CC March 2016 Penile cancer

echoecho's version from 2016-05-29 16:48


Question Answer
In America, this cancer is rare, accounting for < ____ of cancers?0.5%
In other areas of the world, the disease is more common and may be related to what risk factors?1) genetics 2) tobacco use 3) hygiene 4) circumcision rates 4) exposure to HPV
This cancer is almost always a ____ cell carcinoma with a high risk of _____ spread and a poor prognosis?1) squamous 2) lymphatic
Less then ____% of men diagnosed survive 5 years?50
Why is this disease devastating?it is emotional devastatin and disfiguring as primary treatment is amputation resulting in voiding difficulties and sexual dysfunction
What is critical at the time of dx to determine appropriate and potentially curative treatment?staging of the disease
Why should assessment of potential inguinal node involvement be accomplished immediately?because the spread of malignant cells is primarily via regional lymphatics
What should physical exam include?genital area exam identifying penile skin lesions or nodules as well as a thorough palpation of inguinal nodes
What presenting symptoms may occur but are much more frequently associated with prostate disorder than a possible penile lesion?1) urinary flow issues 2) dysuria 3) hematuria
Website which provides easy and immediate access to guidelines based on specific cancer diagnoses, staging criteria and treatment options?
Antibiotics used to be given shortly after initial surgical treatment when abnormal lymph nodes were identified, with the thinking that these were reactive adenopathy. However, this is no longer treatment, what is?because delay in identifying malignant adenopathy can affect pronosis, some suggest US-guided fine-needle aspiration sampling of inguinal nodes with excision of nodes if pathology confirms malignant cells
Because FNA may fail to identify the pathology, and a negative sample should still require what?surgical exploration (most recommend ipsilaterla inguinal lymph node dissection with contralateral exploration if any of the ipsilateral nodes are positive for the disease)
List another option of the above scenario?DSNB (dynamic sentinel node biopsy) which is a technique using combined lymphoscintigraphy with labeled dye to guide dissection) as a means to identify malignant patholology in nonpalpable nodes. DNSB is limited to tertiary centers and is not applicable if palpable nodes are present
What are the risks of inguinal exploration?1) infection 2) wound margin necrosis 3) disorders of lymph drainage
While recent NCCN recommendations list radiotherapy as a choice of primary therapy for small (<4 cm ) penile lesions without node involvement, what is the primary treatment for penile SCC?surgery as it can be curative if lymphatic spread has not occurred
*** Inguinal nodes of > ____ cm or tumor-bearing nodes > ____ in number impart a poor prongosis and would suggest the need for intensive treatment such as neoadjuvant or adjuvant chemotherapy, exploration of pelvic nodes, and/or chemoradiation?4; 3
If the nodes are < 4 cm and the most distant nodes are negative, then what would be the treatment?surveillance program with imaging (CT) or (MRI) and reexamination every 3 months for the first year
Because these tumors have limited radiosensitivity, what is radiotherapy generally reserved for?palliation of bulky disease in recurrences
Why does chemotherapy have limited benefit?has a high potential toxicity in early stage disease
When are immunomodulators used?these are used in combination with chemotherapy agents when initial chemotherapy has failed and palliative options are being considered but would not be appropriate in the early stage disease
Evidence of recurrent or metastatic penile cancer requires an _____ approach?aggressive
Why is it difficult to develop radomized clinical trials of sufficient size to provide evidence-based recommendations for chemotherapy in recurrent or extensive disease?because of the limited number of cases in the US
*** The combination of what 3 drugs has been promising in centers in India and Italy and is currently the primary choice of cancer treatment in the US?Combination of paclitaxel (Taxol) PLUS ifosfamide (Ifex) PLUSE cisplatin (Patinolo)
*** Older 5-FU based treatment programs or those using _____ and ____ are either less effective or more toxic?cisplatin and bleomycin (Blenoxane)
While ________ has been recommended in the past as part of a second line approach to widespread metastatic or recurrent disease, it is no longer recommended?panitumumab (Vectibix)
*** SUMMARY = Penile CA is almost always a _____ cell CA with a high risk of ____ spread and a ____ prognosis?1) squamous 2) lymphatic 3) poor
*** SMUUARY = Less than ____% of men diagnosed survive ___ years?50; 5
*** SUMMARY = What should be accomplished immediately because the spread of malignant cells is primarily via regional lymphatics?assessment of potential inguinal involvement
*** SUMMARY = What is the primary treat for penile SCC and can be currative if lymphatic spread has not occurred?surgery