Ca penis

This is 62 years gentle man complaint ing of non healing ulcer in glans penis for 2 1/2 months.

Biopsy done outside...which showed..poorly differentiate squamous cell carcinoma.
On examination... bilateral mobile inguinal less then 4cm lymph nodes present.
Is any other investigation needed?
How to manage local tumour.?
How to manage inguinal lymph nodes?

Ca penisCa penis


  • Dr. Anil Takvani
    Dr. Anil Takvani
    17 Mar 2020 03:34:13 PM

    Fine needle aspiration cytology for clinically palpable bilateral nodes... 


  • Tikenjit Mazumdar
    Tikenjit Mazumdar
    17 Mar 2020 06:11:49 PM

    Sir,is there any role of CECT / 

    MRI inguinal region and pelvis in palpable lymph node.
    How many nodes to be sampled in fnac in this case"."
    What is ur algorithm for investigation in non palpable inguinal nodes with same penile lesion

  • Utsav Shah
    Utsav Shah
    17 Mar 2020 07:09:45 PM

    Hello Dr Mazumdar,

    Since this patient has a PALPABLE groin, he needs CT Contrast of TAP(Thorax, Abdo n pelvis). 
    (Attaching EAU recommendation for this)

    There is no confusion regarding palpable inguinal lymphadenopathy:
    This patient needs upfront modified inguinal lymph node dissection. If >2 LN are positive during this surgery(frozen) then one has to proceed with conversion to radical ilioinguinal block dissection which should also include the pelvic nodes. Also, opposite groin superficial LN dissection should be done. 
    All these are based on EAU recommendations and they don’t advise FNAC anymore for palpable LNs. 

    NCCN on the other hand guides us to do a FNAC as Anil sir has suggested and then proceed as per the attachment provided. 

  • Tikenjit Mazumdar
    Tikenjit Mazumdar
    17 Mar 2020 07:29:14 PM

    Thank you...but...what is situation where frozen section not available?

    Patient not happy doing same surgery in same location twice,told to do whatever in one go.
    What is template for  modified inguinal dissection?

  • Utsav Shah
    Utsav Shah
    17 Mar 2020 10:07:36 PM

    If frozen not availabl,  go for ipsilateral 

    radical inguinal lymphadenectomy(as per EAU). Also do superficial LN dissection on opp side. 

    Or u can choose to follow NCCN—>Do FNAC. If positive, do radical inguinal LNectomy. 
    If negative, do excision biopsy of LN. If excision biopsy is +ve do radical inguinal LNectomy. If negative then surveillance. 

  • Dr. Anil Takvani
    Dr. Anil Takvani
    18 Mar 2020 12:18:12 PM

    A very useful article from department of urology Pondicherry, on role of simultaneous FNAC of palpable inguinal node in Ca. Penis

  • Tikenjit Mazumdar
    Tikenjit Mazumdar
    18 Mar 2020 03:07:11 PM

    How to manage local tumour. .organ preserving surgery...laser ablation...Mohs surgery...glans resurface ng or complete penile deassemble and tumour excisions.

  • Tikenjit Mazumdar
    Tikenjit Mazumdar
    18 Mar 2020 03:10:35 PM

    How to stage the tumour clinical examination is enough or imaging MRI ,Doppler use of penis needed.

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