih.gov/1746081" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1746081</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_58_11">Perdonà S, Autorino R, De Sio M, et al.: Dynamic sentinel node biopsy in clinically node-negative penile cancer versus radical inguinal lymphadenectomy: a comparative study. Urology 66 (6): 1282-6, 2005. [<a href="https://pubmed.ncbi.nlm.nih.gov/16360457" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16360457</span></a>]</div></li></ol></div></div><div id="CDR0000062897__69"><h2 id="_CDR0000062897__69_">Treatment of Stage IV Penile Cancer</h2><p id="CDR0000062897__188">
|
|
<b>Stage IV penile cancer is defined by the following TNM classifications:[<a class="bibr" href="#CDR0000062897_rl_69_1" rid="CDR0000062897_rl_69_1">1</a>]</b>
|
|
</p><ul id="CDR0000062897__90"><li class="half_rhythm"><div>T4, Any N, M0</div></li><li class="half_rhythm"><div>Any T, N3, M0</div></li><li class="half_rhythm"><div>Any T, Any N, M1</div></li></ul><p id="CDR0000062897__71">No standard treatment exists that is curative for patients with stage IV penile cancer.
|
|
Therapy is directed at palliation, which may be achieved either with surgery or
|
|
radiation therapy.
|
|
</p><p id="CDR0000062897__72"><b>Treatment options:</b>
|
|
</p><ol id="CDR0000062897__85"><li class="half_rhythm"><div>Palliative surgery may be considered for control of the local penile lesion
|
|
and even for the prevention of the necrosis, infection, and hemorrhage that
|
|
can result from neglected regional adenopathy.
|
|
</div></li><li class="half_rhythm"><div>Radiation therapy may be palliative for the primary tumor, regional adenopathy,
|
|
and bone metastases.
|
|
</div></li><li class="half_rhythm"><div>Clinical trials combining chemotherapy with palliative methods of local control
|
|
are appropriate. Tested chemotherapeutic drugs with some
|
|
efficacy include vincristine, cisplatin, methotrexate, and bleomycin. The
|
|
combination of vincristine, bleomycin, and methotrexate has been effective both
|
|
as adjuvant and neoadjuvant therapy.[<a class="bibr" href="#CDR0000062897_rl_69_2" rid="CDR0000062897_rl_69_2">2</a>]</div></li></ol><div id="CDR0000062897__TrialSearch_69_sid_8"><h3>Current Clinical Trials</h3><p id="CDR0000062897__TrialSearch_69_22">Use our <a href="https://www.cancer.gov/research/participate/clinical-trials-search/advanced" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">advanced clinical trial search</a> to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062897_rl_69"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062897_rl_69_1">Penis. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. Springer; 2017, pp 701–14.</div></li><li><div class="bk_ref" id="CDR0000062897_rl_69_2">Pizzocaro G, Piva L: Adjuvant and neoadjuvant vincristine, bleomycin, and methotrexate for inguinal metastases from squamous cell carcinoma of the penis. Acta Oncol 27 (6b): 823-4, 1988. [<a href="https://pubmed.ncbi.nlm.nih.gov/2466471" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2466471</span></a>]</div></li></ol></div></div><div id="CDR0000062897__77"><h2 id="_CDR0000062897__77_">Treatment of Recurrent Penile Cancer</h2><p id="CDR0000062897__78">Patients with locally recurrent disease can be treated with surgery or radiation therapy.
