Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Penile cancer is an uncommon disease in the industrialized world that most frequently presents at low stage and is cured with treatment of local and regional surgery. In cases of advanced cancer, the use of more aggressive surgical techniques and the addition of adjuvant therapy may be warranted. So far, few agents have been found that improve survival with metastatic disease and thus aggressive primary treatment is required. This review discusses diagnosis, staging, and therapy for high risk penile cancer.
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PMID:Advanced penile cancer. 2181 40

Penile carcinoma usually occurs in older than 40 years men with an incidence in western communities of 0.5 to 1.6 per 100,000 men per year while in developing countries the rate is much higher in men. Extensive lymph node dissection of lymphatic inguinal metastases evident by inguinal lymphoscintigraphy (ILS) induces improved overall survival. A 75 years old male with penile squamous cell carcinoma stage pT2N0M0 of less than 2cm diameter, with tumor invasion of the penis corpora underwent partial penectomy with a 2-cm disease-free margin. Three months postoperation, computed tomography (CT) was negative for local recurrence or distant metastases. A dynamic ILS was performed after local anaesthesia and intradermal injection of 80MBq of (99m)Tc-nanocolloid at the lower edge of the left and right inguinal ducts. The lymphatic chain and a hot spot suggestive of a first draining lymph node appeared after 15min on the right inguinal region in the second zone according to Daseler mapping. The left inguinal area was negative for sentinel node (SN). In view of this finding an exploratory laparotomy was performed and pathology showed that this lymph node that was probably a SN was infiltrated by the squamous cell carcinoma. The patient was upstaged to T2N1M0 and scheduled to receive adjuvant chemotherapy with two courses of cisplatin and 5-fluorouracil. While T1 and T2 tumours of diameters <2cm are best treated with penile-preserving methods such as circumciand/or local excision. Tumours of T2 >2cm, T3 tumours, and T4 tumours are treated with glans amputation and/or partial or total penile amputation. Imaging with magnetic resonance imaging (MRI) or computed tomography (CT) scan do not always give accurate staging information, because positive findings are usually found only in patients with clinically palpable, enlarged inguinal lymph nodes. Computed tomography and MRI have low sensitivity to identify occult metastases, because they present criteria for malignant involvement mainly based on the size of the lesions. The main pitfall of these diagnostic modalities is due to occult metastatic disease occurring within normal sized nodes. Approximatively 20% of the patients with non palpable lymph nodes harbour occult inguinal metastases, and there is evidence that this group of patients may benefit from early surgical dissection of the inguinal nodes, compared to a wait-and-see policy. It is understood that current imaging techniques cannot accurately detect occult metastases, while ILS is more reliable. In 80% of patients with penile cancer, after ILS, drainage to both groins is observed. Bilateral nodes are often visualized early, sometimes asynchronously with one of the lymph nodes filling late. This is why delayed images are recommended. Pitfalls of ILS are: a) Contamination of the skin with the tracer and b) radiopharmaceutical entering the blood. There are also several reasons that may account for absent or faint SN uptake: low dose of the tracer or low tracer quality, patient's age (better in young patients), tumor involvement of the sentinel node, and finally too short or too long interval between tracer injection and ILS. The ILS can be mapped according to Daseler's inguinal zones. Penile cancer drains directly to the nodes in the superior and central Daseler zones. According to others, the majority (73%) of SN was located in the medial superior, 8.7% in the lateral superior, and 18.3% in the central zone. No drainage was seen on the two inferior quadrants. The majority (62.1%) of higher-tier nodes was found in the external iliac zone. Inguinal LS can save us from watchful waiting in cases of otherwise occult metastases. In conclusion, ILS has shown lymph node metastases while clinical and CT examinations were negative. The false positive and false negative results of ILS are mentioned.
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PMID:Positive lymphoscintigraphy (ILS) and negative computed tomography for metastatic penile cancer. 2208 56

