79,030 600K + living most
diagnosed in with bladder 5th common
2017 cancer cancer
16,870 will Most
Expensive CA Age 60-
die in 2017
to teat 70yrs
50% - 80% 4th 11th
most most
recurrence common common in
rate in men women
1
Signs Symptoms
Hematuria Abdominal pain
Dysuria Fatigue
Urgent need to Lower back pain
urinate
Appetite or weight
Urinary retention loss
2
3x more common in smokers
Chemical/occupational exposure
Arsenic in water
Race, age, gender, birth defects
Chronic bladder inflammation
Medical history recurrence
Low fluid intake
Previous cancer treatment
4
5
• Dry cleaners
• – Painters
• – Autoworkers
• – Truck drivers
• – Paper manufacturers
• – Metal workers
• – Plumbers
• – Hairdressers
• – Tire and rubber workers
• – Chemical workers
• – Petroleum workers
7
• Gross hematuria most common
Most commonly intermittent
Gross 68-97%
Microhematuria 11%
• Timing of hematuria
• Initial – suggests urethral source
• Terminal – suggests posterior urethra, bladder neck,
prostate
• Continuous – suggests bladder etiology • Irritative voiding
symptoms (especially in absence of UTI
Diagnostics
• Cystoscopy
• Tissue sample
• Radiologic Tests
• CT scan
• Stage & Grade
9
10
Treatments
• TURBT
• Intravesical therapy
• Bladder removal and
urinary reconstruction
• Chemotherapy
Immunotherapy is the first
significant FDA approved • Bladder preservation
advancement in bladder cancer
treatment in over 30 years. • Immunotherapy
11
• Penile cancer is a relatively rare SCC. It usually originates
in the epithelium of the inner prepuce and glans. It shares
similar pathology and natural history with SCC of the
oropharynx, female genitalia (cervix, vagina and vulva),
and anus. Phimosis, poor hygiene, and smoking are the
major risk factors for penile cancer.
13
Uncommon malignancy in developed countries
Higher incidence rates are seen in Africa and Asia (10% to
20%)
Commonly affects those between 50 and 70 years of age
22% of patients are less than 40 years of age
• Intact foreskin
• Phimosis (25%)
• Precancerous lesions are found in 15%-20% of patients
• Human papilloma virus(HPV 16,18)
• Chronic inflammatory conditions (eg, balanoposthitis and
lichen sclerosus et atrophicus)
• Primary malignancies (those that originate from either the
soft tissues, urethral mucosa, or covering epithelium)
• Secondary malignancies (ie, those that represent metastatic
disease and often affect the corpus cavernosum
• squamous cell carcinoma is found on
glans: 48%,prepuce: 21%,glans & prepuce:9%,coronal
sulcus: 6%, and shaft: <2%
• Primary, non squamous malignancies comprise <5% of
penile cancers.
• Sarcomas are the most frequent non squamous penile
cancers, followed by melanomas, basal cell carcinomas, and
lymphomas
• Area of induration or erythema to a non healing ulcer or a
warty exophytic growth
• Palpable inguinal lymphadenopathy is present at diagnosis in
58% of patients ( 20%-96%)
• In non palpable inguinal lymph nodes at the time of resection
of the primary tumor, 20% will found to have metastatic
disease
Jackson
• Grade
• Depth of invasion
• Number of positive lymph nodes
• Unilateral or bilateral inguinal extension
• Pelvic nodes involvement
• Presence of lymph node extracapsular extension
• Physical examination
• Cytological and/or histological diagnosis
• Chest x-ray
• CT scan/PET-CT scan
• Bone scan
• Small tumors limited to foreskin:
• circumcision+2-cm margin
Circumcision alone, especially with tumors in the proximal
foreskin, may be associated with recurrence rates of 32%
• Small superficial penile cancers:
• Moh’s micrographic surgery
• Radiation therapy (EBRT/brachytherapy)
• RT has yielded local control rates similar to surgical resection:
• Carcinomas involving the glans & distal shaft:
• partial penectomy excising 1.5 to 2 cm of normal
tissue proximal to the margin of the tumor.
This should leave a 2.5- to 3-cm stump of penis
• Bulky T3 or T4 proximal tumors involving the base of the
penis:
total penectomy with perineal urethrostomy
Lymphadenectomy in Penile Cancer
• Lymphadenectomy is indicated in patients with palpable
inguinal lymphadenopathy that persists after treatment of
the primary penile lesion following a course of antibiotic
therapy
• Staging tool
• Identifies patients likely to benefit from adjuvant chemo
• Adds to locoregional control
• No additional morbidity
• If pre-op pelvic node identified : NACT followed by surgery in
responders
Value of pelvic LND unproven
Patients with minimal inguinal disease & limited
pelvic LN mets may benefit
• >2 metastatic inguinal nodes
• Extranodal extension of disease
• Pelvic lymph node metastases
• Neoadjuvant chemo + surgery in
responders
• Palliative chemotherapy
• Chemotherapy + radiation therapy
• Persistent lymphorrhoea
• Wound breakdown, necrosis, infection
• Lymphocyst
• Femoral blowout
• Lymphangitis
• Lymphoedema of lower extremity
• Uncommon disease
• No systematic study & complete absence of RCTs
• Small no of patients over a long time
