22 Penis Cancer

480 Penis Cancer

2 Anatomical Topography The penis is divided into three portions: the root, the body (or shaft) and the glans. The root is embedded into the superficial perineum; the body consists of erectile bodies (corpora cavernosa, corpus spongiosum) and overlying tissues; the glans constitutes the distal part of the corpus spongiosum covered by the prepuce. (10) The arbitrary limit between glans and body is the coronal sulcus or balanopreputial area. (11,18) Critical organs are the distal penile urethra and the testis. (10,11) Pathology Premalignant lesions are present before or associated with invasive lesions in 20 to 30% of cancers. Bowen’s disease, balanitis xerotica obliterans, erythroplasia of Queyrat, Buschke-Lowenstein disease, Kaposi’s sarcoma and leucoplakia are the most frequent. (3) Three kinds of macroscopic lesions are described: infiltrative-ulcerative tumours, serpiginous forms and exophytic papillary tumours (Fig 21.2): the two latter types have a better prognosis. (21) 3

Fig 21.2: Macroscopic appearance of a tumour limited to the glans with involvement of urethral meatus. The primary tumour is mainly localized in the glans (83%), prepuce (55%) and shaft (7%) (30). In 80% of the cases, the tumour starts at the level of the balano-preputial sulcus. While inguinal nodes are palpable in one third of patients, only half of them are related to secondary nodal metastasis; 15 to 20% of patients without palpable nodes have occult metastases. (2) Squamous-cell carcinoma represents more than 90% of invasive cancers of the glans; other histopathological primary tumour types are: malignant melanoma, basal cell carcinoma, sarcoma. (21) Work Up After general history and physical examination, under general anaesthesia if necessary, the following investigations are needed: (10) 4