|
|
If the initial treatment of radiation therapy fails, patients often undergo
|
|
penile amputation. Patients with nodal recurrences not controlled
|
|
by local measures are candidates for phase I and phase II clinical trials testing new
|
|
biological and chemotherapeutic agents.[<a class="bibr" href="#CDR0000062897_rl_77_1" rid="CDR0000062897_rl_77_1">1</a>-<a class="bibr" href="#CDR0000062897_rl_77_5" rid="CDR0000062897_rl_77_5">5</a>]</p><div id="CDR0000062897__TrialSearch_77_sid_9"><h3>Current Clinical Trials</h3><p id="CDR0000062897__TrialSearch_77_22">Use our <a href="https://www.cancer.gov/research/participate/clinical-trials-search/advanced" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">advanced clinical trial search</a> to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062897_rl_77"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062897_rl_77_1">Pizzocaro G, Piva L: Adjuvant and neoadjuvant vincristine, bleomycin, and methotrexate for inguinal metastases from squamous cell carcinoma of the penis. Acta Oncol 27 (6b): 823-4, 1988. [<a href="https://pubmed.ncbi.nlm.nih.gov/2466471" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2466471</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_77_2">Ahmed T, Sklaroff R, Yagoda A: Sequential trials of methotrexate, cisplatin and bleomycin for penile cancer. J Urol 132 (3): 465-8, 1984. [<a href="https://pubmed.ncbi.nlm.nih.gov/6206239" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6206239</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_77_3">Dexeus FH, Logothetis CJ, Sella A, et al.: Combination chemotherapy with methotrexate, bleomycin and cisplatin for advanced squamous cell carcinoma of the male genital tract. J Urol 146 (5): 1284-7, 1991. [<a href="https://pubmed.ncbi.nlm.nih.gov/1719241" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1719241</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062897_rl_77_4">Fisher HA, Barada JH, Horton J, et al.: Neoadjuvant therapy with cisplatin and 5-fluorouracil for stage III squamous cell carcinoma of the penis. [Abstract] J Urol 143(4 Suppl): A-653, 352A, 1990.</div></li><li><div class="bk_ref" id="CDR0000062897_rl_77_5">Hussein AM, Benedetto P, Sridhar KS: Chemotherapy with cisplatin and 5-fluorouracil for penile and urethral squamous cell carcinomas. Cancer 65 (3): 433-8, 1990. [<a href="https://pubmed.ncbi.nlm.nih.gov/2297633" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2297633</span></a>]</div></li></ol></div></div><div id="CDR0000062897__97"><h2 id="_CDR0000062897__97_">Latest Updates to This Summary (02/02/2024)</h2><p id="CDR0000062897__98">The PDQ cancer information summaries are reviewed regularly and updated as
|
|
new information becomes available. This section describes the latest
|
|
changes made to this summary as of the date above.</p><p id="CDR0000062897__232">
|
|
<b>
|
|
<a href="#CDR0000062897__1">General Information About Penile Cancer</a>
|
|
</b>
|
|
</p><p id="CDR0000062897__233">Updated <a href="#CDR0000062897__131">statistics</a> with estimated new cases and deaths for 2024 (cited American Cancer Society as reference 1). </p><p id="CDR0000062897__234">Added <a href="#CDR0000062897__231">Fluorouracil dosing</a> as a new subsection.</p><p id="CDR0000062897__disclaimerHP_3">This summary is written and maintained by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/adult-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Adult Treatment Editorial Board</a>, which is
|
|
editorially independent of NCI. The summary reflects an independent review of
|
|
the literature and does not represent a policy statement of NCI or NIH. More
|
|
information about summary policies and the role of the PDQ Editorial Boards in
|
|
maintaining the PDQ summaries can be found on the <a href="#CDR0000062897__AboutThis_1">About This PDQ Summary</a> and <a href="https://www.cancer.gov/publications/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ® Cancer Information for Health Professionals</a> pages.
