CANCER PENIS
Carcinoma of the penis occurs primarily on the glans of the penis; it is frequently associated with poor personal hygiene and the accumulation of smegma under the skin of an uncircumcised penis.
Causes & Pathophysiology
1. Several types of penile lesions are potentially pre-malignant.
a. Condylomata acuminata
b. Giant condylomata acuminata (buschke- Lowenstein tumor.)
C. Kaposi's sarcoma.
d. Leukoplakia
2. Erythroplasia of the glans (Erythroplasia of queyrat) is a carcinoma in situ of the penis and may involve the glans, prepuce, penile shaft or may spread to the remainder of the genitalia and perineal region.
3. Malignant lesions that ulcerate metastasize quickly to the regional femoral of iliac lymph nodes.
4. Distant metastasis occur in the inguinal lymph nodes: in rare cases to lungs, liver, bone or brain.
Clinical Manifestations
1.Painless, wartlike growth or ulcer on the glans prepuce or coronal sulcus.
2.Phimosis (constriction of foreskin with inability to retract over glans) may obscure a lesion, preventing detection until advanced stages.
3.lymphadenopathy (2ยบ infection of lesions)
Diagnostic Evaluation
1. Biopsy of penile lesion.
2. Ultrasonography and or MRI of inguinal lymph nodes.
3. Chest x-ray, CT scan (or MRI), bone scan to assess for distal nodal metastasis.
Medical Management
1. Smaller lesions involving only the skin may be controlled by excisional biopsy.
2. Topical chemotherapy with 5-fluorouracil cream may be 10% in selected patients.
3. Radiation therapy or radioactive needle implant produces varying results.
4. Partial penectomy (removal of the penis) is preferred to total penectomy. Total penectomy is indicated when the tumor is not amenable to conservative treatment.
After other causes of lymphadenopathy are ruled out, bilateral inguinal lymphadenectomy may be performed.
Complications
1. Disfigurement due to ulceration or treatment.
2. Complication of lymphadenectomy necrosis and infection of skin flap, chronic Edema of lower extremities.
Nursing Management
1. Provide patient with opportunity to acquire information about causes and prognosis of disease.
2. Encourage realistic expectation regarding outcome of treatment.
3. Allow patient to ventilate feelings about loss of a part or all of penis.
4. Provide routine post-operative care confidently, watching for bleeding, monitoring urination and anticipating pain.
5. Provide opportunity for patient to discuss alternative methods of expression with knowledgeable professional. sexual
6. Monitor patient for symptoms of depression requiring intervention.
7. Provide information about follow up and monitoring for recurrences or radiation and chemotherapy as appropriate.
8. Instruct the uncircumcised patient about proper hygiene importance of daily removal of all retained smegma. [(secretion of sebaceous glands of the clitoris and prepuce)]