There are 3 distinct variants of penile squamous cell carcinoma frequently associated with human papillomavirus (HPV): basaloid, warty-basaloid, and warty carcinomas. Considering the high incidence rates of penile cancer in some countries, a large international study was designed to evaluate the presence of HPV, its genotype distribution, and its association with histologic types of penile cancer. In this international review of >900 cases, we found a group of highly distinct papillary neoplasms composed of basophilic cells resembling urothelial tumors but frequently associated with HPV. Macroscopically, tumors were exophytic or exoendophytic. Microscopically, there was a papillomatous pattern of growth with a central fibrovascular core and small basophilic cells lining the papillae. Positivity for HPV was present in 11 of 12 tumors (92%). Single genotypes found were HPV-16 in 9 tumors and HPV-51 in 1 tumor. Multiple genotypes (HPV-16 and HPV-45) were present in another case. Overexpression of p16 was observed in all cases. Uroplakin-III was negative in all cases. The differential diagnosis was with basaloid, warty-basaloid, warty, and papillary squamous cell carcinoma and with urothelial carcinomas. Local excision (4 cases), circumcision (3 cases), or partial penectomy (5 cases) were preferred treatment choices. Tumor thickness ranged from 1 to 15 mm (average, 7 mm). Two patients with tumors invading 11 and 15 mm into the corpus spongiosum developed inguinal nodal metastasis. Of 11 patients followed up (median 48 mo), 7 were alive with no evidence of metastatic disease, 3 died from causes other than penile cancer, and another died postoperatively. This morphologically distinct tumor probably represents a papillary variant of basaloid carcinomas (papillary-basaloid carcinomas). Unlike typical basaloid carcinomas, the overall prognosis was excellent. However, deeply invasive tumors were associated with regional nodal metastasis indicating a potential for tumor-related death.
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PMID:Basaloid squamous cell carcinoma of the penis with papillary features: a clinicopathologic study of 12 cases. 2236 99

Inguinal lymph node metastasis is the single most important factor for predicting survival in patients with penile squamous cell carcinomas. To estimate the likelihood of this event, investigators have combined pathologic features of the primary tumor in the form of stratification systems. In this article we review 3 such systems (Solsona et al, J Urol 2001;165:1506; Hungerhuber et al, Urology 68:621, 2006; and Chaux et al, Am J Surg Pathol 2009;33:1049) built upon histologic grade, extent and depth of tumor invasion, and perineural invasion. We evaluate their usefulness, limitations, and possible implications for the management of patients with penile cancer. We also provide clues for the proper identification and interpretation of these pathologic features. Inguinal metastases were observed in 64% to 83% of patients in high-risk groups, 20% to 33% of intermediate groups, and 0% to 8% of low-risk groups. The results of these studies suggest that patients in high-risk groups could benefit from prophylactic bilateral groin dissection. In addition, patients in low-risk groups might be managed by surveillance alone. Finally, the authors suggest that additional approaches, such as sentinel lymph node biopsy, should be used for the intermediate-risk group. The identification of other pathologic features, such as vascular and perineural invasion, could tip the scales in problematic or paradoxical cases. The fate of these risk groups would be better defined by the identification of molecular biomarkers and genetic profiling.
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PMID:Stratification systems as prognostic tools for defining risk of lymph node metastasis in penile squamous cell carcinomas. 2264 57

Penile cancer is an aggressive disease and after systemic progression it is virtually incurable. While this squamous cell cancer responds to chemotherapy, successful treatment of lymphatic metastases can only be achieved with aggressive surgical treatment in combination with chemotherapy. However, because penile carcinoma is relatively rare there is a paucity of clinical data on the chemotherapy for this aggressive disease. Recent advances have included the establishment of less toxic regimens incorporating taxanes, while cisplatinum remains central to all regimens. Multi-institutional studies are urgently needed to advance the multimodal care for patients with penile cancer.
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PMID:Chemotherapy in penile cancer. 2265 65