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</p></div><div id="CDR0000062897__AboutThis_1"><h2 id="_CDR0000062897__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000062897__AboutThis_2"><h3>Purpose of This Summary</h3><p id="CDR0000062897__AboutThis_3">This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of penile cancer. It is intended as a resource to inform and assist clinicians in the care of their patients. It does not provide formal guidelines or recommendations for making health care decisions.</p></div><div id="CDR0000062897__AboutThis_4"><h3>Reviewers and Updates</h3><p id="CDR0000062897__AboutThis_5">This summary is reviewed regularly and updated as necessary by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/adult-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Adult Treatment Editorial Board</a>, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).</p><p id="CDR0000062897__AboutThis_22"> Board members review recently published articles each month to determine whether an article should:</p><ul id="CDR0000062897__AboutThis_6"><li class="half_rhythm"><div>be discussed at a meeting,</div></li><li class="half_rhythm"><div>be cited with text, or</div></li><li class="half_rhythm"><div>replace or update an existing article that is already cited.</div></li></ul><p id="CDR0000062897__AboutThis_7">Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.</p><p id="CDR0000062897__AboutThis_9">Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website's <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Email Us</a>. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.</p></div><div id="CDR0000062897__AboutThis_10"><h3>Levels of Evidence</h3><p id="CDR0000062897__AboutThis_11">Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a <a href="/books/n/pdqcis/CDR0000062796/?report=reader">formal evidence ranking system</a> in developing its level-of-evidence designations.</p></div><div id="CDR0000062897__AboutThis_12"><h3>Permission to Use This Summary</h3><p id="CDR0000062897__AboutThis_13">PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary].”</p><p id="CDR0000062897__AboutThis_14">The preferred citation for this PDQ summary is:</p><p id="CDR0000062897__AboutThis_15">PDQ® Adult Treatment Editorial Board. PDQ Penile Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="https://www.cancer.gov/types/penile/hp/penile-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.cancer.gov/types/penile/hp/penile-treatment-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389381]</p><p id="CDR0000062897__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in <a href="https://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>, a collection of over 2,000 scientific images.
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</p></div><div id="CDR0000062897__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000062897__AboutThis_18">Based on the strength of the available evidence, treatment options may be described as either “standard” or “under clinical evaluation.” These classifications should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the <a href="https://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000062897__AboutThis_20"><h3>Contact Us</h3><p id="CDR0000062897__AboutThis_21">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="https://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Email Us</a>.</p></div></div></div></div><div class="fm-sec"><h2 id="_NBK65943_pubdet_">Publication Details</h2><h3>Author Information and Affiliations</h3><p class="contrib-group"><h4>Authors</h4><span itemprop="author">PDQ Adult Treatment Editorial Board</span>.</p><h3>Publication History</h3><p class="small">Published online: February 2, 2024.</p><h3>Version History</h3><ul class="simple-list" style="padding:0"><li><span class="bk_col_itm">NBK65943.16</span> February 2, 2024 (Displayed Version)</li><li><span class="bk_col_itm"><a href="/books/NBK65943.15/?report=reader">NBK65943.15</a></span> June 2, 2023</li><li><span class="bk_col_itm"><a href="/books/NBK65943.14/?report=reader">NBK65943.14</a></span> February 10, 2023</li><li><span class="bk_col_itm"><a href="/books/NBK65943.13/?report=reader">NBK65943.13</a></span> February 2, 2022</li><li><span class="bk_col_itm"><a href="/books/NBK65943.12/?report=reader">NBK65943.12</a></span> July 22, 2021</li><li><span class="bk_col_itm"><a href="/books/NBK65943.11/?report=reader">NBK65943.11</a></span> February 11, 2021</li><li><span class="bk_col_itm"><a href="/books/NBK65943.10/?report=reader">NBK65943.10</a></span> August 3, 2020</li><li><span class="bk_col_itm"><a href="/books/NBK65943.9/?report=reader">NBK65943.9</a></span> March 24, 2019</li><li><span class="bk_col_itm"><a href="/books/NBK65943.8/?report=reader">NBK65943.8</a></span> February 6, 2019</li><li><span class="bk_col_itm"><a href="/books/NBK65943.7/?report=reader">NBK65943.7</a></span> October 17, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65943.6/?report=reader">NBK65943.6</a></span> August 9, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65943.5/?report=reader">NBK65943.5</a></span> January 30, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65943.4/?report=reader">NBK65943.4</a></span> February 3, 2017</li><li><span class="bk_col_itm"><a href="/books/NBK65943.3/?report=reader">NBK65943.3</a></span> February 18, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65943.2/?report=reader">NBK65943.2</a></span> February 10, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65943.1/?report=reader">NBK65943.1</a></span> February 5, 2015</li></ul><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div></div><h3>Publisher</h3><p><a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>, Bethesda (MD)</p><h3>NLM Citation</h3><p>PDQ Adult Treatment Editorial Board. Penile Cancer Treatment (PDQ®): Health Professional Version. 2024 Feb 2. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. <span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobCDR0000062897214"><div id="CDR0000062897__214" class="table"><h3><span class="title">Definitions of TNM Stages 0is and 0a<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65943/table/CDR0000062897__214/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062897__214_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">TNM</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Description</th></tr></thead><tbody><tr><td colspan="1" rowspan="3" style="vertical-align:top;">0is</td><td colspan="1" rowspan="3" style="vertical-align:top;">Tis, N0, M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">Tis = Carcinoma <i>in situ</i> (PeIN).</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = <i>cN0</i>, no palpable or visibly enlarged inguinal lymph nodes; <i>pN0</i>, no lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="3" style="vertical-align:top;">0a</td><td colspan="1" rowspan="3" style="vertical-align:top;">Ta, N0, M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">Ta = Noninvasive localized squamous cell carcinoma.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = <i>cN0</i>, no palpable or visibly enlarged inguinal lymph nodes; <i>pN0</i>, no lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">T = primary tumor; N = regional lymph node; M = distant metastasis; cN = clinical N; PeIN = penile intraepithelial neoplasia; pN = pathological N.</p></div></dd></dl><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Penis. In: Amin MB, Edge SB, Greene FL, et al., eds.: <i>AJCC Cancer Staging Manual</i>. 8th ed. New York, NY: Springer, 2017, pp 701–14.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobCDR0000062897215"><div id="CDR0000062897__215" class="table"><h3><span class="title">Definitions of TNM Stage I<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65943/table/CDR0000062897__215/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062897__215_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">TNM</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Description</th></tr></thead><tbody><tr><td colspan="1" rowspan="3" style="vertical-align:top;">I</td><td colspan="1" rowspan="3" style="vertical-align:top;">T1a, N0, M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">T1a = Tumor is without lymphovascular invasion or perineural invasion and is not high grade (i.e., grade 3 or sarcomatoid).</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = <i>cN0</i>, no palpable or visibly enlarged inguinal lymph nodes; <i>pN0</i>, no lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">T = primary tumor; N = regional lymph node; M = distant metastasis; cN = clinical N; pN = pathological N.</p></div></dd></dl><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Penis. In: Amin MB, Edge SB, Greene FL, et al., eds.: <i>AJCC Cancer Staging Manual</i>. 8th ed. New York, NY: Springer, 2017, pp 701–14.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobCDR0000062897216"><div id="CDR0000062897__216" class="table"><h3><span class="title">Definitions of TNM Stages IIA and IIB<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65943/table/CDR0000062897__216/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062897__216_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">TNM</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Description</th></tr></thead><tbody><tr><td colspan="1" rowspan="6" style="vertical-align:top;">IIA</td><td colspan="1" rowspan="3" style="vertical-align:top;">T1b, N0, M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">T1b = Tumor exhibits lymphovascular invasion and/or perineural invasion or is high grade (i.e., grade 3 or sarcomatoid).</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = <i>cN0</i>, no palpable or visibly enlarged inguinal lymph nodes; <i>pN0</i>, no lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="3" style="vertical-align:top;">T2, N0, M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">T2 = Tumor invades into corpus spongiosum (either glans or ventral shaft) with or without urethral invasion.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = <i>cN0</i>, no palpable or visibly enlarged inguinal lymph nodes; <i>pN0</i>, no lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="3" style="vertical-align:top;">IIB</td><td colspan="1" rowspan="3" style="vertical-align:top;">T3, N0, M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">T3 = Tumor invades into corpora cavernosum (including tunica albuginea) with or without urethral invasion.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = <i>cN0</i>, no palpable or visibly enlarged inguinal lymph nodes; <i>pN0,</i> no lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">T = primary tumor; N = regional lymph node; M = distant metastasis; cN = clinical N; pN = pathological N.</p></div></dd></dl><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Penis. In: Amin MB, Edge SB, Greene FL, et al., eds.: <i>AJCC Cancer Staging Manual</i>. 8th ed. New York, NY: Springer, 2017, pp 701–14.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobCDR0000062897217"><div id="CDR0000062897__217" class="table"><h3><span class="title">Definitions of TNM Stages IIIA and IIIB<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65943/table/CDR0000062897__217/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062897__217_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">TNM</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Description</th></tr></thead><tbody><tr><td colspan="1" rowspan="7" style="vertical-align:top;">IIIA</td><td colspan="1" rowspan="7" style="vertical-align:top;">T1–3, N1, M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">T1 = <i>Glans:</i> Tumor invades lamina propria; <i>Foreskin:</i> Tumor invades dermis, lamina propria, or dartos fascia; <i>Shaft:</i> Tumor invades connective tissue between epidermis and corpora regardless of location; <i>All sites</i> with or without lymphovascular invasion or perineural invasion and is or is not high grade.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–T1a = Tumor is without lymphovascular invasion or perineural invasion and is not high grade (i.e., grade 3 or sarcomatoid).</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–T1b = Tumor exhibits lymphovascular invasion and/or perineural invasion or is high grade (i.e., grade 3 or sarcomatoid).</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T2 = Tumor invades into corpus spongiosum (either glans or ventral shaft) with or without urethral invasion.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T3 = Tumor invades into corpora cavernosum (including tunica albuginea) with or without urethral invasion.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N1 = <i>cN1</i>, palpable mobile unilateral inguinal lymph node; <i>pN1</i>, ≤2 unilateral inguinal metastases, no ENE.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="7" style="vertical-align:top;">IIIB</td><td colspan="1" rowspan="7" style="vertical-align:top;">T1–3, N2, M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">T1 = <i>Glans:</i> Tumor invades lamina propria; <i>Foreskin:</i> Tumor invades dermis, lamina propria, or dartos fascia; <i>Shaft:</i> Tumor invades connective tissue between epidermis and corpora regardless of location; <i>All sites</i> with or without lymphovascular invasion or perineural invasion and is or is not high grade.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–T1a = Tumor is without lymphovascular invasion or perineural invasion and is not high grade (i.e., grade 3 or sarcomatoid).</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–T1b = Tumor exhibits lymphovascular invasion and/or perineural invasion or is high grade (i.e., grade 3 or sarcomatoid).</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T2 = Tumor invades into corpus spongiosum (either glans or ventral shaft) with or without urethral invasion.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T3 = Tumor invades into corpora cavernosum (including tunica albuginea) with or without urethral invasion.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N2 = <i>cN2</i>, palpable mobile ≥ unilateral inguinal nodes or bilateral inguinal lymph nodes; <i>pN2</i>, ≥3 unilateral inguinal metastases or bilateral metastases, no ENE.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">T = primary tumor; N = regional lymph node; M = distant metastasis; cN = clinical N; ENE = extranodal extension; pN = pathological N.</p></div></dd></dl><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Penis. In: Amin MB, Edge SB, Greene FL, et al., eds.: <i>AJCC Cancer Staging Manual</i>. 8th ed. New York, NY: Springer, 2017, pp 701–14.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobCDR0000062897218"><div id="CDR0000062897__218" class="table"><h3><span class="title">Definitions of TNM Stage IV<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65943/table/CDR0000062897__218/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062897__218_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">TNM</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Description</th></tr></thead><tbody><tr><td colspan="1" rowspan="36" style="vertical-align:top;">IV</td><td colspan="1" rowspan="12" style="vertical-align:top;">T4, Any N, M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">T4 = Tumor invades into adjacent structures (i.e., scrotum, prostate, pubic bone).