This report describe the case of a patient presenting with pulmonary metastases from a penile cancer, where the presence of the human papillomavirus (HPV) type 16 DNA both in the primary tumor and in the distant metastases confirmed the spreading of the disease, ruling out a possible primary lung squamous cell carcinoma. Indeed, according to the findings, the HPV genotyping test might help in the identification of metastatic disease from anogenital malignancies or other HPV-related cancers.
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PMID:Human papillomavirus type 16 DNA detected in pulmonary metastases from a penile squamous cell carcinoma: a case study. 2267 19

Background Penile cancer (PC) is a rare cancer in western countries, but is more common in parts of the developing world. Due to its rarity and the consequent lack of randomized trials, current therapy is based on retrospective studies and small prospective trials. Design Studies of PC therapy were searched in PubMed and abstracts at major conferences. Results PC is generally an aggressive malignancy characterized by early locoregional lymph node (LN) spread and later metastases in distant sites. Given the strong predictive value of LN involvement for overall survival, evaluating regional LNs is critical. Advanced LN involvement is increasingly being treated with multimodality therapy incorporating chemotherapy and/or radiation. A single superior cisplatin-based regimen has not been defined. Further advances may occur with a better collaboration on an international scale and comprehensive understanding of tumor biology. To this end, the preventive role of circumcision and understanding of the oncogenic roles of Human Papilloma Virus-16, and smoking may yield advances. Preliminary data suggest a role for agents targeting epidermal growth factor receptor and angiogenesis. Conclusion Advances in therapy for PC will require efficient trial designs, synergistic collaboration, incentives to industry and the efforts of patient advocacy groups and venture philanthropists.
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PMID:Penile cancer: current therapy and future directions. 2329 17

Lymph node status is a key prognostic factor in penile squamous cell carcinoma. Recently, growing evidence indicates a multimodality approach consisting of neoadjuvant chemotherapy followed by consolidation surgery improves the outcome of locally advanced penile cancer. Thus, accurate estimation of survival probability in node-positive penile cancer is critical for treatment decision making, counseling of patients and follow-up scheduling. This article reviewed evolving developments in assessing the risk for cancer progression based on lymph node related variables, such as the number of metastatic lymph nodes, bilateral lymph node metastases, the ratio of positive lymph nodes, extracapsular extension of metastatic lymph nodes, pelvic lymph node metastases, metastatic deposit in sentinel lymph nodes and N stage in TNM classification. Controversial issues surrounding the prognostic value of these nodal related predictors were also discussed.
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PMID:Lymph node metastases and prognosis in penile cancer. 2335 65

This review highlights the significant advances made in the diagnosis and management of penile cancer. This often-aggressive tumor phenotype has been characterized by its poor prognosis, mostly attributable to its late presentation and heterogeneity of surgical care because of the paucity of cases treated at most centers. Recent advances in understanding of the risk factors predisposing to penile cancer, including its association with the human papilloma virus (HPV), have brought forth the socioepidemiologic concept of HPV vaccination in certain high-risk populations and countries, which remains highly debated. The management of penile cancer has evolved in recent years with the adoption of penile-sparing and minimally invasive surgical approaches to the inguinal lymph nodes, which are a frequent site of regional spread for this malignancy. Lastly, this review highlights the importance of adopting a multimodal approach consisting of neoadjuvant systemic chemotherapy followed by consolidative surgical resection in patients presenting with bulky/locally advanced nodal metastases from penile cancer.
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PMID:Current concepts in penile cancer. 2366 10

Although anatomically the penis is closely related to the prostate, penile metastasis from prostate cancer is an uncommon phenomenon. These patients usually present late in the course of the disease with wide spread metastasis. We report a patient who presented with a penile mass and inguinal lymphadenopathy. He was clinically diagnosed as a case of penile cancer but the penile mass as well as the inguinal lymphadenopathy was subsequently diagnosed to be metastases from carcinoma of the prostate.
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PMID:Penile nodule with inguinal lymphadenopathy: Prostatic adenocarcinoma masquerading as penile cancer. 2367 67


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