</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">cNX = Regional lymph nodes cannot be assessed.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">cN0 = No palpable or visibly enlarged inguinal lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">cN1 = Palpable mobile unilateral inguinal lymph node.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">cN2 = Palpable mobile ≥ unilateral inguinal nodes or bilateral inguinal lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">cN3 = Palpable fixed inguinal nodal mass or pelvic lymphadenopathy unilateral or bilateral.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">pNX = Lymph node metastasis cannot be established.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">pN0 = No lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">pN1 = ≤2 unilateral inguinal metastases, no ENE.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">pN2 = ≥3 unilateral inguinal metastases or bilateral metastases, no ENE.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">pN3 = ENE of lymph node metastases or pelvic lymph node metastases.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="12" style="vertical-align:top;">Any T, N3, M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">TX = Primary tumor cannot be assessed.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T0 = No evidence of primary tumor.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Tis = Carcinoma <i>in situ</i> (PeIN).</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Ta = Noninvasive localized squamous cell carcinoma.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T1 = <i>Glans:</i> Tumor invades lamina propria; <i>Foreskin:</i> Tumor invades dermis, lamina propria, or dartos fascia; <i>Shaft:</i> Tumor invades connective tissue between epidermis and corpora regardless of location; <i>All sites</i> with or without lymphovascular invasion or perineural invasion and is or is not high grade.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–T1a = Tumor is without lymphovascular invasion or perineural invasion and is not high grade (i.e., grade 3 or sarcomatoid).</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–T1b = Tumor exhibits lymphovascular invasion and/or perineural invasion or is high grade (i.e., grade 3 or sarcomatoid).</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T2 = Tumor invades into corpus spongiosum (either glans or ventral shaft) with or without urethral invasion.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T3 = Tumor invades into corpora cavernosum (including tunica albuginea) with or without urethral invasion.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T4 = Tumor invades into adjacent structures (i.e., scrotum, prostate, pubic bone).</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N3 = <i>cN3</i>, palpable fixed inguinal nodal mass or pelvic lymphadenopathy unilateral or bilateral; <i>pN3</i>, ENE of lymph node metastases or pelvic lymph node metastases.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="12" style="vertical-align:top;">Any T, Any N, M1</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any T = See descriptions above in this table, stage IV, Any T, N3, M0.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">cNX = Regional lymph nodes cannot be assessed.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">cN0 = No palpable or visibly enlarged inguinal lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">cN1 = Palpable mobile unilateral inguinal lymph node.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">cN2 = Palpable mobile ≥2 unilateral inguinal nodes or bilateral inguinal lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">cN3 = Palpable fixed inguinal nodal mass or pelvic lymphadenopathy unilateral or bilateral.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">pNX = Lymph node metastasis cannot be established.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">pN0 = No lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">pN1 = ≤2 unilateral inguinal metastases, no ENE.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">pN2 = ≥3 unilateral inguinal metastases or bilateral metastases, no ENE.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">pN3 = ENE of lymph node metastases or pelvic lymph node metastases.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M1 = Distant metastasis present.</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">T = primary tumor; N = regional lymph node; M = distant metastasis; cN = clinical N; ENE = extranodal extension; PeIN = penile intraepithelial neoplasia; pN = pathological N.</p></div></dd></dl><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Penis. In: Amin MB, Edge SB, Greene FL, et al., eds.: <i>AJCC Cancer Staging Manual</i>. 8th ed. New York, NY: Springer, 2017, pp 701–14.</p></div></dd></dl></dl></div></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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